What IS Infertility ?

Is the inability to get pregnant after a year of unprotected intercourse.


What Causes Female Infertility?

Female infertility can be also be caused by a number of factors, including the following:) Age, Smoking, Sexually Transmitted Infections, and Being Overweight or Underweight can all affect fertility.

  • Damage to fallopian tubes.Damage to the fallopian tubes (which carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries may lead to scar formation and fallopian tube damage.
  • Hormonal causes.Some women have problems with ovulation. Synchronized hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits, and blood tests to detect hormone levels.
  • Cervical causes.A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations.
  • Uterine causes.Abnormal anatomy of the uterus; the presence of polyps and fibroids.

Unexplained infertility. The cause of infertility in approximately 20% of couples will not be determined using the currently available methods of investigation.

If female infertility is suspected, your doctor may order several tests, including
• Complete physical checkup including detail sonography
• A blood test to check hormone levels
• An endometrial biopsy to check the lining of the uterus
Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.
• Hysterosalpingography (HSG). This procedure involves eitherultrasound or X-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and travel up through the fallopian tubes. This enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
• Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. Thelaparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check to see if the fallopian tubes are open at the same time.
• Serial sonography for ovulation study.
What is male infertility ?

Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive.
A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy.
Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male.
Father holding baby


Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications.

What are the symptoms of male infertility?

In most cases, there are no obvious signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.

Medical tests are needed to find out if a man is infertile.

What causes male infertility?

Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.

About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.

Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Known causes of male infertility

Sperm production problems • Chromosomal or genetic causes
• Undescended testes (failure of
the testes to descend at birth)
• Infections
• Torsion (twisting of the testis in scrotum)
• Varicocele (varicose veins of the testes)
• Medicines and chemicals
• Radiation damage
• Unknown cause
Blockage of sperm transport • Infections
• Prostate-related problems
• Absence of vas deferens
• Vasectomy
Sexual problems
(erection and ejaculation problems)
• Retrograde and premature ejaculation
• Failure of ejaculation
• Erectile dysfunction
• Infrequent intercourse
• Spinal cord injury
• Prostate surgery
• Damage to nerves
• Some medicines
Hormonal problems • Pituitary tumours
• Congenital lack of LH/FSH (pituitary problem from birth)
• Anabolic (androgenic) steroid abuse
Sperm antibodies • Vasectomy
• Injury or infection in the epididymis
• Unknown cause

How is male infertility diagnosed?

If a couple has been trying for a pregnancy without success, they should go to their local doctor, family planning clinic or women’s health clinic, and have some initial tests.

Both partners should be tested, even if one has a child from another relationship. Diagnosis can involve a medical history from the man and a physical examination along with a semen analysis to check the number, shape and movement of sperm in the ejaculate.
Blood tests may also be done to check the levels of hormones that control sperm production.

Genetic investigations and testicular biopsies are sometimes done.

How is male infertility treated?

One in eight infertile men has a treatable condition, and after treatment, couples can become pregnant naturally.
In some cases, the doctor will recommend that the couple seek assisted reproductive technologies (ART), such as IVF (in vitro fertilisation).

ART do not cure or treat the cause of infertility but they can help couples achieve a pregnancy, even if the man’s sperm count is very low.

What is ICSI?

Intracytoplasmic sperm injection (ICSI) is a form of IVF where a single sperm is placed directly into each egg by piercing the outer covering of the egg. ICSI is particularly helpful for men with poor sperm production. Sperm are collected from the semen or removed carefully from the testis or epididymis.

Possible Causes of Secondary Infertility

Causes of secondary infertility vary, but there are a number of factors that may be at play.

Advanced reproductive age:

The woman’s age is one of the most common reasons for secondary infertility. Although a woman like Claire may have had no problem getting pregnant a few years ago, those interim years can change things. It is critical to understand that a woman is born with all of the eggs she will ever have. As a woman ages, her ovarian reserve will diminish. This means that her egg quantity and egg quality will decrease, while the chance of miscarriage increases. This is true whether or not she conceived easily in the past.

Structural complications :

Some other important factors relate to the structures in the pelvis which includes the fallopian tubes. Pelvic adhesions – which may be caused by endometriosis or prior abdominal surgeries – may make it difficult for the egg to be picked up by the fallopian tube. Without a connection that functions normally, pregnancy cannot result. In addition, if there were complications that developed during a prior delivery and a uterine infection resulted, she may have developed Asherman’s syndrome (intrauterine adhesions) or adhesions that develop around the fallopian tube.

Sperm quality and quantity :

The third category to consider is the sperm. Just as a woman’s fertility can change with time, so can a man’s. Changes in sperm quality and quantity may occur due to changes in health or new medications. A semen analysis is one of the basic aspects of the initial infertility evaluation.

Weight gain :

Weight can have a huge impact on the ability to conceive. Excessive weight gain can contribute to ovulatory dysfunction. With increased weight, insulin resistance can increase as well which leads to elevated production of testosterone from the ovaries, a phenomenon that can further prevent normal ovulation. In men, excessive weight can also negatively affect sperm production by increasing estrogen levels.

Smoking :

Cigarette smoking in both the male and female can significantly impair the ability to conceive. And, smoking can seriously impact a woman’s ability to carry a normal pregnancy.

Recommended Treatments

Fertility treatments are constantly improving: pregnancy rates for infertile couples using Assisted Reproductive Technologies (ART) are currently higher than the average monthly fertility rates. Even if you already have a child, if you suspect secondary infertility, seek help from a fertility specialist as early as possible! Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue.

Medication :

Medications that are used to enhance fertility include oral medications such as clomiphene citrate (Clomid) and injectable gonadotropins. Both are used to increase the number of eggs that are available for fertilization.

Fertilization :

Once the eggs are ready, doctor and patient will determine if the best way to proceed is via intercourse, intrauterine insemination or in vitro (in the lab). In vitro fertilization has been useful in circumventing some of the tubal and pelvic disorders that can cause secondary infertility and is also helpful in increasing rates of fertilization–even if a woman’s fallopian tubes are already opened, as in the case of severe sperm-related abnormalities.

Egg donation :

In the case of women who are diagnosed with severely diminished ovarian reserve with no remaining ovarian function, egg donation is an option.

Obesity and infertility

One of the best established connections between obesity and reproductive problems is the link between obesity and infertility. Obesity decreases the rates of successful pregnancy in natural conception cycles.

In women who are undergoing reproductive therapies by accelerating and augmenting their ovulation cycles for better chances of conception, obesity may reduce the rates of pregnancy as well.

High levels of leptin and low levels of adiponectin may also reduce rates of conception. Fertility can be partially restored if weight loss can be achieved.

Obesity and anovulation

Obesity is likely to cause insulin resistance that is linked to anovulation or failure of a woman to produce the egg from each ovary each month. Insulin levels and obesity also lead to altered sex hormones, high androgens (male hormones), high levels of free growth factor 1 etc.

Studies show that women having anovulation related infertility is 30% higher in women with BMI ranged between 24 and 31 as compared to that of normal weight women. Furthermore for those with BMI over 31, the chance is even 170% higher.

Only 5% loss of body weight can increase in ovulation rates and reduces biochemical abnormalities.

Studies show that in obese women with anovulation, the underlying cause is most likely due to polycystic ovary syndrome (PCOS). PCOS is associated with obesity or overweight along with symptoms of high male hormone secretion such as hairiness, acne, high cholesterol level and insulin resistance.

Obesity and complicated pregnancies

Obesity leads to common pregnancy complications like pregnancy induced high blood pressure called preeclampsia or in severe cases eclampsia.

Obesity and related insulin resistance is also responsible for diabetes during pregnancy or gestational diabetes.

Obesity and miscarriage

Obesity raises the rate of miscarriage and thus decreases successful pregnancy rates among obese women. This could be due to various causes including:-

• Poor quality of eggs or ovum
• Defective implantation or reception of the fertilized egg onto the womb mainly due to insulin resistance
• Defective and altered levels of hormones that help in sustaining pregnancy

Obesity and assisted reproductive technique failure

Obesity is responsible for high failure rates of successful pregnancy even after employing artificial methods including stimulation of ovulation and assisted conception.

The British Fertility Society recommends that, “Women who are obese must initiate a weight reduction programme and those severely overweight (defined as having a BMI of 36 or more) should not receive treatment until their weight has reduced.”

Obesity and hormones

Obesity leads to decrease in testosterone, follicle stimulating hormone, inhibin B and sex hormone binding globulin. This leads to low sperm count and quality in obese men.

In obese women there is increase in androgen metabolism and elevated estrogen levels. Obese men show low estrogen and low testosterone levels as well.

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