Introduction
Infertility affects more than 80 million people worldwide. In general, one in ten couples experiences infertility.[1] Infertility is generally defined as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but have miscarried several times may also be considered infertile.
The cause of infertility can be a result of problems with the man or woman’s reproductive system, a combination of factors, or factors that cannot be explained.
Infertility in women
Problems with ovulation account for most cases of infertility in women. Signs of problems with ovulation include having irregular or no menstrual periods. Some conditions that may effect ovulation include when the ovaries stop functioning before natural menopause (premature ovarian failure), when the ovaries do not release an egg regularly or do not release a viable, healthy egg (polycystic ovary syndrome (PCOS)), or when the fertilized egg cannot successfully implant. Other contributors to infertility in women include: blocked fallopian tubes, physical problems with the uterus, and uterine fibroids. Certain lifestyle, environmental, or genetic factors can also affect a woman's ability to have a baby including: age, stress, poor diet, being overweight or underweight, smoking, drugs and alcohol, sexually transmitted infections (STIs) medication, environmental toxins, genetic conditions and health problems that cause hormonal changes.
Infertility in men
Infertility in men is most often caused by problems making sperm, that is, producing too few sperm or none at all, problems with the sperm's ability to reach the egg and fertilize it, or abnormal sperm shape or structure that prevents it from moving correctly. Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. Like female infertility, male infertility can also result from lifestyle, environmental, or other health related factors including: age, stress, exposing the testes to high temperatures, which can affect the ability of the sperm to move and to fertilize an egg, smoking, drugs, and alcohol, medications, environmental toxins, and genetic conditions.
Screening and Diagnosis
There are a variety of tests for both men and women to screen and diagnose infertility. The tests that are used should be decided based on each couple’s situation and discussion between them and their doctor. In general, infertility tests check whether reproductive organs are healthy and functional.
Tests for Men
Male tests for infertility seek to determine if the testicles are producing sufficient amounts of healthy sperm and that the sperm can reach the egg (ejaculateseffectively). These include:
- General physical examination. This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and sexual habits.
- Semen analysis. A man will usually be asked for a semen sample which he will ejaculate into a container. This semen is then analyzed for quantity, color and infections or blood. Tests will also look at the number of sperm in the sample as well as any possible abnormalities in shape and movement. Since sperm counts may differ between specimens doctors may ask for more than once sample.
- Hormone testing. Men may also be asked to take a blood test to measure the level of testosterone and other male hormones.
Tests for Women
Fertility test for women determine whether the ovaries are releasing health eggs, and the eggs and the sperm are able to reach the fallopian tubes for fertilization. These include:
- General physical examination. This includes a gynecological exam and questions on your medical history, menstrual cycle and sexual behaviors.
- Confirmation of ovulation. A blood test is sometimes performed to determine whether there are sufficient hormone levels for ovulation.
- Hysterosalpingography. This test is used to see if there are any blockages or problems in the uterus and fallopian tubes. Fluid is injected into the uterus, and an X-ray is used to see if the fluid moves from the uterus into the fallopian tubes and general peritoneal cavity.
- Laparoscopy. A surgical procedure that may require general anesthesia. Doctors will make a small incision beneath the navel and insert a thin (illuminated, fiber-optic) telescope (laparoscope) into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. Through this procedure doctors can look for signs of endometriosis and scarring, and blockages or irregularities of the fallopian tubes and uterus.
- Ovarian reserve testing. Tests which determine the quality and functioning of the ovaries. They do not focus on whether the ovaries are producing eggs, as much as the potential effectiveness of the eggs after ovulation.
Treatment
Infertility treatments may involve the man, the woman or both. Infertility can be treated with medicine or hormone treatment, artificial insemination or assisted reproductive technology (ART).
Because they are less expensive, risky and invasive than other treatments, medication or hormone treatments for infertility are tried first. These include trying to stimulate regular ovulation in women who have problems with ovulation, increasing the sperm count a man produces, or preventing premature ejaculation. Medication or hormone treatments are also used to stimulate the ovaries to produce multiple eggs in preparation for ART or insemination.
Artificial insemination involves injecting sperm into a woman’s genital tract. It can be placed in the vagina, cervix or in or near the mouth of the fallopian tubes. Intrauterine insemmination is the most common type of artificial insemination. Artificial insemination may be appropriate for couples in which men cannot ejaculate into the woman’s vagina, men have problems with the quantity (too little) or quality of their sperm, women’s cervical mucous is poor quality or inhospitable to sperm, or couples for whom infertility cannot be explained.
Assisted reproductive technologies refer to a range of medical procedures that help a couple get pregnant. These include:
In vitro fertilization: The most common type of ART is in vitro fertilization (IVF); during IVF, eggs and sperm are combined outside the uterus in a petri dish so that the sperm can fertilize the egg. The embryos are left in a petri dish for 3-5 days and then some of them are inserted into the women's uterus. IVF is the ART technique with the highest success rates.
Intracytoplasmic sperm injection (ICSI): A sperm is injected directly into the egg with a microscopic needle and then placed in a dish until fertilization occurs. The embryo is then implanted into the uterus.
Gamete intrafallopian transfer (GIFT): The eggs and sperm are placed in a thin tube and then surgically injected into the fallopian tubes. In contrast to IVF the sperm fertilizes the egg inside the woman’s body and then the embryo implants naturally.
Zygote intrafallopian transfer (ZIFT): The egg and sperm are combined in a dish. Once fertilized, the eggs are surgically injected into the fallopian tubes.
Doctors may treat infertile couples with a combination of these treatments. In addition, there are some lifestyle changes that may help improve fertility, such as reducing stress, modifying diet, ceasing use of drugs or alcohol, or reducing the temperature around the testes. How doctors decide to treatment infertility depends on: test results, how long a couple has been trying to get pregnant, the age of the man and woman, their overall health, and their preference. In some cases infertility cannot be treated.
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