The A-Z of infertility

Summary
Infertility means not being able to get pregnant after trying for a year. If a woman keeps having miscarriages it is also called infertility. About 15% of South African couples experience fertility problems.

Alternative names
Sterility

What is infertility?

Infertility is the term used for women who are unable to get pregnant and for men who are unable to impregnate a woman after trying for at least one year. Usually 60% of couples will be pregnant after trying for 1 year.

Women who are able to get pregnant, but who cannot carry a pregnancy to term may also be considered infertile.

What causes infertility?
Causes of infertility include a wide range of physical as well as emotional factors. There are five main causes of infertility:

• Male factors, such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count
• Blocked fallopian tubes
• Endometriosis
• Ovulation dysfunction, or failure to ovulate
• Fibroids

A woman's peak fertility occurs in her early 20s. When a woman is older than 35 (and particularly 40), her likelihood of getting pregnant drops to less than 10% per month.

Other factors that increase the risk of infertility are:

• Multiple sexual partners
• Sexually transmitted diseases
• History of pelvic inflammatory disease
• History of orchitis or epididymitis (men)
• Mumps (men)
• Varicocele (men)
• Eating disorders (women)
• Anovulatory menstrual cycles
• Endometriosis
• Defects of the uterus (myomas) or cervical obstruction
• Long-term (chronic) disease such as diabetes

What are the symptoms of infertility?
The inability to fall pregnant after trying to conceive for at least one year.

How is infertility diagnosed?
A complete history and physical examination of both partners is essential.

Tests may include:

• Semen analysis to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape (morphology)
• Measuring serum progesterone (a blood test) on day 22 to 24 of cycle
• Serum hormonal levels (blood tests) for either or both partners
• Hysterosalpingography - an X-ray procedure that looks at the route of sperm from the cervix through the uterus and fallopian tubes
• Laparoscopy to allow direct viewing of the pelvic cavity
• Hysteroscopy to allow a look into the uterus
• Pelvic exam (ultrasound) for the woman to determine if there are cysts or any other problems

How is infertility treated?
There are a variety of ways to treat infertility, including:

• Medication
• Surgery
• Intrauterine insemination/artificial insemination
• Assisted reproductive technology (ART), such as in vitro fertilization

Most often health care providers treat infertility with medication or surgical repair of the reproductive organs.In addition, lifestyle changes may also help alleviate infertility, such as reducing stress, diet modification, discontinuing the use of drugs, alcohol and smoking, or reducing the temperature around the testes.

What is the prognosis?
A cause can be determined in about 85 to 90 percent of infertile couples.

Appropriate therapy (not including advanced techniques such as in vitro fertilization) allows pregnancy to occur in 50 -60% of previously infertile couples.

Without any treatment intervention, 15 -20% of couples previously diagnosed as infertile will eventually become pregnant.

When to call your doctor?

• When the woman isn't having regular periods. This could mean that she is not ovulating.
• When the woman has lost a baby (miscarriage) three or more times.
• When the man has had three or more miscarriages with another partner.
• When the woman has had pelvic infections or the man has had mumps or a prostate infection.
• When the woman or man could not get pregnant with another partner.

How infertility can be prevented?
Most types of male infertility aren't preventable. However, avoiding drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility, may help. High temperatures can also affect sperm production and motility. Although this effect is usually temporary, it is better to avoid hot tubs and steam baths.

A couple can increase their chances of becoming pregnant in a number of ways:

• Exercise moderately. Regular exercise is important, but if you're exercising so intensely that your periods are infrequent or absent, your fertility may be impaired.
• Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.
• Avoid alcohol, tobacco and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don't drink alcohol or smoke tobacco. Avoid illegal drugs such as marijuana and cocaine.
• Limit caffeine. Women trying to get pregnant may want to limit caffeine intake to no more than 250 milligrams of caffeine a day (one or two cups of coffee).
• Limit medication. The use of both prescription and non-prescription drugs can decrease your chance of getting pregnant or keeping a pregnancy. Talk with your doctor about any medications you take regularly.
• Both partners should try to maintain a healthy lifestyle.