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The general understanding of the word “INFERTILITY” is that despite regular sexual intercourse, without any form of contraception, a couple is unable to get pregnancy.
Infertility is most commonly caused by problems with ovulation – main cause of infertility in women is anovulation (absence of ovulation). Any dysfunction in menstrual cycles – irregular periods, amenorrhea, oligomenorrhea, menstrual bleedings, light periods, uterine bleedings, etc. Endometriosis - when endometrial tissue grows outside the uterus (on tubes, ovaries, other organs) – this can cause infertility because the new growths form adhesions (sticky areas of tissue) or cysts (fluid-filled sacs) that can block or distort the pelvis.
Cushing’s syndrome, a rare hormonal disease that can prevent ovaries from releasing an egg. Egg quality – sometimes even after ovulation women cannot conceive because of eggs’ poor quality. Neuroleptic medicines are antipsychotic medicines that are often used to treat psychosis.
Spironolactone is a medicine that is used to treat heart failure, and can cause irregular periods and infertility. Illegal drugs such as marijuana and cocaine can seriously affect your fertility, making ovulation (the monthly cycle where an egg is released from the ovaries) more difficult.
Low sperm counts, abnormal sperm morphology (shape), and low sperm motility are usually asymptomatic conditions to most males. Some simple abnormalities may be improved by reducing stress, reducing heat to the genitals (eg. Abnormal semen (the fluid containing sperm that is ejaculated during sex) is the most common cause of male infertility. Many cases of abnormal semen are unexplained, but there are several factors that can affect semen and sperm. Varicocele also could be a reason for male infertility - this happens when the veins on a man's testicle(s) are too large. Some men experience ejaculation problems that can make it difficult for them to ejaculate. Hypogonadism is an abnormally low level of testosterone, the male sex hormone that is involved in making sperm.
Sulfasalazine, an anti-inflammatory medicine used to treat conditions such as Crohn's disease (inflammation of the intestine) and rheumatoid arthritis (painful swelling of the joints). Anabolic steroids, which are often used illegally to build muscle and improve athletic performance. In approximately 10-20% of couples both partners have a problem which is contributing to infertility. As well as factors that specifically affect a man or a woman’s fertility, there are also a number of factors that can affect fertility in both men and women. As well as affecting your general and long-term health, smoking can also adversely affect fertility. Exposure to certain pesticides, metals, and solvents can affect fertility in both men and women. Infertility is stressful and frustrating problem affecting millions of people all over the world.
Hypogonadism refers to a condition of diminished function of the reproductive glands (gonads) - testicles and ovaries (from Greek  hypo- means under, less than, too little, deficient).
Some infections may impair fertility in several particular ways: infections can interfere with sperm production, it can alter sperm properties (sperm count, shape and motility) or it may result in scarring that blocks the passage of sperm. At an early period of fetal life the development of the testicles takes place in the abdomen.
In some cases, for some unknown reasons, immune system cells called antibodies are produced in the semen. In addition to the above-mentioned causes, male infertility can also be associated to such medical conditions as liver or kidney failure and chronic anaemia. The good news is that most cases of male infertility can be resolved either by treating the problem or using fertility treatments. About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. Of men diagnosed with male infertility, 10% to 15% will have azoospermia (a complete lack of sperm). Most of the time, basic semen analysis is all that’s needed to diagnosis male infertility. If a couple doesn’t get pregnant after a year of unprotected intercourse, both the man and woman should be evaluated. Unlike female infertility (where irregular periods may hint at a problem), obvious symptoms are not common with male infertility.
In some cases, hormonal problems may be suspected if a man has abnormal hair growth, low libido, or other indications of sexual dysfunction.
Risk factors for male infertility include obesity, age (over 40 — yes, men also have biological clocks), current or previous infection of an STD, smoking, or excessive drinking. In cases where the above treatments are unsuccessful, or when the cause for male infertility is unknown or untreatable, IUI treatment or IVF treatment may be suggested. IUI treatment, where the sperm are transferred into the uterus via the cervix, is commonly used in cases of low sperm count or quality. In some cases, your doctor may recommend a procedure known as intracytoplasmic sperm injection (ICSI). If sperm does not appear in the ejaculate, but they are being produced, the doctor may be able to take sperm directly from the testicles, or from the bladder (in cases of retrograde ejaculation), and use that sperm to fertilize an egg in the lab.
However, if none of these options are available, or if they are unsuccessful, your doctor may talk to you about using a sperm donor, or considering adoption, to help build your family. According to the World Health Organization (WHO) , approximately 8-10% of couples are facing some kind of infertility problem, however the true scale of the problem is unknown simply because many couples never visit their doctor about the issue; and if they do the issue of when to seek medical advice varies from one couple to the next, with this being especially true when it comes to diagnosing male infertility.
While this clearly shows that time is an important factor in the search for a baby, the truth is that as with everything else, fertility varies within the population, so some people can expect to get pregnant sooner than others. There are many things that need to go right for a pregnancy to be successful, which is explained in the “female fertility” section of this guide, and a number of things that can prevent it. There is quite a lot of variation in explaining the causes of infertility in couples, but one study on a national scale found 14.1% of couples affected.
The main cause of infertility for couples was a combination of problems with both of the partners (39%), issues solely with the woman accounted for 33% of the infertility, with male problems explaining 20% of the infertility. There are a wide range of tests and techniques to assess a person’s fertility and their ability to have a baby, and these are specific to male or female form and function.

For men the standard way to measure their fertility is with a semen sample, which reveals the number of viable sperm he produces. For women the range of tests and investigations is much wider and comprehensive than it is for men, and the standard investigations includes such things as checking the structures of the female reproductive organs, the levels of different hormones levels in the blood, and whether an egg is released at ovulation.
Further tests include investigation of immune state, chromosomal issues and ovarian reserve. The experience of infertility is different to nearly every other branch of medicine; normally a person visits their doctor in response to obvious signs or symptoms, (which they usually want to get rid of), while it’s the absence of a medical issue (pregnancy) that makes couples see a fertility specialist.
Infertility means not being able to get pregnant after one year of trying OR six months, if a woman is 35 or older.
If you have had unprotected regular sex for more than 12 months (or six months - if you are over 35) and are still not pregnant, you should start thinking about possible causes for your infertility. These make it difficult for an egg to be released and become implanted into the womb. Cervical infertility involves inability of the sperm to pass through the cervix due to damage of the cervix.
Successful pregnancy depends upon the sperm being able to reach the egg and the fertilized egg reaching the womb, to implant safely in the wall of the uterus. Long-term use, or a high dosage, of NSAIDs, such as ibuprofen or aspirin, can make it more difficult for you to conceive. The medicines that are used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means that your ovaries will no longer be able to function properly. Unfortunately women fertility is decreasing after 35 - the biggest decrease in fertility begins during the mid thirties.
In fact, about 20 percent of women in the United States now have their first child after age 35. If you have decreased sperm mobility, it will be harder for your sperm to swim to the egg. Sometimes sperm can be an abnormal shape, making it harder for them to move and fertilize an egg.
This could be due to a tumor, taking illegal drugs or Kallman’s syndrome (a rare disorder that is caused by a faulty gene). Sulfasalazine can decrease the number of sperm, but its effects are only temporary and your sperm count should return to normal when you stop taking it. Long-term use, or abuse, of anabolic steroids can reduce your sperm count and your sperm mobility. The medicines that are used in chemotherapy can sometimes severely reduce your production of sperm. Some herbal remedies, such as root extracts of Tripterygium wilfordii (a Chinese herb), can affect the production of sperm or reduce the size of your testicles. Guidelines published by the National Institute of Clinical Excellence (NICE) state that if men follow the Department of Health’s recommendations of drinking no more than three to four units of alcohol a day, it is unlikely that their fertility will be affected. This simply means that the commonly performed tests to diagnose the cause of infertility are all normal and do not define the reason for infertility. For example, chlamydia can damage the fallopian tubes in women, and cause swelling and tenderness of the scrotum (the pouch containing the testes) in men.
Stress can reduce libido (sex drive) which in turn can reduce the frequency of sexual intercourse.
It is defined as the inability of a couple to conceive a child after one year of regular, unprotected sexual intercourse. Infections possibly leading to infertility include chlamydiosis, gonorrhoea, ureaplasma and trichomoniasis.
Usually they descend into the scrotum (the sac that normally contains testicles) until birth or by the age of one year.
It is defined as a condition when the entire or a part of semen enters into the bladder instead of emerging out through urethra (a tube that passes the penis and carries semen and urine) (Fig. Moreover, cancer treatment (chemotherapy and radiation) and the use of certain medications (opiate pain medications and some hormones) may also lead to this disorder. When this is not the case, a couple facing male infertility may turn to a sperm donor or adoption to help build their family. This relatively simple test involves the man providing a semen sample for a lab to evaluate.
IVF treatment may be suggested if IUI is not successful or appropriate, or if female infertility is a contributing problem. Overall humans have an average monthly pregnancy rate of only 20%, which puts us among the least fertile of mammals; by comparison baboons have fertility rates of around 80% , and rabbits usually have fertility rates above 90% . The cause of a couple’s infertility may be due to factors that affect either one or other of the partners, or can be due to an incompatibility issue that exists between the two of them. Specialists in these fields of reproduction are gynecologists for women and andrologists for men.
This is often the end of the investigation route for most men, although there are a number of further tests that can be applied to his sperm, as well as blood tests, all of which is covered in the “male fertility” section. Inevitably this results in very different expectations for patients compared to their ‘normal medical experience’. In order for you to see this page as it is meant to appear, we ask that you please re-enable your Javascript! Women who can get pregnant but are unable to stay pregnant may also be infertile (see miscarriage).
For women who are 35, 95% will get pregnant after three years of having regular unprotected sex.
Some cases are associated with a swollen varicose vein in the scrotum, called a varicocele. Short term illnesses, significant stressful periods, and some medications may temporarily affect sperm counts.
This may occur if you have, or have had in the past, any of the following - an infection of your testicles, testicular cancer, testicular surgery, a congenital defect (a problem with your testicles that you were born with), undescended testicles (when one or both of your testicles has not descended into the scrotum), trauma (injury) to your testicles and a lump in your testicles. This could be due to a blockage in one of the tiny tubes that make up your reproductive system, which may have been caused by an infection or surgery (Sterilisation). Being underweight can also have an impact on fertility, particularly for women, who will not ovulate if they are severely underweight. Approximately one third of infertility cases are associated with health problems of a male partner. Testosterone is the hormone that is crucial to development during puberty and masculine growth.

However, due to various causes (hormonal, anatomical or other) one or both testicles fail to reach the scrotum and remain in the abdomen. Furthermore, lifestyle factors such as drug abuse, smoking, obesity, prolonged bicycling, excessive physical activity and emotional stress, may also interfere with conceiving a baby. The lab uses this sample to measure the amount of semen and the number of sperm, and to evaluate sperm shape and movement.
For more information on how to increase your chances of getting pregnant please read the “Get pregnant” section.
The study predicted that one woman in seven will consult a doctor due to infertility during her reproductive life.
Possible causes of infertility range from clear problems with the physical structure of the reproductive organs to chromosomal issues that require specialist services. When this is added to the inevitable ebb and flow of emotions that comes each menstrual cycle with the desire to be pregnant, it puts different pressures on people compared to any other medical experience.
If there are blockages in the fallopian tubes, the chances of a successful pregnancy will be greatly impeded. There are plenty of factors that may cause male infertility including hormonal disturbances, testicular damage, infections, genetics and environmental factors. The man that has retrograde ejaculation can still reach orgasm but he ejaculates very little or even no semen. This reduces male fertility because sperm have to be mobile enough in order to reach and fertilize the egg. Finally, some environmental factors including pesticides, herbicides, phthalates, organochlorines, heavy metals and radiation may damage testicle function and sperm health.
For a percentage of couples, despite having extensive testing this search for an answer is never answered, and they are left with a diagnosis of ‘unexplained infertility’.
Blocked tubes could be a main reason for female infertility due to pelvic inflammatory disease (PID), sexually transmitted infections (STDs) such as clamydia, infection from the previous birth and blockages from previous surgery (following ectopic pregnancy or sterilisation procedures). However, in more than 30 percent of cases, the cause of male infertility remains unclear (Fig.
But most often, if you are under 35 years of age and have not conceived after a regular and contraceptive free intercourse for a year, you are generally considered eligible for treatment by an Infertility Specialist. As a result, the testicle lacks oxygen and nutrients and its temperature becomes higher than usual.
Also, it may occur due to natural aging processes, obesity, excessive physical activity and stress. This could be a result of a surgery of the prostate or bladder, the use of some medications (antidepressants, antipsychotics and alpha blockers). These factors damage sperm cells and significantly lower levels of testosterone (the most important sex hormone in men). We do not to wish overwhelm you with medical terminologies and concepts, sometimes ignorance is a bliss.Following chart shows the gender bifurcation of the infertility causes.
Hormone tests rarely required.TreatmentLifestyle changes (Exercise and Weight Loss)Induction of Ovulation, Follicular Monitoring, IUIIf ovulation does not occur with oral medicines, injections (Gonadotropins) may be required.
In severe cases which do not respond to medicines, Laparoscopic Surgery is recommended.If Ovarian Hyperstimulation occurs,  IUI can be converted into IVFLikelihood of Pregnancy Post TreatmentVery Good. Pregnancy itself is a good cure for the disease and therefore most of the symptoms like painful periods, pelvic pain etc are relieved after pregnancy.Diminishing Ovarian ReserveDefinitionWhen the number of eggs in the ovary are reduced.
Low AMH and EstradiolTreatmentAttain pregnancy as soon as possible, may require ovarian stimulation with IUI to increase chances of conception per cycle.
Supplementation  with DHEA therapy is recommended for expected poor respondersLikelihood of Pregnancy Post TreatmentVery good till treatment is carried out in a timely manner. When done, absence of secretory changes in endometrium indicate anovulationUltrasonography: Best indicator nowadays. In some cases, laparoscopic correction may not be possible due to extent of damage to the tubes.
In all such cases, IVF is the treatment of choice. Likelihood of Pregnancy Post If minor adhesions are corrected surgically, chances of spontaneous conception are very good. If significant loss of tubal function exists, Good Pregnancy rates with IVF.Male InfertilityIn approximately 40 percent of infertile couples, the male partner is the sole cause and in 20 percent a contributing cause, of infertility.
Despite the male factor being at least partly responsible in about 60 percent of infertile couples, infertility evaluations have traditionally focused on women, because women tend to seek Gynaecological care and because men often are reluctant to seek advice.A variety of disorders ranging from hormonal disturbances to physical problems, to psychological problems can cause male infertility.
Although many treatment options are now available, in many cases treatment will not work.In many instances, male infertility is caused by testicular damage resulting in an inability of the testicle to produce sperm. Besides testicular damage, the main causes of male infertility are low sperm production and poor sperm quality.Causes of Male InfertilityMale factor infertility refers to the failure of a couple to achieve conception due to problems specifically related to the man’s sperm, seminal fluid, or reproductive organs. A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman’s vagina. Tests for male infertility attempt to determine whether any of these processes are impaired.General physical examination. This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications, and sexual habits.Semen analysis.
Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for quantity, colour, and presence of infections or blood.
A blood test to determine the level of testosterone and other male hormones is common.Doppler evaluation of the testis and Transrectal Ultrasound. However, a woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.Simple lifestyle changes, like abstaining from alcohol, tobacco, and illicit drugs can improve male fertility.
A healthy diet, sufficient (not excessive) exercise, and proper amounts of vitamin B12, vitamin C, and zinc also improve fertility.General sexual problemsAddressing impotence or premature ejaculation can improve fertility.
Treatment for these problems often is primarily with medication or behavioural approaches, though mechanical and surgical treatment is sometimes effective.

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