You may be diagnosed with fertility issues if you have been trying to get pregnant or maintain pregnancy for the past year without medical assistance. Most people with fertility issues have to deal with the physical and psychological aspects of this diagnosis. This is the first stigma individuals and couples encounter in their reproductive quest. It is important to learn that they are not alone.
According to the Center of Disease Control, about 6.1 million of women (10 % of US population) have difficulties and getting and staying pregnant. About 9% of men also have experienced fertility problems.
How to couples learn about their infertility issues?
Generally speaking, 40 – 60 % of couples who are younger than 30-years-old are able to impregnate in the first 3 months of trying. However, some couples keep trying to get pregnant and they either can’t conceive or will conceive (will additional help or not), but has difficulties holding onto the pregnancy for many different reasons.
After one year of having unprotected sex, about 12 to 15% of couples are unable to conceive.
After 2 years, 10% of couples may had become pregnant, but still do not have a live-born baby.
It is known that fertility is connected to aging. The older you are, the less fertile you become. However, this curve is much steeper for women than man. Male fertility declines gradually, as for women, it declines significantly after age 35. Women in their 30’s are about as half as fertile as they were in their early twenties.
There are also environmental and lifestyle factors that affects fertility in both men and women, such as:
a. Physical – weight, high blood pressure
b. Psychological stress
c. Substance/medication use/abuse
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There are many different physical reasons why infertility happens. From body chemistry (hormones), to genetics, to body malformation, to environmental factors - there are many different issues that causes infertility alone or compounded. Some of the factors are listed below.
CAUSES OF INFERTILITY
Although modern medicine has advanced tremendously and is been able to identify its causes, there are still many unexplained cases of infertility. About 30% in females and 50% in males’ infertility cases are considered unexplained (idiopathic). This does not prevent, however, to engage in fertility treatment to improve chances of conception.
There are many single and multiple factors that can cause infertility in both man and women.
Although there is a bias that fertility problem is due to the women’s health issues, studies has found that 40% of times, the cause of infertility lies on the male side. The most common causes of male infertility are:
- Hormones – Hormone imbalances play a major role in sperm production. They can have low count (oligospermia) or complete absence of sperm (azoospermia). Fifteen percent of infertile men have azoospermia / are sterile.
- Testicles issues – Blockages can also cause azoospermia. An enlarged vein in the testicle (varicocele) can cause oligospermia.
- Sperm formation – There are many condition that can cause sperm malformation, badly shaped, or low sperm counts, such as:
o Injury to the testicle – sports injury, cancer
o Chromosome defects / disorder (Klinefelter Syndrome)
o Thyroid issues
o Infections – Mumps, gonorrhea, chlamydia
o Prolactin Hormone overproduction
o Androgen Hormone (testosterone) insensitivity
o Testicles has not descended
o Varicocele – large vein, increases temperature, affects sperm production. Forty percent of infertile men has this condition.
- Sperm Transportation – after producing a healthy amount of healthy sperm, males’ body need to make sure that their sperm will reach the egg. There are some issue that prevents the healthy sperm to reach final destination, such as:
o Slow sperm – it may die before reaching the egg
o Thick seminal fluid – may prevent sperm to move properly/fast.
o Blockage on testicle – sperm cannot move from testicle to penis (10 to 20% of infertile males).
o Cystic fibrosis on testicles – cannot carry sperm out of testicles
o Erectile dysfunction – difficulties having intercourse
o Retrograde ejaculation – When the sperm moves up to the bladder, instead out to the penis.
Females have more causes of infertility than males, due to the complexity of their reproductive system and the failures that can happen in many different stages of conception and baby development.
- Failure to Ovulate – The most common cause of infertility issues.
Forty percent of women with infertility issues may suffer from ovulation issues, that could be caused by:
a. Aging – Low number of eggs
b. Hormone issues – due to thyroid diseases
- Problems in the Menstrual Cycle – All, short, long, heavy, light, irregular menstrual cycles can lead to issues of fertility.
- Immature Egg – Obesity, PCOS, or lack of protein can cause eggs to not mature, which can cause being released at the wrong time, or not even reaching the fallopian tubes, thus not being able to fertilize.
- Body Structural Problems – The women body need to have an ideal condition to reproduce. Irregularities in the women body may cause issues of fertility.
a. Fallopian tubes – eggs need to move from ovary to uterus through fallopian tubes. If it’s blocked, the egg cannot move, therefore, the sperm cannot reach to fertilize it.
b. Uterus – there must be a “perfect” smooth wall for the tiny fertilized egg to attach (implant) and develop. Unfortunate, there are many issues that could cause the uterus walls to be not so perfect, such as:
a. Endometriosis – 25 to 50% of women with fertility issue have endometriosis, and 30 to 40% of them are infertile.
b. Fibroids – from not known causes, these growths can change the shape of the uterus, the position of the cervix, block the Fallopian tubes, and interfere with the blood flow to the uterus. Five to ten percent of infertile women suffers from it.
c. Primary ovarian insufficiency (POI) – Women with POI have issues of stopping producing hormones and eggs at a young age; however, 5-10% of them still get pregnant spontaneously.
d. Polycystic ovary syndrome (PCOS) – 5-10% of all American women have PCOS due to genetics /environmental factors that produces high levels of androgens. These hormones interfere with the development of ovarian follicles and release of eggs during ovulation period.
e. Scars from previous injuries, infections, or surgery – even from use of IUD’s
f. Unusual uterus shape
- Infections – In both men and women, infections caused by virus such as gonorrhea, chlamydia, and human papillomavirus (HPV) can cause issues as scarring, blocking fallopian tubes, or reduce amount of cervical mucus.
- Autoimmune disorders – In order to get pregnant, women autoimmune system slows down, so the body will not attack the sperm and/or the fertilized egg or the reproductive organs. However, when a men or women have autoimmune disorders, such as lupus, Hashimoto’s, some types of thyroiditis, or rheumatoid arthritis, and take medication to treat their disorders, the medication may cause inflammation in the uterus and placenta, causing infertility.
There are many different types of treatment for man and women. Fortunately, 85-90% of the infertility cases can be treated by medication or surgeries. The most important factor is to try to identify the cause of infertility and treat it, if possible. If the cause cannot be identified, then doctors may choose try/error types of treatment, starting with the less invasive types first, such as hormonal replacement, medication, then surgery. Half of times, woman end up pregnant with fertility treatments. A successful treatment will depend on many factors, such as woman’s age, underlying factor, history of previous pregnancies, history of fertility issues, and partner’s fertility issues.
After a couple of years trying to conceive, the couple may start looking into options to help with their fertility. The modern medicine has been advancing and finding many (expensive and time consuming) ways to help produce a fertilized egg and implant it successfully. Assisted Reproductive Technology (ART) offer complex procedures as an option to people who have tried other unsuccessful treatment options. Although ART is a viable option (3% of the infertile people uses this venue), it is not guaranteed to work. Only 39% of women under 35 years will conceive, and that number is exponentially lower for women ages 37-40 (21%) or ages 41-42 (11% only). Only 1.7% of all births in the US are accounted through ART.
There are many ways to assist in achieving pregnancy/parenthood, here are some:
- Fertility drugs (Clomiphene, Gonadotropins)
- Surgery - Genetic defects – to open fallopian tubes, remove fibroids, endometriosis, PCOS
- (IUI) Intrauterine insemination– Placing sperm directly into the uterus
- (IVF) In vitro fertilization– Eggs removed from ovaries, then combined with sperm in vitro and transferred onto uterus. 30% success rate.
- (ICSI) Intracytoplasmic sperm injection - Take sperm from inside testicle, then to IVF
- (GIFT) Gamete intrafallopian transfer - Eggs and sperm mixed in a lab then, inject into fallopian tube
- (ZIFT) Zygote intrafallopian transfer - Eggs and sperm mixed in a lab then, inject only fertilized eggs fallopian tube
- Donor sperm, eggs, and embryos. Using other men sperm and /or women egg
- Surrogacy – Other women carry the pregnancy for you, with your egg/sperm or somebody else
However, there are many considerations to take while considering what type of treatment will be ideal for trying getting pregnant:
- How many trials
- How much hormone to take
- How many eggs to implant
- Fertility Preservation - Freezing sperm/egg/embryo for the future, or surgery to protect male/female organs from:
o Receiving radiation (before puberty)
o Exposed to toxic chemicals in the workplace / military duty
o Uterine fibroids
o Autoimmune diseases
o Genetic diseases
o Optional delaying having children
- How many fertilized eggs to keep
o Voluntary abortion
o Forced abortion
Dealing with fertility issues at any stage can cause emotional distress. Some of these feelings might dissipate after a little while, and other deep feelings may stay for many decades. Often there are a range of feelings that combined leads to psychological disorders, such as depression, anxiety, trauma, etc. for both women and men.
INTENSE FEELINGS OF:
Not wanting to be alone – or see anyone
Not wanting to talk
Triggered by other people’s pregnancy/babies
Triggered by dates