Infertility

Infertility is a disease of the male or female reproductive system that affects the body's ability to reproduce. It is the inability to achieve pregnancy after one year of regular, unprotected intercourse. For women over 35, this period is reduced to six months. According to the WHO, infertility affects one in six people of reproductive age globally. Although often seen as a woman's issue, it can involve either or both partners.

What Is Infertility?

Infertility occurs when a couple cannot conceive after a year of regular, unprotected intercourse. For women over 35, this period is shortened to six months. It can result from issues in the male or female reproductive systems or both. In about half of infertile couples, the male is solely or partly responsible. Infertility affects emotional and psychological well-being and should be recognised as a medical condition that often requires treatment.

There are two main types of infertility:

• Primary Infertility: Primary infertility occurs when a person has never achieved a pregnancy despite trying for at least a year.

• Secondary Infertility: Secondary infertility refers to difficulty conceiving again after previously achieving at least one pregnancy.

Some other types of infertility include:

• Male Infertility: Male infertility can result from issues like semen ejection problems, low sperm count, or abnormal sperm shape and movement.

• Female Infertility: Female infertility may stem from abnormalities in the ovaries, uterus, fallopian tubes, or endocrine system.

• Unexplained Infertility: In some cases, no specific cause is found, leading to a diagnosis of unexplained infertility.

Infertility can be a challenging issue for many couples, and identifying the early signs is crucial for timely intervention.

• Menstrual Irregularities: Changes in the menstrual cycle, such as irregular periods or missed periods, can indicate fertility problems in women.

• Hormonal Imbalances: Hormonal issues like severe acne, hair loss, or weight gain may signal fertility-related conditions like polycystic ovary syndrome (PCOS).

• Painful Symptoms: Severe pelvic pain, cramping, and pain during intercourse may suggest endometriosis, affecting a woman's fertility.

• Male Sexual Dysfunction: Low sex drive, erectile dysfunction, and ejaculation difficulties can signal hormonal imbalances or fertility issues in men.

• Testicular Abnormalities: Testicular pain, swelling, or abnormalities may impact sperm production and male fertility.

• Hormonal Symptoms in Men: Hormonal imbalances can cause breast growth, reduced facial/body hair, and smaller testicles, affecting male fertility.

Recognising these early signs and seeking medical advice can help couples address potential infertility causes and explore appropriate treatment options.

The primary symptom of infertility is the inability to conceive after one year of unprotected intercourse for couples under 35 and after six months for those over 35. However, other symptoms can vary depending on the underlying cause.

• Menstrual Irregularities: Women may experience irregular cycles, ovulation problems, heavy periods, or skipped periods.

• Pelvic Pain and Bleeding: Pelvic pain, unpredictable vaginal bleeding, and heavy periods can be symptoms of fertility issues in women.

• Hormonal Imbalances in Women: Symptoms like skin changes, hair loss, excessive hair growth, and weight gain may indicate hormonal issues.

• Sexual Dysfunction in Men: Men may experience changes in sexual desire, hair growth, or erectile function.

• Testicular Symptoms: Men may notice testicular pain, swelling, lumps, or issues with ejaculation.

It's important to note that these symptoms can be associated with various health conditions. Hence, consulting a doctor is essential for accurate diagnosis and appropriate infertility treatment.

Infertility can stem from a variety of factors affecting both women and men, including:

• Ovulation Disorders: For women, ovulation disorders like PCOS are common causes of infertility. These conditions can disrupt the regular release of eggs from the ovaries, making conception difficult.

• Endometriosis: It is a condition where uterine tissue grows outside the uterus. This can cause scarring and blockages in the fallopian tubes, hindering fertilisation.

• Uterine Fibroids and Polyps: These growths can interfere with implantation, affecting a woman's ability to sustain pregnancy.

• Age: Age plays a significant role, as a woman's fertility declines with age due to decreasing egg quantity and quality.

• Low Sperm Quality: For men, low sperm count, poor sperm motility, and abnormal sperm shape can contribute to infertility.

• Varicoceles: Enlarged veins in the scrotum can impair sperm production and quality.

• Hormonal Imbalances in Men: Low testosterone or hormonal problems can disrupt sperm production and sexual function.

• Genetic, Medications, and Environmental Factors: Male fertility may be affected by genetic factors, medications, or exposure to environmental toxins.

• Lifestyle Factors: Obesity, smoking, excessive alcohol use, and pollutants can negatively impact fertility in both genders.

Understanding the underlying causes of infertility is crucial for developing targeted infertility prevention strategies and exploring suitable treatment options.

Infertility can be influenced by a variety of factors affecting both men and women. Some of them include:

• Age: For women, fertility declines notably after the mid-30s due to a decrease in egg quality and quantity. For men, while the decline in fertility with age is less dramatic than in women, it still occurs, especially after age 40.

• Certain Medical Conditions: Ovulation disorders such as polycystic ovary syndrome (PCOS), hyperprolactinemia, and thyroid issues can interfere with ovulation. Endometriosis, uterine fibroids, and other uterine abnormalities can also impact fertility.

• Chronic Diseases: Chronic diseases like diabetes, hypertension, and autoimmune conditions can affect fertility.

• Stress: Extreme stress and excessive or insufficient exercise can disrupt ovulation.

• STIs: Pelvic surgery and sexually transmitted infections (STIs) like chlamydia can cause scarring and damage to reproductive organs.

• Hormonal Disorders: Hormonal disorders involving the hypothalamus or pituitary glands, such as high prolactin levels, can affect sperm production.

• Genetic Conditions: Genetic and congenital conditions like undescended testicles, mumps after puberty, and certain genetic disorders can impact male fertility.

• Environmental and Medical Factors: Environmental toxins, smoking, excessive alcohol use, and medical treatments like chemotherapy and radiation therapy can all impair sperm quality and quantity.

Understanding these risk factors is crucial for preventing and addressing infertility.

Infertility can lead to a range of emotional, psychological, and physical complications for both individuals and couples.

• Emotional Impact: The emotional toll of infertility can be significant, with many experiencing feelings of sadness, anxiety, stress, and hopelessness. The pressure to conceive can strain relationships, leading to communication difficulties and even the breakdown of partnerships.

• Social Isolation: Infertility can lead to social isolation, as individuals may feel uncomfortable discussing their struggles with family and friends. They may also avoid participating in social events that revolve around children.

• Physical Complications: In some cases, infertility can have physical complications, particularly for women undergoing fertility treatments. Ovarian hyperstimulation syndrome (OHSS) is a potential complication of in vitro fertilisation (IVF). This can cause abdominal pain, bloating, and, in severe cases, blood clots and kidney failure.

• Risks of Multiple Pregnancies: Fertility treatments increase the likelihood of multiple pregnancies, raising the risks of premature birth and low birth weight.

• Financial Strain: The high cost of infertility treatments adds significant financial stress to individuals and couples.

Recognising and addressing these potential complications is crucial for maintaining the overall well-being of those struggling with infertility.

While not all causes of infertility can be prevented, there are steps individuals can take to protect their fertility:

• Maintain a healthy weight through a balanced diet and regular exercise.

• Avoid smoking and excessive alcohol consumption.

• Manage chronic health conditions like diabetes and hypertension.

• Reduce exposure to environmental toxins and hazards.

• Practice safe sex to prevent sexually transmitted infections.

• For women, track your menstrual cycle and ovulation to identify any irregularities.

• Consider fertility preservation options like egg or sperm freezing if delaying parenthood.

• Treat any known reproductive health issues promptly.

• Manage stress through relaxation techniques, counselling, or support groups.

• For men, avoid tight-fitting clothing and hot environments that can affect sperm quality.

By making lifestyle changes and being proactive about reproductive health, individuals can take steps to prevent infertility and increase their chances of conceiving.

Diagnosing infertility typically involves a comprehensive evaluation of both partners to identify potential causes and develop an appropriate treatment plan.

• Physical Examination: The process starts with reviewing medical history, menstrual cycles, pregnancies, and lifestyle factors affecting fertility.

• Ovulation and Hormonal Testing for Women: Tests assess ovulation and reproductive hormones like FSH, LH, and progesterone to evaluate fertility status.

• Imaging Tests: Ultrasound and hysterosalpingography (HSG) help identify abnormalities or blockages in the uterus and fallopian tubes.

• Laparoscopy: This minimally invasive surgery diagnoses conditions like endometriosis or pelvic adhesions affecting fertility.

• Semen Analysis: Semen analysis checks sperm count, motility, and morphology as key factors in male fertility.

• Additional Tests for Men: Hormonal tests, genetic testing, and imaging may diagnose structural issues; a testicular biopsy might assess low sperm production.

Once the cause of infertility has been identified, healthcare providers can develop a personalised treatment plan to help couples achieve their goal of starting a family.

The management of infertility involves a multidisciplinary approach, considering the cause, duration, and individual preferences.

• Timed Intercourse: Timed intercourse is recommended when the sperm count is normal, and the woman’s fallopian tubes are functional.

• Fertility Medications: Fertility medications like clomiphene citrate, gonadotropins, metformin, letrozole, and bromocriptine regulate or stimulate ovulation. These medications mimic natural hormones to trigger ovulation or improve sperm production.

• Intrauterine Insemination (IUI): It is recommended for couples with mild male factor infertility, unexplained infertility, or same-sex female couples using donor sperm.

• Surgery: Surgery may also be used to remove fibroids, correct blocked fallopian tubes, or repair varicoceles in men. However, it is less common due to the success of other treatments like IUI and IVF.

• Assisted Reproductive Technology (ART): It includes procedures like in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). IVF involves retrieving eggs, fertilising them with sperm in a lab, and transferring the embryos to the uterus. Meanwhile, ICSI is often used when semen quality is poor.

However, fertility treatments can come with complications, such as the risk of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Proper management and monitoring of these treatments are crucial to minimise these risks and optimise outcomes for patients dealing with infertility.

Medication for Infertility

Medications play a crucial role in the management of infertility, particularly for ovulation disorders and hormonal imbalances.

• Clomiphene Citrate: It is a common medication that stimulates ovulation by causing the pituitary gland to release more follicle-stimulating hormone (FSH). This leads to the development of one or more mature follicles, increasing the chance of successful fertilization.

• Gonadotropins: Other medications used in the treatment of infertility include gonadotropins. These are injectable hormones that directly stimulate the ovaries to produce multiple eggs.

• Metformin: It is often prescribed for women with polycystic ovary syndrome (PCOS) to help regulate ovulation and improve insulin sensitivity.

• Letrozole: It is an aromatase inhibitor and is also used to stimulate ovulation in women with PCOS or unexplained infertility.

• HCG: For men with infertility, medications such as clomiphene citrate or human chorionic gonadotropin (hCG) may be used to improve sperm production and quality.

• Antibiotics: In some cases, antibiotics may be prescribed to treat infections that can impact sperm health.

It is important to note that while these medications can be effective in treating infertility, they may also come with side effects and risks. Close monitoring by a healthcare provider is essential to ensure the safety and efficacy of these treatments.

Infertility can be a distressing issue for couples trying to conceive. It's important to know when to seek medical help. If you're under 35 and haven't conceived after a year, consult a fertility specialist. For women over 35, this timeline is reduced to six months as fertility declines more rapidly with age. Men should also seek medical advice if they have been unable to conceive with their partner after a year of trying.

However, there are certain situations where it's advisable to see a doctor sooner:

• If you have irregular or absent menstrual periods, known fertility issues, or have undergone cancer treatment, consult a fertility specialist.

• If you have a history of pelvic inflammatory disease, endometriosis, or multiple miscarriages.

• Men with low sperm count, testicular or prostate issues, or cancer treatment.

  Early intervention can help identify the cause of infertility and improve the chances of successful treatment.

• Infertility affects millions of couples worldwide, with various causes, including ovulation disorders, male factor infertility, and anatomical issues.

• Symptoms of infertility include the inability to conceive after one year of regular, unprotected sexual intercourse (or six months for women over 35).

• Infertility can be caused by factors affecting both men and women, such as hormonal imbalances, reproductive disorders, and lifestyle factors.

• The management of infertility involves a range of treatments, including medications, intrauterine insemination, surgical procedures, and assisted reproductive technologies like IVF and ICSI.

• Medications used to treat infertility include clomiphene citrate, gonadotropins, metformin, letrozole, and antibiotics for male infertility.

• Couples who have been trying to conceive for a year or more should consider seeking medical advice from a fertility specialist.

• Prevention strategies for infertility include maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, managing stress, and protecting against sexually transmitted infections (STIs).