Infertility or sterility is the inability to conceive after 1 year of unprotected intercourse. It affects around 10-15% of reproductive-aged couples. As a woman’s age increases, the incidence of infertility also increases.
- What is the etiology of infertility?
- Female Factor Infertility
- Male Factor Infertility
- What are the factors affecting both sexes?
- Tests for men
- Tests for women
- Treatment for men
- Treatment for women
- Vitamins that boost fertility:
- Natural ways to help optimize fertility
What is the etiology of infertility?
Reproduction requires the interaction of the male and female reproductive tracts, which involves the release of a normal preovulatory oocyte, the production of adequate spermatozoa, the normal transport of the gametes to the ampullary portion of the fallopian tube, and the subsequent transport of the cleaving embryo into the endometrial cavity for implantation and development. The factors involve in infertility can be male, female and both.
Female Factor Infertility
Female factor infertility is divided into several categories: cervical or uterine, ovarian, tubal, and other.
- Cervical: Stenosis or abnormalities of the mucus-sperm interaction can cause the female factor infertility.
- Uterine: Congenital or acquired defects; may affect endometrium or myometrium; may be related to primary infertility or with premature delivery and pregnancy wastage.
- Ovarian: Alteration in the frequency and duration of the menstrual cycle. Inability to ovulate is the most general sterility issue.
- Tubal: Abnormalities or damage to the fallopian tube; may be congenital or acquired
- Peritoneal: It can be anatomic defects or physiologic dysfunctions (eg, adhesions, infection, adnexal masses)
Male Factor Infertility
Male factor infertility can be pre-testicular, testicular, and post-testicular causes.
- Pretesticular: It includes congenital or acquired diseases of the hypothalamus, pituitary, or peripheral organs that alter the hypothalamic-pituitary axis.
- Testicular: The testicular causes of infertility can be genetic or nongenetic. Klinefelter syndrome is the most common chromosomal cause of male infertility and results in primary testicular failure. Nongenetic causes include drugs, infections, trauma, radiation, and varicoceles.
- Posttesticular: Congenital or acquired factors that disrupt normal transport of sperm through the ductal system
What are the factors affecting both sexes?
Environmental/occupational factors: there is also the impact of environmental factors on fertility.
Toxic effects related to tobacco, alcohol, or other drugs: smoking, chronic alcoholism and some drugs have been associated with infertility in both males and females. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men. Alcohol use: for women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.
Excessive exercise: even though, compulsive exercise is deleterious, especially for long-distance runners. In males, exercise has been associated with oligospermia.
Inadequate diet associated with extreme weight loss or gain: obesity may be associated with oligomenorrhea and anovulation. In men, obesity has been associated with decreased sperm quality.
Advanced age: can also be a main etiology of infertility. A woman’s fertility drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.
Laboratory, imaging, and/or surgical evaluation
Tests for men
In fertility, it requires that the testicles produce enough healthy sperm and that the sperm is effectively ejaculated into the woman’s vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are abnormal. You may have a general physical exam, including examination of your genitals, including:
Semen analysis: The analysis assesses sperm concentration, morphology, motility, and viability. The World Health Organization’s semen analysis parameters are as follows:
- Volume – 2-5 mL
- pH level – 7.2-7.8
- Sperm concentration – 20 million or greater
- Motility – 50%, forward progression
- Morphology – Normal sperm (>4%)
- White blood cells – Fewer than 1 million cells/µL
Hormone testing: it determines the level of testosterone and other male hormones.
Genetic testing: it may be done to mark whether there’s a genetic defect causing infertility.
Testicular biopsy: a testicular biopsy may be performed to identify abnormalities contributing to infertility and to retrieve sperm to use with assisted reproductive techniques, such as IVF.
Imaging: In some cases, imaging studies such as a brain MRI, transrectal or scrotal ultrasound, bone mineral density scan, or a test of the vas deferens (vasography) may be performed.
Tests for women
Due to the MedScape, laboratory, radiologic, and/or surgical assessment for the female includes the following areas:
Cervical: Postcoital test or Sims-Huhner test; no longer routine in standard infertility workup.
Uterine and endometrial: Hysterosalpingogram, most frequently used a diagnostic tool to assess endometrial cavity; pelvic ultrasonograms; saline infusion sonograms; pelvic magnetic resonance imaging; hysteroscopy; endometrial biopsy.
Tubal and peritoneal: Hysterosalpingogram and laparoscopy.
Ovarian: Progesterone levels and/or serial ultrasonography to assess ovulation; follicle-stimulating hormone and estradiol levels (or antral follicle counts, ovarian volume, inhibin B level, and antimüllerian hormone level) to assess ovarian reserve; clomiphene citrate challenge test for dynamic ovarian reserve testing.
Treatment of infertility
Treatment or assisted reproductive technologies of female and/or male factors affecting fertility may include surgical intervention, medical treatment, or both.
Treatment for men
- Altering lifestyle factors: this can improve chances of conceiving, including discontinuing select medications, improving frequency and timing of intercourse, establishing regular exercise, reducing/eliminating harmful substances, and optimizing other factors that may otherwise impair fertility.
- Medications: some medications may improve a man’s sperm for achieving a successful pregnancy. These medicines may increase testicular function, including sperm production and quality.
- Surgery: in certain conditions, surgery may be performed to be able to reverse a sperm blockage and restore fertility. In other cases, surgically repairing a varicocele may improve overall chances for pregnancy.
- Sperm retrieval: These techniques obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid. They may also be used in cases where assisted reproductive techniques are planned and sperm counts are low or otherwise abnormal.
Treatment for women
- Stimulating ovulation with fertility drugs: this is the basic treatment for women who are infertile due to ovulation disorders. The medications regulate or induce ovulation.
- Intrauterine insemination (IUI): during IUI, healthy sperm is placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
- Surgery to restore fertility: uterine issues such as endometrial polyps, an intrauterine scar tissue or uterine septum can be treated with hysteroscopic surgery.
Alternative treatment plans
According to the MedScape, if pregnancy has not been established within a reasonable time, consider further evaluation and/or an alternative treatment plan, such as the use of donor oocyte, sperm, or embryo, or the use of a gestational carrier or surrogate mother.
Donor oocyte: Patients with poor ovarian reserve have a rather low chance of overcoming infertility; yet, some of them, along with patients with premature menopause and patients with physiologic menopause, are interested in having a child. The only alternative for these patients is adoption or an oocyte donation.
Donor sperm: Men who cannot produce sperm or women who do not have a partner and wish to become pregnant may opt for donor sperm.
Donor embryo: Donor embryo is one option the patient can choose; therefore, those embryos can be donated according to the IVF program policy.
Gestational carriers: Patients who were unable to have a biological child because of the absence of the uterus (congenital or acquired) or patients in whom a pregnancy is contraindicated are now able to have a biological child by the use of a gestational carrier or surrogate mother.
Vitamins that boost fertility:
Folate: folate is well known as an important vitamin in early pregnancy to prevent complications, but it is most beneficial when taken for several months before the pregnancy as well as during. It helps cell division and promotes ovulation. It is recommended to take up to 5,000 micrograms a day and women hoping to get pregnant should take at least 2,000 micrograms a day. It is important to note that many people have trouble using the synthetic form, folic acid, and do better with folate or
Vitamin D: vitamin D deficiency is very common etiology, and can be very detrimental to overall health. Recent studies have proved the link of inadequate vitamin D with miscarriage and infertility.
B-Vitamins: b-vitamins deficiency is common in anyone who consumes large amounts of processed foods, grains or sugars. Optimizing b vitamin levels can increase luteinizing hormone and follicle stimulating hormone to improve fertility.
Vitamin C: vitamin C is good for both male and female infertility. Take for at least 2,000 mg a day pre-conception.
Selenium: it helps protect the body from free radicals and protects sperm and egg. In addition, it is known to help cell division and might prevent miscarriage.
Zinc: this mineral is very important for cell division including sperm production and ovulation. It is even better when taken in combination with b-vitamins.
Natural ways to help optimize fertility
Improve your lifestyle
The common lifestyle factors, which can help optimize fertility, are:
- Having enough sleep: even though, sleep plays an important role in production of many hormones. Studies have shown that women with low serotonin and melatonin levels have a shorter luteal phase and consequently have a lower chance of pregnancy. Haven’t enough sleep also decrease the body’s ability to properly regulate adrenaline, insulin and cortisol, which make conception very difficult. Make sleep a priority and get enough to feel rested, not just awake. This may mean taking a nap during the day or going to bed a few hours earlier. A completely dark sleep environment may also help melatonin levels and sleep.
- Get the suitable amount of exercise: getting enough exercise is useful for fertility, but too much can have the opposite effect. Most women do well with several hours of recreational activity a week (walking, fun sports, or swimming) and a few weight training sessions. Too much moderate/intensive exercise will keep the body from ovulation if done regularly. While weight loss can greatly help fertility, having too little body fat (below 15-18%) can make the body go into an anovulatory state.
- Reduce stress: it is said that it is not that so easy as saying, especially for anyone who is going through the emotions of fertility difficulties. You’ve probably been told that if you can relax, you will get pregnant. While this is certainly not true for everyone, reducing stress is a good idea. Often, the ideas above will help with many of the physical causes of stress, leaving you more time torelax.
- Reduce exposure to harsh chemicals: this should be a book in itself, but most women notice improvement from limiting exposure to household chemicals, conventional cosmetic and beauty products and plastic water bottles.
- For some women, nutrition alone can be enough to support the body for fertility. Of course, it is very necessary to continue these things when pregnant, and not stop giving yourself proper nutrition, which is even more vital for the growth of an unborn child.
- Add enough protein: especially from grass-fed meats, eggs, and nuts to your diet. This is also important during pregnancy as adequate protein can help minimize the risk of certain pregnancy complications.
- Eat more healthy vegetables: such as; green leafy varieties like lettuce, cauliflower, kale, collard, chard, cabbage, spinach, broccoli, Brussels sprouts and similar veggies.
- Drink enough water: as keeping hydrated is important for so many functions within the body, including fertility.
- Take more nutrient dense carbohydrates: from some vegetables, fruits and starchy sources like sweet potatoes and squash.
- Include more healthy fats in your diet: like olives and olive oil, coconuts, coconut oil, butter, grass-fed meats, avocado, eggs, and nuts.
- Get insulin levels under control: even if you don’t have Type II diabetes, a high carbohydrate diet often goes hand-in-hand with some level of insulin resistance. Optimizing dietary factors with the above methods will help make your body more sensitive to insulin, which will help production of other hormones and proper function of the body.
Important sources: Mayo clinic, WebMD, MedScape, medicalnewstoday.