UNDERSTANDING INFERTILITY

"Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained."- ASRM.ORG

What is infertility?

Infertility is defined as the inability to conceive after having sexual intercourse without the use of contraception. Although there is no specific time frame to diagnose infertility, it is highly recommended to seek the assistance of a fertility specialist if a couple has been trying to conceive for at least 12 months with no success.

What are the causes of infertility?

There are multiple reasons why it may be difficult to conceive.  Individuals often question whether infertility is a male or female factor.  The truth is, it could be either a male or female infertility factor... or even both. Diagnostic testing is highly recommended on both male and female intimate partners to get a full evaluation on what the diagnosis may be.

Common Female Infertility Factors:

Advanced Maternal Age

Although every women's egg quality and ovarian reserve varies from patient to patient, a delay in pregnancy until a later age may decrease both egg quality and ovarian reserve.  The traditional definition of advanced maternal age refers to women >35 years of age who are looking to get pregnant. It is possible for women who have a low egg quality (high FSH level) or low ovarian reserve (low AMH level) to get pregnant through infertility treatment such as egg preservation, egg donor and IVF. A woman with advanced maternal age may experience a higher risk of miscarriages and irregular periods.

Ovulatory Disorders

Releasing of the egg in an ovary is called ovulation.  If a woman is not able to ovulate, she is unable to conceive.  Ovulatory disorders are broken down into two groups: anovulation and oligo-ovulation. Anovulation is the state in which ovulation does not occur at all.  Oligo-ovulation is the state in which ovulation may occur irregularly or infrequently.

Polycystic Ovarian Syndrome (PCOS)

A common hormonal disorder that falls within both the anovulation and oligo-ovulation category is whats known as PCOS. It is one of the most leading causes of infertility in today's reproductive age. PCOS occurs when a woman's reproductive hormone levels are imbalanced causing issues in the ovaries. Because the ovaries creates the egg that is released as a part of a normal menstrual cycle, any problems in the ovaries will not allow proper ovulation to take place.

Common Signs of PCOS:

  • Irregular periods

  • Increased or thick facial hair

  • Hair loss or thinning of hair

  • Weight gain or difficulty losing weight

  • Acne

  • Issues conceiving

Uterine or Cervical Abnormalities

The lower part of the uterus is called the cervix. The uterus or womb of a female is where implantation occurs.  Abnormalities in the uterus (most common abnormalities are congenital uterine conditions, polyps or fibroids) interfere with the implantation of an embryo.

 

Congenital uterine conditions are abnormalities that start at birth. The types of congenital uterine conditions may refer to size, shape or structure of the uterus which includes:

  • Septate Uterus - occurs during the embryological development, a tissue or septum wall divides a normal uterus either partially or fully into two sections. 

  • Bicornuate Uterus (heart shaped uterus )-  a condition in which the uterus is split by a septum wall and partially slit on the outside of the uterus creating two horns at the end.

  • Unicornuate Uterus (one sided uterus)-  the malformation of the uterus that only forms one side of the uterus.

  • Didelphic Uterus (double uterus)-  a condition where two small uterus cavities are formed with two separate cervix openings.

Women with congenital uterine conditions may not necessarily have issues conceiving but have higher risks of pregnancy complications such as miscarriages, pre-term labor or breech positioned babies during delivery.

Endometriosis​

A condition in which tissue that is similar to the endometrial lining (also known as the endometrium), forms on the outside of the uterus is called endometriosis.  Severe endometriosis may lead to the distortion of pelvic anatomy and pelvic scarring which causes infertility. In some cases, severe endometriosis may affect the ovaries leading to decreased egg quality and quantity or ovarian reserve.

Common Signs of endometriosis:

  • Painful Periods

  • Pain in the lower abdomen or pelvic area

  • Pain during sexual intercourse

  • Issues conceiving

If left untreated, endometriosis may progress and get worse with time.

Blocked Fallopian Tube

The Fallopian Tubes are two thin tubes that are connected to the uterus, one on each side. Each month when ovulation occurs, the egg that is released from the ovary travels through the Fallopian tube and fertilizes with the sperm creating an embryo.  The embryo then makes its way to implant into the uterus.  Fluid in a Fallopian tube that becomes a barrier between the sperm and the egg is often referred to as a blocked Fallopian tube.  The most common cause of a blocked Fallopian tube is Hydrosalpinx.

Hydrosalpinx is a common form of abnormality in the fallopian tubes.  It is caused by a tubal infection such as pelvic inflammatory disease (also known as PID). Untreated sexual transmitted diseases (also known as STD's) such as chlamydia or gonorrhea may lead to hydrosalpinx.  Other causes of may stem from history of ectopic pregnancies, endometriosis, previous miscarriages or abortions, ruptured appendix, previous surgical procedures involving the Fallopian tubes or abdominal surgery.

 

Unlike the previous female infertility factors mentioned, signs of blocked Fallopian tubes are hard to distinguish unless it is diagnosed through fertility testing.  In some cases, having a blocked Fallopian tube may cause pelvic pain. A hysterosalpinogram (also known as an HSG) is a radiology test often performed to diagnose tubal factors.

Common Male Infertility Factors:

Abnormal sperm quality and quantity is the most common causes of male infertility. There are multiple infertility factors that come into play when determining if it is a male infertility issue.  The more common is abnormal shaped sperm, poor sperm motility and quality.  Other issues include sperm that is not able to attach or penetrate the egg.

Azoospermia is also a factor of male infertility. It a condition where the ejaculation does not contain any sperm.

Male infertility factors may be caused by:

 

  • Infection

  • Hormonal issues

  • Testicular failure

  • Varicocele

  • Previous vasectomy

  • Chromosomal defects

  • STD's

  • Birth defects

A semen analysis is highly recommended to diagnose male infertility factors.  A male hormone blood panel may also be recommended to determine if it may be a hormonal factor.