The Basics of Infertility! 

Infertility….. I am sure that you all know someone who has been affected or you have been affected by infertility. April 23-29 2017 is Infertility Awareness Week.  To give you an idea of just how many are affected, here are some staggering statistics regarding infertility. 

7.4 million women, or 11.9% of women, have ever received any infertility services in their lifetime. (2006-2010 National Survey of Family Growth, CDC)

1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. (2006-2010 National Survey of Family Growth, CDC)

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. (www.asrm.org)

A couple ages 29-33 with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month (National Women’s Health Resource Center). After six months of trying, 60% of couples will conceive without medical assistance. (Infertility As A Covered Benefit, William M. Mercer, 1997)

Approximately 44% of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65% give birth. (Infertility As A Covered Benefit, William M. Mercer, 1997)

Approximately 85-90% of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3% need advanced reproductive technologies like in vitro fertilization (IVF). (www.asrm.org)

The most recently available statistics indicate the live birth rate per fresh non-donor embryo transfer is 47.7% if the woman is under 35 years of age and 39.2% if the woman is age 35-37. (Society for Assisted Reproductive Technology, 2013)

According to the Women’s Health Organization, Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”… (WHO-ICMART glossary1). It is also defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. The male partner can be evaluated for infertility or subfertility using a variety of clinical interventions, and also from a laboratory evaluation of semen.” (Semen manual, 5th Edition3).

As seen in the definition of infertility it is just not something that affects women.  Men can also be affected by infertility. Male factor infertility is the primary cause in about 30% of all infertility cases. Male infertility is a factor in 30 – 50% percent of all couples who are trying to get pregnant a second time.

So now we know how frequently infertility occurs. Let’s look at possible causes for female infertility. According to the American Pregnanct Association, the most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can also contribute to infertility because as a woman ages, her fertility will naturally decrease.

Problems with ovulation may be caused by one or more of the following: hormone imbalance, a tumor or cyst on the reproductive organs, alcohol or drug use, and problems with the thyroid gland excess weight, excess stress, any exercise that causes a significant loss of body fat, brief menstrual cycles. 

Damage to the fallopian tubes or the uterus can be caused by any of the following: pelvic inflammatory disease, polyps in the uterus, endometriosis or fibroids, scar tissue or adhesions any kind of chronic medical illness, previous ectopic (tubal) pregnancy, birth defect. Also DES syndrome (The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.)

 Male fertility is a complex process, not that women’s isnt, but male infertility can oftentimes be hard to diagnose or even overlooked. In order for a man to get his partner pregnant, certain things must occur: first off, healthy sperm must be produced. This involves the growth and formation of the male reproductive organs during puberty. If there is something that affects growth of the male reproductive organs it can affect future fertility. At least one of a mans testicles must be functioning correctly, and they must produce testosterone and other sex hormones in order to trigger and maintain sperm production. 

That being said there has to be enough sperm in the semen. If the sperm count is low, it decreases the chances that one of the mans sperm will fertilize his partner’s egg. A low sperm count is considered to be fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.  In order for a mans sperm to be able to fertilize a womens egg he must not only have an appropriate sperm count he must also have functional sperm that are able to move. If the movement (motility) or function of the sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.

Male infertility generally is caused by completely different things than women’s infertility. Let’s take a look. 
There are a variety of health issues and medical treatments that can cause male infertility.  Some of these include: infertility can be caused by a Varicocele which is a swelling of the veins that drain the testicle. Varicocele is the most common reversible cause of male infertility. Varicoceles can cause infertility because it reduces the quality of the sperm.

Some infections may interfere with sperm production or general sperm health. An infection can also cause scarring that can block the passage of sperm. These possible kinda of infection include: inflammation of the epididymis (epididymitis) or testicles (orchitis) and possibly some sexually transmitted infections, including gonorrhea or HIV. 

Ejaculation issues can also cause male infertility. One issues could be retrograde ejaculation, which occurs when semen enters the bladder during orgasm instead of emerging out of the penis. There are many health conditions that can potentially cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.

Another cause could be Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that identify sperm as harmful invaders and attempt to eliminate them.

In some men, during fetal development one or both testicles will fail to descend from the abdomen into the scrotum. Decreased fertility is more likely in men who had this condition.

Infertility can result from disorders of the testicles themselves or an abnormality affecting the hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.

Blockages can occur at any level of the male reproductive system, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra. And each of these blockages can cause some level of male infertility 

A number of inherited disorders and chromosome abnormalities such as Klinefelter’s syndrome cause abnormal development of the male reproductive organs, thus infertility. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
Certain medications that can cause infertility and decrease sperm production, such as testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal meds and some ulcer drugs. 

Believe it or not there are also environmental causes for male infertility. Some of these environment causes are: Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function.  Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts. As well as heavy metal exposure. A mans  Exposure to lead or other heavy metals also may cause infertility.  Long periods of elevated temperatures can impair sperm production and function. Frequent use of saunas or hot tubs may temporarily impair sperm count.  

There are many options for treating male infertility. For example, a varicocele or obstructed vas deferenscan often be surgically corrected or an  repaired. Prior vasectomies can potentially be reversed. In cases where no sperm is found in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques. Antibiotic treatment might cure an infection of the reproductive tract, but doesn’t always restore fertility. Hormone treatments/replacement can be used in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses the hormones. ART treatments which involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals.  The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

As for female infertility treatment is going to vary depending on what the cause of the the infertility is. Many treatments significantly improve the chances of getting pregnant. Treatment options include hormone treatments, fertility drugs, and surgery. In addition, assisted reproduction uses various medical techniques to fertilize an egg.

If the couple wants to try to handle things on their own, naturally they can tryplanning intercourse within 5 days of ovulation to improve
The chances of becoming pregnant.

If they okay with medication there are several options. One options is called an
Estrogen modulator, this mimics the effect of estrogen on various tissues, including
the breast, bones, and reproductive organs. Examples: Clomiphene (Clomid and Serophene)
 Another medication option is a certain category of Anti-Diabetic medication. This kind of medication will control the amount of sugar (glucose) in the blood. Examples are Metformin (Glumetza, Glucophage, Riomet, and Fortamet). They can also try a women on Hormone therapy, which affects the body processes by regulating the activity of the organs. Examples are: Estradiol (Estrace, Estring, Vagifem, Delestrogen, EstroGel, Alora, Evamist, Elestrin, Estrasorb, Femring, Innofem, Vivelle, Menostar, Estraderm, Divigel, and Climara)
Gonadotropin-Releasing hormone analogue
Testosterone (Axiron, Androgel, Delatestryl, Testim, Testopel, Fortesta, Striant, Natesto, Vogelxo, Aveed, Depo-Testosterone, and Androderm)
Progesterone (Prometrium, Crinone, Endometrin, and Prochieve). There are also Sex hormone suppressors which stop or slows the production of hormones involved in sexual health. Examples: Leuprolide (Lupron and Eligard) 

There are also medical procedures that can be atttemped. One of these is Artificial insemination which is insertion of sperm directly into a woman’s womb so she
can get pregnant. Other medical procedures that help women become pregnant can be options as well. Examples include artificial insemination (AI) and in vitro fertilization (IVF).
Ovulation induction: Using medication to make the ovaries release eggs (ovulation).

Even though this is a long post I hope I have provided you with some information on infertility of both kinds. I know I learned a lot while doing the research for this post!!  

-Amber

http://www.resolve.org/about/fast-facts-about-fertility.html

http://www.who.int/reproductivehealth/topics/infertility/definitions/en/

https://www.gstatic.com/healthricherkp/pdf/infertility.pdf

http://www.mayoclinic.org/diseases-conditions/male-infertility/basics/causes/con-20033113

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