What is infertility?
Infertility is defined by the American Society for Reproductive Medicine (ASRM) as a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors, including the following, as listed by the ASRM:
- production of healthy sperm by the man
- production of healthy eggs by the woman
- unblocked fallopian tubes that allow the sperm to reach the egg
- the sperm’s ability to fertilize the egg
- the ability of the fertilized egg to become implanted in the uterus
- adequate embryo quality
What causes infertility?
Many different factors and problems can cause infertility, including problems in the female reproductive system, the male reproductive system, or a combination of the two. The following are some of the conditions or factors that are associated with infertility:
- ovulation dysfunction
With this condition, the woman’s reproductive system does not produce the proper amounts of hormones necessary to develop, mature, and release a healthy egg.
- anatomical problems Abnormal development or function of the female anatomy can prevent the egg and the sperm from meeting. The most common anatomical problem is blockage of the fallopian tubes. Other anatomical problems may include the presence of pelvic scar tissue from previous surgeries or infections.
- endometriosis Endometriosis is a condition in which the tissue that lines the uterus develops outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down, resulting in internal bleeding which can cause scar tissue to form and affect reproductive organ function.
- o birth defects Abnormal development and function of reproductive organs resulting from birth defects can affect fertility. One of the most common reproductive system birth defects occurs following a woman’s exposure to DES (diethylstilbestrol) taken by her mother during pregnancy. In years past, DES was given to women at risk for pregnancy loss. Fetal DES exposure often causes abnormal development of the uterus and cervix.
- infection Pelvic inflammatory disease (PID) is caused by a type of bacteria such as gonorrhea and chlamydia. PID can affect the uterus, fallopian tubes, and/or the ovaries. It can lead to pelvic adhesions and scar tissue that develops between internal organs, causing ongoing pelvic pain and the possibility of an ectopic pregnancy (the fertilized egg becomes implanted outside the uterus).
- immunological problems A problem with a woman’s immune system can lead to pregnancy loss. Antibodies (immune or protective proteins) in a woman’s system can fail to recognize a pregnancy, or there may be an abnormal immune response to the pregnancy. Women can also develop antisperm antibodies which attack and destroy sperm.
- low or absent sperm production Without proper numbers of healthy sperm, the chance of fertilization is decreased.
- abnormal sperm function Sperm must have proper motility and the ability to penetrate the egg.
- varicocele This is a condition in which varicose veins develop around the testes. It is a very common cause of male factor infertility and is usually treatable and reversible with surgery.
- lifestyle Use of recreational drugs (i.e., marijuana, cocaine), heavy alcohol use, cigarette smoking, certain medications, and excessive heat to the genital area (as in hot tubs) can affect sperm quality and function.
- hormonal disorders Improper male hormone or endocrine function can affect sperm production and fertilization ability.
- chromosomal defects Certain chromosomal abnormalities are associated with male infertility.
- birth defects Abnormalities in a man’s reproductive system can occur during fetal development. Some birth defects are due to a man’s exposure to DES (diethylstilbestrol) taken by his mother during pregnancy.
- immunological problems A man may have antisperm antibodies (immune or protective proteins) which attack and destroy sperm
Treatment for infertility:
Specific treatment for infertility will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disorder
- cause of the disorder
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disorder
- your opinion or preference
Once a diagnosis is made, the specialist can work with you to determine the course of treatment. According to the ASRM, most infertility cases (85 to 90 percent) are treated with conventional therapies, such as drug treatment or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many options to offer an infertile couple.