Infertility is a disease of the reproductive system that inhibits a couple’s ability to have a baby. Infertility approximately affects men and women equally without discrimination, and for this reason both partners should actively participate in the diagnosis and treatment process. Infertility is not uncommon and you are not alone.
One in every six couples of childbearing age have fertility challenges. There is a female problem in 35% of the cases, a male problem in 35% of the cases, and a combined problem of the couple in 20% of cases. In 10% of cases, the problem is “unexplained," meaning that all testing yielded normal results.
Causes of Infertility
Common female conditions associated with infertility include polycystic ovary syndrome (PCOS), endometriosis, uterine abnormalities, and hormonal imbalances that prevent regular ovulation (egg release) each month.
Common male conditions associated with infertility include abnormal or low sperm production, hormonal imbalances, varicoceles, defects of tubules that transport sperm, and ejaculation issues.
When should I seek help for infertility?
Conventional medical advice is to seek treatment if you have been trying to conceive for at least one year of unprotected intercourse in couples where the woman is under the age of 35. Because a woman’s fertility declines naturally as she gets older, couples should consider seeking medical help after six months of trying when the female partner is over the age of 35.
However, if the male partner has a known or suspected low sperm count or the female partner is over 30 years of age, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods, then we suggest you seek treatment sooner.
Why is age so important?
A woman’s fertility peaks in her mid-20’s, begins to decline around 27 and drops off more steeply after age 35. A woman’s fertility is measured by her ability to achieve a pregnancy on a given month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place. There is a lot going on but of particular interest are the two main hormones controlling the development and release of the egg each month. These are FSH (follicle stimulating hormone) and LH (lutenizing hormone).
A rising FSH level is linked to a decreasing egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally. There may even be chromosomal abnormalities occurring within the egg itself, which is why amniocentesis is recommended for pregnant women over 35.
To illustrate this point, the natural pregnancy rate for women >30 is 20-30% per month but by age 40 the likelihood of conception occurring drops to > 5% per month.
The quality of a man’s sperm decreases with age. As a man ages, it takes longer for his partner to get pregnant. There’s also an increased risk of not conceiving at all.
Whatever the age of the mother, the risk of miscarriage is higher if the father is over 45. The children of older fathers are at greater risk of autism, mental health problems and learning difficulties. For couples having IVF, the risk of not having a baby is more than five times higher if the male partner is aged 41 or older. The risk of miscarriage is twice as high for women whose male partner is aged over 45 than for those whose partners are under 25.
Basic fertility treatments include interventions aimed at correcting the identified cause for infertility, as well as treatments to enhance fertility in couples with unexplained infertility. Fertility medications can improve the timing and quality of ovulation, as well as correct luteal phase deficiencies. Some women may need minimally invasive surgeries, such as laparoscopy to remove scar tissue, endometriosis, endometrial polyps, a uterine septum, or open a blocked fallopian tube.
Intrauterine insemination (IUI) includes washing and concentrating the sperm, which also may activate sperm function and placing sperm past the cervical mucous directly into the uterus, improving the probability of more sperm reaching the egg. IUI in combination with fertility medication use (both oral and injectable), ultrasound monitoring, and HCG injection are used to trigger ovulation, increasing the chances of the egg and sperm interacting. Almost 60% of couples are able to conceive with these types of treatments suggesting that the majority of couples are able to conceive with basic treatment interventions.
Of the remaining 40% of couples who do not conceive with basic treatments or in whom basic treatments would not be appropriate, the vast majority are able to become parents through the in vitro fertilization (IVF). IVF involves the use of injectable fertility medications to increase the number of eggs produced, removing the eggs directly from the ovaries under sedation and uniting the eggs and sperm in a petri dish outside of the body. Fertilization and cell division are confirmed before the embryos are replaced directly into the uterus.