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Symptoms and causes

Infertility-causes, diagnosis and treatments

Infertility is described as the inability to conceive in spite of trying to have a baby for more than a year. Accepting the fact that one has challenges in having their own child is a difficult but critical step. According to latest studies, 20% of the couples across the world are affected by infertility. Thankfully there are effective and safe remedies to improve the chances of getting pregnant. Infertility is not confined to women alone. Latest trends show that male causes for infertility is increasing dramatically. 

General indications of infertility

Not getting pregnant even after 12 months of unprotected intercourse is the main symptom of infertility and sometimes there may be no other symptoms at all!

In some cases, infertile women may have irregular or no menstrual periods. In men, normal sexual functions can be present but still their fertility levels may be compromised. The most common causes are genetics, bad lifestyle and hormones.

Risk factors that lead to infertility in both men and women

  • Obesity. A sedentary lifestyle and being overweight is a major cause for infertility
  • Age. A woman’s fertility gradually declines with age, especially in her mid-30s. In older women, age adversely affects both the number and quality of eggs. Men over age 40 may be less fertile than younger men. In older men, the sperm count, motility and morphology may be normal, but the DFI (DNA Fragmentation Index) may be abnormal. This can cause infertility.
  • Smoking and Alcohol consumption.  Addictions such as alcohol , tobacco or marijuana can cause infertility and impair the benefit of fertility treatment too. Women who smoke have higher chances of miscarriages. In men, substance abuse increases the risk of erectile dysfunction along with reduction in sperm count. It’s best to avoid these addictions if one is planning to become pregnant as it increases the risk of birth defects, and may contribute to infertility.
  • STD. Sexually transmitted diseases can seriously hamper fertility, so it’s best to be safe.
  • Anorexia. Those with eating disorders and those who follow a severely low calorie or restrictive diet may find it difficult to conceive
  • Physical exertion. Ovulation and sperm production problems have also been associated due to insufficient exercise and over exercise
  • Other Medications. Contra-indications (side effects) of other medicines prescribed for other ailments like psychiatric drugs, drugs prescribed for some specific surgeries etc. may be causing infertility

Female infertility

Female infertility

Women need to consult a fertility specialist if they have been trying regularly to conceive for at least one year, but have been unsuccessful. For conception to occur, ovulation, fertilization and embryonic development needs to happen properly and smoothly. If there is an issue in any of these 3 crucial steps, the woman will not be able to conceive. In some women, the reasons for such challenges could be due to genetics. For others, it may have developed due to external conditions like environment, lifestyle or medication.

It is not a surprise that in about one-third of cases, the issue is male related. Female infertility is attributed to about one-third of the cases and the rest can be due to problems with both the male and female. Sometimes the cause cannot be identified at all, and such cases are termed as unexplained infertility.

When do women need to talk to a fertility specialist?

  • Irregular periods and / or painful periods 
  • Have been unsuccessful in conceiving for six months or longer and aged 35 to 40
  • Diagnosed with Endometriosis or PCOS
  • Has had multiple miscarriages
  • Undergone treatment for cancer

Below are some causes for female infertility.

  • Ovulation disorders could be affecting the release of good quality eggs. Some common causes are PCOS or polycystic ovary syndrome, Hyperthyroidism or hypothyroidism, excess production of Prolactin (a hormone that stimulates breast milk production) etc. These can affect menstrual cycle and cause infertility. In some cases, over exercising, eating disorders, injury or tumors and lifestyle can be causing infertility too
  • Blockage or damage of Fallopian tubes, uterine or cervical abnormalities, polyps or fibroids in the uterus or the anatomy and shape of the uterus may cause infertility
  • Sexually transmitted infections, endometriosis or adhesions, can result in a woman not getting pregnant. Scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery can be a cause too
  • Endometriosis is a condition where endometrial tissue grows outside of the uterus. This can affect the function of the ovaries, uterus and Fallopian tubes and cause conception problems
  • Early menopause is a condition when the ovaries stop working and the woman will not menstruate before the age of 40. Although the cause is often unknown, certain factors associated with early menopause are immune system disorders, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment etc.
  • Delayed puberty or the absence of menstruation, poorly controlled diabetes and some autoimmune diseases such as lupus can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy

Infertility tests for women

The 3 high level functions for a successful pregnancy are proper ovulation, effective fertilization and smooth embryonic development. Tests for female infertility attempt to determine whether any of these processes are impaired. Below are some tests we recommend at GarbhaGudi based on your condition. Not everyone requires every test though.

  • Ovulation Testing. A set of blood tests are done to measure levels of various to determine whether you’re ovulating properly. 
  • Ovarian reserve testing. This test can evaluate a woman’s remaining supply of eggs and the quality of the eggs. This is a combination of a few hormone tests in conjunction with an ultrasound scan on the second day after periods. 
  • Hysteroscopy. In this minimally invasive procedure, a fiber-optic ‘telescope’ is passed through the vagina into the uterus to examine and check for physiological abnormalities
  • Additional hormone tests. A set of additional hormone tests are done to evaluate levels of various hormones that play a role in conception and in continuation of pregnancy. These include estradiol (a form of estrogen), follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Progestrone, Prolactin, Thyroid (TSH)  as well as some pituitary hormones that control reproductive processes.
  • Imaging tests. Uterus evaluation, including vaginal ultrasound, hysterosalpingogram (HSG), sonohysterogram and hysteroscopy, can determine if fibroids, polyps or adhesions may have compromised the uterine cavity’s ability to attain and maintain a healthy pregnancy
  • Biopsy. A sample of the cells lining the uterus after ovulation occurs can show if there are signs of inflammation, changes in the endometrium (due to ovulation), and a change in hormones
  • Laparoscopy. A laparoscopy may help identify endometriosis, scarring, blockages or irregularities of the Fallopian tubes and problems with the ovaries and / or uterus
  • Genetic testing. Sometimes DNA abnormalities may be present and in such rare cases, tests to evaluate the quality of the egg may be advised by us.

Not everyone needs to undergo all or even many of these tests though. It is decided by the clinician based on the woman’s health condition and clinical history.

Male infertility

Male infertility, like female infertility, can be diagnosed only after a set of blood investigations, semen analysis test and ultrasound scans (if needed). Male infertility is more common in environments with high levels of environmental pollution, including water contaminants, pesticides and herbicides. It is not a surprise that among all cases of infertility, more than 50% of the cases have some form of male contribution. Sometimes, it can be exclusively due to male factors and in some cases the cause can be due to issues in both the male and the female.

When do men need to talk to a fertility specialist?

  • When you and your partner have been unsuccessful in achieving pregnancy even after trying for more than 12 months
  • Have a history of testicular, prostate or sexual problems
  • Undergone cancer treatment
  • Swelling in the scrotum or if the testis is small in size
  • People in the family have had infertility problems
  • Lack of libido or excessive pain during sexual intercourse

Below are some causes for male infertility.

  • Abnormal semen parameters like low count (oligospermia) or may not be present at all (azoospermia), or lower motility or bad morphology
  • Varicocele veins in the scrotum is a common reason for infertility in men. They harm sperm growth by blocking proper blood drainage which makes the testicles too warm for producing sperm
  • Premature ejaculation, certain genetic diseases (cystic fibrosis); structural problems (such as a blockage in the testicle; or damage or injury to the reproductive organs)
  • Antibodies that attack sperm. This may be because of injury, surgery or infections, which keep sperm from moving and working normally
  • Prolonged exposure to pesticides, chemicals and radiation
  • Extreme lifestyle factors like smoking, alcohol or narcotic use
  • Frequent exposure to heat, such as in hot steam and saunas or in the work environment (furnaces, drivers etc.)

Infertility tests for men

When the testicles produce enough healthy sperm, and when that sperm is ejaculated effectively into the woman’s vagina, the sperms can travel to the egg and the chances of conception is rather high.  We offer many investigations and scans for men in an attempt to determine the cause for infertility. Some of them are:

  • Semen analysis. A male’s medical history and physical examination along with a semen analysis is a mandatory step to determine male infertility. Certain parameters like count, motility, shape of and many more attributes of the sperm can be evaluated.
  • Biopsy. In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility. This can also be used to retrieve sperm for IVF.
  • Blood tests. A blood test can reveal a lot about a man’s hormone levels of testosterone and other male hormones. These hormones play a vital role in the production of sperms and its ability to fertilize the egg
  • Genetic testing. Sometimes DNA abnormalities may be present and in such rare cases, other tests to evaluate the quality of the sperm may be advised by us
  • Scans. Imaging studies such as bone scrotal ultrasound scan or a Vasography may be performed to determine other problems

Tips to improve fertility

improve fertility

While prevention is best, in some cases it may not be possible or practical. Several strategies can be adopted to increase chances of pregnancy.

  • Regular intercourse several times around the time of ovulation ensures highest pregnancy rate. Being sexually active from 5 days before ovulation  until a couple of days after ovulation, improves the chances of pregnancy. For most women with menstrual cycles of 28 – 30 days, ovulation occurs around the middle of the cycle – roughly between the 13th and 16th day after the start of periods.
  • Avoiding drugs, tobacco use and excessive alcohol consumption
  • Prolonged exposure to higher temperatures can affect sperm production and motility. So it’s best to avoid hot tubs and steam baths
  • Exposure to industrial or environmental toxins can impact sperm production. It’s also best to limit medications that may impact fertility, both prescription and non-prescription drugs
  • Moderate and regular exercise is shown to improve sperm quality and increase the chances for achieving a pregnancy
  • Stress plays a vital role. Being able to de-stress effectively can help a lot. Having engaging hobbies, practicing yoga, pranayama, meditation etc. can help relieve stress, which in turn helps improve the chances of pregnancy.

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