Frequently Asked Questions
Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.
No, infertility is not always a woman's problem. In about one-third of cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors
Infertility in men is most often caused by: Problems making sperm -- producing too few sperm or none at all Problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
Infertility in men is most often caused by:
- Problems making sperm -- producing too few sperm or none at all.
- Problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly.
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:
- Environmental toxins, including pesticides and lead,
- Smoking cigarettes,
- Health problems,
- Radiation treatment and chemotherapy for cancer,
Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Less common causes of fertility problems in women include:
- Blocked fallopian tubes due to pelvic inflammatory disease,
- Endometriosis, or surgery for an ectopic pregnancy,
- Physical problems with the uterus Uterine fibroids.
Many things can affect a woman's ability to have a baby. These include:
- Poor diet
- Athletic training
- Being overweight or underweight
- Tobacco smoking
- Sexually transmitted diseases
- Health problems that cause hormonal changes
More and more women are delaying parenthood until their 30s and 40s. So age is an increasingly common cause of fertility problems. Aging decreases a woman's chances of having a baby in the following ways:
- The ability of a woman's ovaries to release eggs ready for fertilization declines with age,
- The health of a woman's eggs declines with age,
- As a woman ages she is more likely to have health problems that can interfere with fertility,
- As a women ages, her risk of having a miscarriage increases.
Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed.
In some cases, women should talk to their doctors sooner. Women in their 30s who've been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.
Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:
- Irregular periods or no menstrual periods
- Very painful periods Endometriosis
- Pelvic inflammatory disease
- More than one miscarriage
No matter how old you are, it's always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
- Test results
- How long the couple has been trying to get pregnant
- The age of both the man and woman
- The overall health of the partners
- Preference of the partners
Doctors often treat infertility in men in the following ways:
Sexual problems: If the man is impotent or has problems with premature ejaculation, doctors can help him address these issues. Behavioral therapy and/or medicines can be used in these cases. Too few sperm: If the man produces too few sperm, sometimes surgery can correct this problem. In other cases, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count. Various fertility drugs are often used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the risks, benefits, and side effects.
Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery. Intrauterine insemination (IUI) is another type of treatment for infertility. IUI is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
- Mild male factor infertility
- Women who have problems with their cervical mucus
- Couples with unexplained infertility
Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory, and putting the embryos back into a woman's body.
There are several treatments under assisted reproduction such as intra uterine insimination (IUI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), intra-cytoplasmic sperm injection (ICSI), testicular sperm aspiration (TESA ).
IUI – intra-uterine insemination
Intra-uterine insemination - also known as artificial insemination is a relatively straightforward technique involving the insemination of a prepared sperm sample directly into the uterus at the time of ovulation.
IVF – in vitro fertilization
IVF is a technique involving the fertilisation of eggs by sperm outside the body. The term literally means 'fertilization in glass' - hence the commonly used description 'test-tube baby' technique.
GIFT- gamete intrafallopian transfer
GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm and immediately placing them into a fallopian tube. One of the main differences between this procedure and the in vitro fertilization (IVF is that the fertilization process takes place inside the fallopian tube rather than in a laboratory. However, healthy tubes are necessary for GIFT to work.
ICSI – intra-cytoplasmic sperm injection
ICSI -the microsurgical fertilisation technique of ICSI is currently the most advanced technique available for the treatment of male infertility. It is used in conjunction with IVF and involves an extremely precise microscopic surgical procedure on an egg to assist fertilisation. ICSI can be used in cases where the man produced only a very small number of sperm which are incapable of penetrating the barriers surrounding the egg unassisted. This is usually because the sperm have extremely poor movement or no movement at all. ICSI is also mandatory when sperm is directly retrieved from the testes. The preparation to ICSI procedure is the same like for IVF procedure.
TESA – testicular sperm aspiration
Total azoospermia (total absence of sperm in the ejaculate) can be due either to a blockage, absence of the vas deferens or to a failure of the testes to produce spermatozoa. The degree of this failure can be variable. Testicular Biopsy involves taking one or several small samples of the testes - either for analysis, or for the recovery of sperm in the most severe cases of azoospermia. These operations are done as day cases under general or local anaesthesia with or without intravenous sedation. However, the sperm that is collected is not able to fertilise the egg in the natural way and ICSI is always necessary