While it's generally believed that one in every six couples will have a hard time conceiving, some experts believe the number is much higher. And that there are many causes.
While "unexplained infertility" does account for a few cases, there are a number of health issues that can impact on the fertility of a couple. These problems can be due to male or female factors, which are equally responsible, or a combination of both. Here are some of the areas which can cause delays in conception, but it's important to keep in mind that no matter what the problem, overall, the vast majority of couples can and will conceive if not naturally, then with assistance.
Blocked tubes. Your partner's sperm must make its way from his testes through a whole series of tubes, large and small, before being ejaculated during sex. In a small proportion of cases of male infertility, blockages or abscesses of these tubes are the cause of infertility. The blockages may be present at birth or can be the result of a sexually transmitted infection or previous vasectomy. Either way, they will result in low numbers of sperm (oligospermia) or no sperm at all (azoospermia) in the semen. If a testicular biopsy reveals this problem, a couple may have to consider artificial insemination or in-vitro fertilisation (IVF).
Low sperm count. While tube blockages account for some cases of low sperm count, there can be other causes: exposure to toxins, chronic disease or considerable heating of the testes are just a few. Low sperm count doesn't necessarily mean infertility it may just mean that it takes longer than average to conceive. However, when there are fewer sperm, they are more likely to be abnormal and have poor motility.
Abnormal sperm. A healthy sperm has a long, whipping tail that helps it swim through the female reproductive system. Sperm with poor motility may swim poorly or not move at all. Abnormally shaped sperm may also have problems penetrating the surface of the egg. Analysis of the semen is necessary to check for abnormalities.
Testicular problems. If your partner's testes are small, enlarged or completely absent, it may contribute to his infertility. While it's very rare for testes to be totally absent, sometimes they fail to descend. Small testes may be a result of a past illness, an injury or earlier developmental problems. Enlargement of the testes can cause problems as this condition raises the testicular temperature, which in turn inhibits sperm production this can be a symptom of testicular cancer, which is the cause of infertility in about one in 400 men. If a testicle is enlarged, has an irregular surface or feels painful, see a GP immediately.
Hormonal problems. Healthy sperm creation relies on the pituitary gland producing testes-stimulating hormones and follicle-stimulating hormones. If your partner's pituitary gland isn't releasing enough of these hormones, the production of his sperm will be impaired.
Underactive or overactive functioning of the thyroid and adrenal glands can have a negative impact on sperm, too. To rule this out as a contributing factor in your infertility, your partner would need to have blood tests to assess his hormone levels. If this is thought to be part of the problem, there's effective treatment. But remember that taking hormone preparations, including testosterone, will hinder rather than help fertility.
Defective genetic material. Research has shown that men who have fertility problems have a high number of sperm with broken or damaged DNA, the molecular chain that makes up a gene. This kind of DNA damage will make it harder for you to conceive a baby with him.
Making lifestyle changes, such as an improvement in diet and a reduction of exposure to toxins, can help improve DNA quality. Another treatment is taking Menevit, a vitamin supplement that's been shown to improve the DNA quality of a man's sperm, which was created by Dr Kelton Tremellen, deputy medical director at IVF clinic Repromed in Adelaide.
Functional problems. The most significant functional problem that can cause or contribute to male infertility is impotence, the inability to get or maintain an erection. Some men may even have difficulty with erections under the pressure of trying to make a baby. There are many treatments for impotence, some good, some outright dodgy, so it's best for the man to shelve the embarrassment and speak with his GP if this is a problem.
Immune reaction. Sometimes the immune system can produce antibodies that attack his sperm as if it were foreign. The antibodies may hinder the activity of sperm, therefore reducing the sperm's ability to latch onto the egg. This problem is usually due to an injury or infection and can be detected by the presence of white blood cells in his semen.
Other causes. There are many other conditions, including genetic diseases or chromosomal abnormalities, which can cause male infertility. Speaking to your doctor is the first step in finding out why you're having trouble but bear in mind that you may be part of the one in 10 couples that have idiopathic infertility, where it's not possible to find a cause for the infertility. But even without a known cause, you can get reproductive help.
Ovulation problems. An ovulation problem generally refers to issues with releasing a mature egg from your ovaries once a month. If you're not ovulating, or ovulating erratically, this can be due to hormonal problems, a disturbance in your pituitary gland, chronic illness or being either excessively underweight or overweight/obese.
If your menstrual cycle is all over the place or even a complete no-show, this may be a sign that ovulation is a problem for you. A blood test to measure progesterone levels about a week before your period is due can determine if you're ovulating or not. Treatment to stimulate ovulation usually involves fertility drugs, such as Clomid; if this is successful, you can often go on to conceive normally. A common combination, however, is having Clomid and also artificial insemination to boost your conception chances.
Blocked tubes. If you have blocked or damaged fallopian tubes, this could either stop your partner's sperm reaching your egg or stop the fertilised egg making its way to your uterus. Tube damage can be the result of pelvic inflammatory disease, previous surgery or ectopic pregnancy, but you generally won't show any symptoms. A surgical procedure called a laparoscopy can be used to check for obstructions. Treatment may involve surgery to open the tubes or IVF if surgery is unsuccessful or the tubes are too badly damaged to repair.
Polycystic ovarian syndrome. When you ovulate, your ovaries produce small follicles. Generally, one follicle ripens to release an egg, but if you suffer from polycystic ovarian syndrome (PCOS) the follicles fail to ripen, forming little cysts on your ovary instead. The results of this are unpredictable ovulation patterns and irregular periods, making pregnancy more difficult. Other signs you may have PCOS are excessive hair growth, acne and otherwise unexplained weight gain. This condition affects up to 10 percent of women experiencing fertility problems and treatment involves lifestyle changes such as improved diet and exercise. Fertility drugs or IVF may be options for PCOS sufferers.
Poor quality eggs. In some cases, ovulation may be occurring but the eggs may be damaged or have chromosomal abnormalities, so pregnancy can't be sustained. While there are no outward signs to look for in terms of egg quality, your age is a significant factor. You're born with your entire egg supply of around two million immature eggs and only around 400 will ever mature; as you age, the quality of your eggs diminishes. You can determine how many good quality eggs you still have within your ovaries thanks to an innovation called the Egg Timer, created by Dr Tremellen. It involves a combination of a blood test and pelvic ultrasounds.
Endometriosis. Endometriosis is a condition in which cells from the lining of your uterus (the endometrium) grow in other parts of your pelvic area, such as the fallopian tubes, ovaries and the abdomen, which can in turn lead to fertility problems. Some endometriosis sufferers have no symptoms, while others have painful periods or pelvic pain. Endometriosis is often treated with surgery to remove the abnormal tissue or unblock tubes. Fertility drugs or IVF may also be options.
Uterus problems. Besides endometriosis, there are other uterine problems that affect fertility. Some women suffer from fibroids (non-malignant tumours inside the uterus) or polyps (small growths in the endometrium). Both conditions can impede a fertilised egg being implanted in the uterus. Treatment options include the use of drugs to shrink the fibroids or surgical removal. Once the problem is treated, it may be possible for you to conceive in the normal way.
Cervix problems. Your cervix has an opening that allows sperm to pass into your uterus and fallopian tubes. Around the time of ovulation, your cervical mucous increases and is thin and slippery so sperm can swim through it if your cervical mucous remains thick, however, it can stop sperm from getting through. Some women may also have an immune reaction to sperm; it's thought that about two percent of women produce antibodies that kill sperm cells. Besides failing to fall pregnant, you won't show any symptoms of having this reaction. If you suffer from these problems, your treatment may include intrauterine insemination (IUI) or IVF.
Idiopathic causes. If you don't suffer from any of these conditions and your partner has been given the all-clear in his fertility tests, the infertility may
be due to some other factor or you may be one of the 10 percent of couples investigated for infertility in which no cause can be found. This is called unexplained or idiopathic infertility. Since there's no definite cause, there's some chance that you'll conceive sooner or later without treatment. It may take a while, though, so you might want to look into reproductive assistance, such as IVF.
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