Infertility refers to an inability to conceive after having regular unprotected sex for a year. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term.
Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. Fortunately, there are many safe and effective therapies for overcoming infertility. These treatments significantly improve the chances of becoming pregnant.
There can be many possible causes for infertility, and in some cases no cause may be identified. Infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include:
Ovulation disorders: Problems with ovulation are the most common cause of infertility in women. Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs. Older women have a higher risk of producing eggs that are damaged or develop genetic abnormalities and thus cannot sustain a pregnancy.
Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumours in the uterus can all contribute to infertility.
Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
Other medical conditions: Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, Cushing’s disease, sickle cell disease, kidney disease or diabetes, can affect a woman’s fertility. Also genetic abnormalities can make conception and pregnancy less likely.
Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases. Some medications used in Chemotherapy can result in ovarian failure, and in some cases this side effect may be permanent.
The risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.
When to see the Doctor
In general, you may consider seeing a doctor about infertility if you and your partner have been trying regularly to conceive for at least one year. You may consider being seen earlier if you’re a woman and:
- You’re age 35 to 40 and have been trying to conceive for six months or longer
- You’re over age 40
- You menstruate irregularly or not at all
- You have known fertility problems
- You’ve been diagnosed with endometriosis or pelvic inflammatory disease
- You’ve had more than one miscarriage
- You’ve had prior cancer treatment
Treatment for infertility depends on the individual, and factors such as the cause of infertility, your age and your partner’s age, and many personal preferences. Some causes of infertility can’t be corrected. However, a woman may still become pregnant with assisted reproductive technology, like IVF. Your doctor will suggest a treatment suitable for your problem.
If infertility is caused due to ovarian disorders, fertility drugs may be recommended to stimulate and regulate ovulation. You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs.
Problems with the uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.
In vitro fertilization (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilizing them with sperm outside the body in a lab. Once fertilized, the embryos are implanted into the uterus within three to five days.
Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg), assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a non-functional uterus.