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What is Infertility?

In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist – an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss – 2 or more spontaneous miscarriages.

What causes infertility in men?

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Conditions that can contribute to abnormal semen analyses include –

  • Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
  • Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
  • Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
  • Environmental toxins including exposure to pesticides and lead.

What causes infertility in women?

  • Age: The ability to conceive starts to fall around the age of 32 years.
  • Smoking: Smoking significantly increases the risk of infertility in both men and women, and it may undermine the effects of fertility treatment. Smoking during pregnancy increases the chance of pregnancy loss. Passive smoking has also been linked to lower fertility.
  • Alcohol: Any amount of alcohol consumption can affect the chances of conceiving.
  • Being obese or overweight: This can increase the risk of infertility in women as well as men.
  • Eating disorders: If an eating disorder leads to serious weight loss, fertility problems may arise.
  • Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. Women who are at risk, including those on a vegan diet, should ask the doctor about supplements.
  • Exercise: Both too much and too little exercise can lead to fertility problems.
  • Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a woman and cause inflammation in a man’s scrotum. Some other STIs may also cause infertility.
  • Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and solvents have been linked to fertility problems in both men and women. A mouse study has suggested that ingredients in some household detergents may reduce fertility.
  • Mental stress: This may affect female ovulation and male sperm production and can lead to reduced sexual activity.

What Are the Treatments for Infertility?

In men, fertility is treated with:

  • Surgery, if the cause is a varicocele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
  • Antibiotics to treat infections in the reproductive organs.
  • Medications and counseling to treat problems with erections or ejaculation.
  • Hormone treatments if the problem is a low or high level of certain hormones.

In women, infertility is treated with:

  • Fertility drugs and hormones to help the woman ovulate or restore levels of hormones
  • Surgery to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes

Infertility in men and women can also be treated with assisted reproductive technology, or ART. There are several types of ART:

  • IUI (intrauterine insemination): Sperm is collected and the placed directly inside the woman’s uterus while she is ovulating.
  • IVF (in vitro fertilization): The sperm and egg are collected and brought together in a lab. The fertilized egg grows for 3 to 5 days days. Then the embryo is placed in the woman’s uterus.
  • GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer): The sperm and egg are collected, brought together in a lab, and quickly placed in a Fallopian tube. With GIFT, the sperm and eggs are placed into the Fallopian tube. With ZIFT, a fertilized egg is placed into the tube at 24 hours.

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