Health news of the week: Infertility; causes, diagnosis & more

What is Infertility?

Infertility is defined as the failure to conceive after a year of unprotected and unrestricted intercourse. In women over 35, the period is defined as six months. Primary infertility is when a couple has never had children, whereas secondary infertility refers to couples who have had children together but are at present unable to conceive.

Causes of infertility

The causes of infertility are equally split between male, female and unknown causes.

Male causes

Oligospermia/azoospermia

Varicocele

Prostatic infection

Majority of sperms are inactive or non-motile

Blockage of the reproductive tract, following surgery or injury

Reduction in sperm quality or quantity may be idiopathic, or a result of conditions such as:

Congenital – Klinefelter’s syndrome

Acquired:

Infections of the male reproductive tract

Alcohol or drug abuse

Exposure to environmental pollutants

Smoking

Following mumps orchitis

Chronic illnesses such as kidney disease

Testosterone underproduction

Medications

Chemotherapy/ radiation

Heat exposure to the testes, such as overly warm tubs, use of a laptop on the lap for long periods, varicoceles.

Impotence or premature ejaculation

Female causes

An ovulation:

Polycystic ovarian syndrome, a metabolic disease in which infertility is often associated with diabetes and obesity.

Primary ovarian failure

Blockage of the fallopian tubes, due to endometriosis, pelvic inflammatory disease, ectopic pregnancy, or surgery.

Uterine developmental abnormalities, fibroids, or adhesions.

An ovulation may be due to many factors, including:

Age

Smoking

Alcohol abuse

Stress

Obesity

Malnutrition

Diagnosis of the cause of infertility

In men, testing starts with semen analysis, and hormonal assays if indicated, as when sperm counts are very low.  

In women, ovulation is tested for, either at home, using means such as basal body temperature or cervical mucus tests, or in hospital, with an ultrasound or blood tests.

If ovulation is present, tests may be performed to rule out tubal or uterine blockages and assure normal uterine anatomy.

If ovulation is absent, hormonal levels are checked, as well as metabolic parameters.

Treatment

Treatment is based on:

The couple’s age

The period of infertility

The test results, showing any abnormalities, if present.

The health of the couple

Treatment includes:

Medication for obvious problems, such as anovulation or infection.

Surgery for blockages or for varicoceles.

Impotence or premature ejaculation require behavioral and medical therapy.

Other modes of treatment such as:

Artificial insemination

Assisted reproductive technologies, such as in vitro fertilization, intracytoplasmic sperm injection, or gamete intra-fallopian transfer.

ART is costly, time-consuming and carries a relatively higher risk of certain birth defects, such as heart, digestive and cleft lip/palate problems.

More modern choices include the use of a surrogate mother or a gestational carrier.