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Infertility – Types, Causes, Symptoms and Risk factors

INFERTILITY

What is Infertility?

Infertility is a disease that occurs in both men and women. According to the World Health Organisation, infertility is a failure to become pregnant naturally after twelve months of unprotected sex. Infertility can occur in both women and men.

Infertility may be caused due to one of the partners being infertile or not being able to contribute to conception after having unprotected sexual intercourse for one year.

Infertility is a medical condition that involves both people’s medical detriment. Infertility is caused by many reasons like injury, ovulation disorder, low sperm count, damage to fallopian tubes, drugs, ejaculation and egg formation problems.

According to a study conducted by World Health Organisation (WHO), the gender distribution of infertility was determined. It stated that among 37% of infertile couples, infertility was due to females in 35% of the couples and male infertility accounted for 8%.

The common female infertility factors are ovulatory disorders, endometriosis, pelvic adhesion, tubal blockage, uterine abnormalities and hyperprolactinemia.

Types of Infertility

Primary

When a woman has never conceived during her fertility period, it is called primary infertility.

Secondary

When a woman had at least one successful pregnancy in the past it is called secondary infertility.

Causes of Infertility

Infertility may be caused due to various reasons regardless of age. Factors like stress, occupation, age, hormonal imbalance and socio-economic status.

Medicines and drugs

Certain medications can cause infertility in men and women. For men, medications like sertraline, venlafaxine, sulfasalazine, anabolic steroids, narcotic pain killers and medication that is taken for testosterone can cause infertility. These medications affect the total sperm count in men.

In women, medication use can raise the prolactin hormone levels, which affects ovulation and causes fertility problems.

Medications like prochlorperazine, chlorpromazine, haloperidol, risperidone, methyldopa, metoclopramide, cimetidine and other antidepressants like sertraline and fluoxetine can cause infertility in women.

Immunosuppressants like cyclophosphamide can cause a reduction in ovarian reserve.  Antirheumatic medications like hydroxychloroquine and methotrexate are also said to reduce ovarian reserve.

Cervical mucus problems

Cervical mucus is the fluid released by the cervix. Hormonal changes during the menstrual cycle cause changes in the texture and colour of the mucus.

The cervical mucus fluid has two important functions. The mucus helps the sperm swim across and attach to an egg, preventing other substances and sperms from getting into the cervix.

The mucus will help to identify if a person is fertile and is easy to get pregnant. There will be changes in the mucus during different stages of ovulation.

The mucus will be thick, dry and white before ovulation. When the mucus is clear and slippery it indicates that you have ovulated just in time and it is the perfect time to have sex.

The slippery consistency of mucus makes it easy for the sperms to swim and get attached to an egg. The mucus also helps to identify when you are not fertile and there will be a difficulty in getting conceived. This method is called natural family planning.

When the mucus becomes abnormal, it makes it difficult for the sperms to swim and make it unlikely for you to become pregnant.

Mucus will allow the bacteria and other substances to pass through the vagina that can cause infection. These substances not only cause infection but also destroys the sperm cells making it more difficult for you to get pregnant.

Another rare case is the antibiotics in the cervical mucus may kill the sperm cells before they reach the egg.

However, these problems occur rarely and interfere with fertility. These are possible in women diagnosed with chronic cervicitis, cervical stenosis and cervical dysplasia.

The treatment for cervical mucus problems includes by placing the semen directly in the uterus to bypass the mucus. This method is called in vitro fertilisation.

Scarring from surgery

Uterine scarring is scar tissue present in the uterus. More bands of scar tissue can disrupt the function of the uterus and alters its shape. Infertility caused due to uterine scarring accounts for about 20%.

These scarring tissue can cause severe scarring which can even stop the menstrual flow and cause infertility.

Scarring to the uterus is commonly caused by surgery. When a C-section is performed, it can cause the development of scar tissue. Another scarring is caused by other methods like miscarriage and abortion.

Fibroids

Fibroids

Fibroids are non-cancerous tumour cells that grow in the female uterus. Fibroids are the most common benign tumours that are found in the uterus. These fibroids usually grow as round and well-circumscribed mass cells.

The cause of fibroid growth is unknown. They are dependent on the hormones progesterone and oestrogen for growth during the reproductive period and shrink back to a lesser size after the onset of menopause.

Common symptoms of fibroids include pelvic pain, uterine bleeding, infertility, obstructive effects on the bladder and rectum and dyspareunia (painful sex).

Other symptoms like painful urination, menstrual cycle that lasts for more than a week, heavy menstrual bleeding, constipation and leg pain.

Endometriosis

The women’s uterus has a small inner layer of lining called the endometrium. The endometrium cells move to other parts in some women like the fallopian tube and ovaries.

These cells multiply and form mass cells inside the fallopian tubes and ovaries. During the menstrual cycle, these cells break and start to bleed. This results in painful periods for women with such conditions.

These cells also cause inflammation and later develops into a uterine scar. Women with such conditions may have many uterine scars that can lead to infertility.

The disease is observed in women aged between 25 to 29 years. The pain caused due to endometriosis is characterised to be chronic and progressive.

There are three subtypes of endometriosis that overlap with each other. The superficial peritoneal lesions, the ovarian endometrioma and the deep infiltrating endometriosis.

The clinical manifestation does not always depend on the size of the endometrium growth or lesion.

People with bowel endometriosis experience a wide range of symptoms like diarrhoea, constipation, abdominal pain and bloating. Other clinical conditions like inflammatory bowel disease and irritable bowel syndrome. These symptoms develop and lead to significant health issues like infertility if left untreated.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection caused by bacteria that occurs in the female reproductive organ. It is caused when the sexually transmitted bacterial infection spreads from the vagina to other parts like fallopian tubes, ovaries and the uterus.

There are no significant symptoms of the pelvic inflammatory disease until you have trouble getting conceived.

Some of the common symptoms are pain during sex, painful urination, fever accompanied by chills and unpleasant vaginal discharge with an unpleasant odour.

The disease is caused by bacteria like chlamydia and gonorrhoea. The disease can be treated with a course of antibiotics which usually lasts for about 14 days.

The fallopian tubes get affected by this disease and they become narrowed. If the tubes become narrowed it will be difficult for the egg to pass through the fallopian tubes and infertility can occur.

The risk of sexually transmitted diseases can be reduced by using a condom. Usually, men are affected by the bacterial species chlamydia and are mostly asymptomatic. When you have sexual intercourse with men affected by chlamydia the bacterial infection spreads and causes infertility in women.

Common symptoms of pelvic inflammatory disease are painful urination, heavy blood flow and painful periods, unpleasant vaginal discharge, pain around the pelvis and pain around the lower abdomen accompanied by high temperature.

Pelvic inflammatory disease can be treated with an antibiotic course. If left untreated it can lead to significant health issues like tubal blockage due to the formation of scar tissues, the formation of a baby outside the uterus (ectopic pregnancy) and infertility.

Sterilisation

Sterilisation can make you infertile. It is a permanent method of contraceptive that involves surgery to avoid fertilisation. Sterilisation can be done for both men and women.

Male sterilisation is called vasectomy. It will stop the sperm travelling from the testis to the penis. Sperms are usually made in the testis and are ejaculated during intercourse.

The surgery the involves removal of the sperm duct. So the sperms can no longer be stored and ejaculated. As a result, fertilisation will not occur.

Vasectomy is a successful sterilisation method, yet one in two thousand men can become fertile again. This is due to the two ends of the sperm duct can reunite after some time.

Female sterilisation is a permanent contraceptive method. The surgery is performed to avoid the eggs reaching the sperms.

The surgery involves blocking the fallopian tubes of the female reproductive organ. As a result, the eggs will remain in the ovary and will not be fertilised by the sperm.

The laparoscopic method is carried out to block or cut the fallopian tubes. A small instrument is inserted in your abdomen and the fallopian tube is blocked with a ring or a clip. In the traditional method of female sterilisation, the fallopian tube is cut or removed. The process is called salpingectomy.

Sterilisation is a permanent method of contraceptive. So if you have decided to go for sterilisation make sure you and your partner do not want children. Sterilisation is best suggested after the birth of a baby and you don’t want to get conceived anymore.

Sterilisation does not require either of your partner’s consent and it is legal for you to sterilise yourself. Compared to female sterilisation, male sterilisation is safe, effective and easier. There are no or fewer side effects.

Symptoms of Infertility

Some couples will try to conceive for years but it will be very difficult for them. About 85% of infertile couples can identify their infertility problems and the common cause of infertility will be tube blockage, dysfunction in ovulation and male infertility.

The other 18% of the infertile couples will have unexplained infertility. Early symptoms can be an indication of certain health conditions and if treated early infertility can be prevented.

Pain during sex

Intercourse should be enjoyed by both men and women. If you experience pain during sex it might be a sign of infertility. Pain during intercourse can be caused by uterine fibroids or endometriosis.

Other reasons may be due to dryness and adhesion. Painful sex can make both men and women uncomfortable.

Your body is most fertile during the ovulation period and it happens once a month. You have a high chance of getting pregnant during the ovulation period. But if you experience pain during sex, it will be very challenging for you to get pregnant.

Vaginal dryness, lack of foreplay before the intercourse and decreased level of cervical mucus can be a reason for painful sex in women. Low oestrogen levels can cause vaginal dryness in women.

Men also experience pain during sex. Common reasons include infections caused by sexually transmitted disease, tight foreskin, inflammation and small tears in the foreskin, swelling in the testis and prolonged erection.

Heavy, long or painful periods

Heavy bleeding with long and painful periods may indicate signs of endometriosis. When the endometrium tissue grows outside the uterus, the condition is called endometriosis. It can lead to infertility and other chronic pain.

Menstrual cramps are normal in women but if the cramps get bad it can indicate other medical conditions like endometriosis. The subcategory of endometriosis is adenomyosis.

When the endometrium tissue grows in the muscle part of the uterus it is called adenomyosis. Adenomyosis can also cause a painful and long menstrual cycle that can lead to infertility.

Fibroids can also be a reason for painful periods. According to the U.S. Department of Health and Human Services estimated that 80% of women will face this problem at least once in their lifetime.

Symptoms of fibroids differ widely from one woman to another. Symptoms like painful periods, heavy bleeding and abdominal pain or swelling are common.

Dark or pale menstrual blood

The colour of menstrual blood can show signs of infertility. The colour of menstrual blood will be bright red at the start of the cycle and after some days it can get dark in colour.

Discharge of dark blood during the onset of the menstrual cycle can be a symptom of endometriosis. Discharge of dark blood indicates that old blood is being flushed out and this might be a clear sign of endometriosis.

Irregular menstrual cycle

Irregular menstrual cycle

A menstrual cycle usually occurs every 27 days. An irregular cycle can occur every 21 days and the bleeding will persist for more than 7 days. The length of the menstrual cycle differs from one woman to another but the gap between one cycle to another will be the same.

If you have an irregular length between one cycle to another then it can be a sign of infertility. The irregular menstrual cycle can be due to other health conditions like Polycystic ovary syndrome (PCOS), underweight, obesity and thyroid problems.

However, women with irregular periods can get pregnant naturally but the chances of getting pregnant will be decreased.

Hormone changes

Hormonal imbalance is the leading cause of infertility. Hormones are important for the body as they regulate the functions of the body. Hormonal changes can cause irregular periods, PCOS and anovulation in women.

In men, hormonal changes can lead to low testosterone levels which affect their infertility. On average, the human body has 50 hormones that regulate growth, metabolism and development.

The hormones in the woman’s reproductive system regulate the formation of the egg and then the release of the newly formed egg into the fallopian tube to be fertilised by the sperm. If the hormones are not in the normal range or there is an abnormal activity the formation of the egg or the release of the egg into the fallopian tubes will be delayed. This results in infertility or difficulty getting pregnant.

Hormonal changes associated with the reproductive system can cause difficulty in getting pregnant and lead to infertility. Hormonal changes can be treated and fertility can be made possible again.

Underlying medical conditions

Previous health conditions like PCOS, endometriosis, fibroids and hypothyroidism are the major causes behind infertility.

During the menstrual cycle, it is normal to feel gloomy with frequent mood swings and weight gain. But when you have frequent mood swings it might indicate hypothyroidism. Unusual weight gain is also a symptom of hypothyroidism.

Sexually transmitted diseases like gonorrhoea and chlamydia will show no symptoms and this can lead to pelvic inflammatory disease. The pelvic inflammatory disease is caused by bacteria that cause infection in the vagina and uterus. These infections can be treated with an antibiotic course.

Obesity

Men and women with overweight issues have infertility problems. Obese women are more prone to health problems like infertility. They experience health issues like menstrual dysfunction and anovulation. Obesity is a common problem among women of reproductive age.

Risk factors like subfecundity, infertility, lower rate of conception, pregnancy complications and miscarriage rates are higher in overweight and obese women. The rate of conception is very low in natural and artificial conception.

Weight loss in obese and overweight women has beneficial effects and conception rates increase. Obesity increases the risk of other health issues like coronary heart disease, diabetes mellitus, hypertension and osteoarthritis. Obesity is also linked to other malignancies like colon, endometrium and breast cancer.

In obese women, the sex hormone-binding globulin (SHBG), growth hormone (GH), and insulin-like growth factor binding proteins (IGFBP) will be low and leptin levels will be high. As a result, the neuro-regulation of the hypothalamic-pituitary-gonadal (HPG) axis deteriorates and these alterations cause impaired ovulatory function and affects reproductive health.

Not getting pregnant

Early symptoms like irregular periods, fibroids and endometrium may indicate infertility. Later, during the reproductive age when not being able to conceive naturally is an indication of infertility.

Both men and women may be equally affected by infertility. In some couples, either one person may be infertile. Lifestyle, stress levels and other factors play an important role in conception.

Risk Factors of Infertility

Age

The rate of conception decreases as your age increases. The most fertile age for both men and women is considered to be 25-32. Even if you are not able to conceive naturally and wanted to go for in vitro fertilisation if you are above the age of 35 the rate of successful conception will be very low.

However, due to increased research facilities, some cases have been successfully conceived on the first try irrespective of age.

Tobacco Use

According to U.S. Food & Drug Administration, tobacco use reduces the fertility rate and makes it difficult to conceive for both men and women. Smoking affects hormone production and causes an abnormal level in the body that leads to hormonal diseases like hypothyroidism.

Second-hand smoking can harm the reproductive system. Tobacco can damage the DNA in the sperm cells and leads to low sperm count and other complications.

Alcohol Use

Consumption of alcohol can result in low sperm count. Alcohol can also affect the motility and shape of sperm cells. Over consumption of alcohol is associated with low testosterone levels, follicle-stimulating hormones and raised oestrogen levels. The imbalance of hormonal levels results in low sperm count and can lead to infertility.

Overweight

Being overweight and obese can lead to major diseases like infertility and cancers. Excess weight can lead to abnormal hormone production which eventually leads to infertility.

Being underweight

Managing a healthy weight is important to avoid any health condition. Women who have an eating disorder like anorexia become underweight. As a result, there is no nutrition supplied for the body required and they become underweight.

Treatments of Infertility

Intrauterine insemination

Intrauterine insemination is an artificial method of fertilisation. The sperm will be directly placed with the help of a catheter directly in the uterus of the woman. The sperm is placed at a time when a new egg is released waiting to fertilise with sperm. This artificial method of insemination will help in conception.

This method is will be helpful for couples experiencing infertility due to medical problems and unexplained infertility.

In vitro fertilization

In vitro fertilisation (IVF) involves a series of procedures to help in conception. In vitro fertilisation involves collecting the matured egg and fusing the sperm in a lab environment as natural methods did not help in conception.

After the in vitro fertilisation, the fertilised egg is directly placed in the uterus of the woman. In vitro fertilisation takes about three weeks to complete. IVF treatment can be done with the couple’s own egg and sperm or they can use a donor’s egg and sperm.

IVF has been considered the most effective treatment and the rate of conception depend on age and other factors. The IVF treatment is expensive, time-consuming and can be invasive. IVF is mainly helpful for couples with unexplained infertility and genetic problems.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection is an in vitro fertilisation. The sperm is directly injected into the cytoplasm of the egg in a laboratory. As a result, the egg will be fertilised and an embryo will be formed.

Intracytoplasmic sperm injection is used in the case of male infertility. When there is low sperm count, poor sperm quality, inability to ejaculate and backward flow of semen the intracytoplasmic sperm injection method is used and the estimated success rate is 50-80%.

Assisted reproductive technology ART

Assisted reproductive technology (ART) is a fertility treatment that involves both the egg and sperm fertilised in a laboratory. The eggs are removed from the ovaries and then made to fertilise and the embryo is formed. The embryo is then placed in the uterus of the woman.

The assisted reproductive technology will help to freeze the embryo and even frozen eggs and sperms can be used during the treatment. The common complication of assisted reproductive technology is multiple pregnancies.

Preventions of Infertility

Eat a well-balanced diet and maintain a healthy weight

Consume foods that are rich in nutrition. Avoid junk foods as they can add empty calories and there will be an increase in your weight.

Don’t smoke

Smoking and second-hand smoking can increase the risk of infertility. Tobacco contains toxins that can cause harmful effects. Continuous smoking can lead to infertility.

Get treated for STDs

The sexually transmitted disease will have no or fewer symptoms. If sexually transmitted diseases are left untreated they can result in permanent infertility. Always practise safe sex and use a condom to avoid any transmission of sexually transmitted diseases.

Limit exposure to toxins

Limit yourself from getting exposed to tobacco smoke. Second-hand smoking has a considerable effect on your health.

Stay physically active

Make it a to exercise daily. Less physical activity or no physical can make you obese and result in infertility.

When to see a Doctor

When you have unusual symptoms like painful urination and inflammation in your private area consult your doctor.

If you recently had any unprotected sex go for a medical check-up immediately. The risk of sexually transmitted diseases like gonorrhoea and AIDS can be avoided by early diagnosis.

Conclusion

Infertility is not a major problem and with the enormous growth of medical facilities, infertility can be treated. Consume foods like nuts and raisins, which will benefit your reproductive system and keep your healthy

FAQ

1. What is the best treatment for infertility?

Some of the suggested treatments for infertility are artificial insemination, in vitro fertilisation, surrogacy and fertility drugs.

2. How can I test my fertility at home?

Fertility can be tested with a blood test. A urine test will help you get the levels of luteinizing hormone and oestrogen levels.

3. What increases the chances of being infertile?

Smoking, overconsumption of alcohol, anabolic steroids and certain medication can increase the risk of infertility.

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