Fertility Basics – Treating Infertility as the Medical Condition That It Is

Understanding Infertility

In simple terms, infertility is a disease of the male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse. Unlike the many myths circulating around us, infertility does not only affect women, and it can occur due to male, female, and even unexplained factors.

Primary vs Secondary Infertility

Infertility is not “one size fits all”. There are multiple types of the condition, including primary and secondary.

• Primary infertility: This refers to the inability to achieve pregnancy, even though you have been engaging in regular unprotected intercourse for 12 months. The above limit drops to 6 months after the age of 35.
• Secondary infertility: When a couple has given birth once and is unable to conceive again. Secondary infertility might be overlooked by many, as they may assume that having a successful pregnancy once before could not mean infertility.

What Causes Infertility?

Since infertility affects both men and women, the causes may differ between men and women.

In women, causes of infertility include:

• Ovulatory problems (PCOS, premature ovarian insufficiency) resulting in irregular egg release.
• Fallopian tube blockage or damage due to Pelvic Inflammatory Disease (PID) or infection, or following surgical procedures.
• Endometriosis (where tissue similar to the lining of the uterus develops outside the uterus).
• Uterine abnormalities (fibroids, polyps, abnormalities of the uterine shape).
• Thyroid and other hormonal problems.
• Ageing (reduction in egg number and quality).

In men, causes of infertility include:

• Low or no sperm count (oligospermia or azoospermia)
• Low or abnormal motility (movement) or morphology (shape) of sperms
• Blockage in the reproductive system that prevents sperm from being released
• Hormonal imbalances affecting sperm production
• Varicocele: A dilated network of veins of the scrotum associated with poor sperm quality.
• Genetic issues that affect sperm production

Men and women have some common risk factors too, such as smoking, too much alcohol, obesity, very low weight, environmental toxins, STIs, etc. It is also interesting to note that in some cases, infertility might be there for no reason at all. This is called unexplained infertility.

Common Causes of Infertility at a Glance

Diagnosing Infertility

The first step to diagnosing infertility is always a thorough fertility evaluation for both men and women. This can include:

• Transvaginal ultrasound: To examine the ovaries and uterus and check for abnormalities like polyps, fibroids, and cysts. It also helps count antral follicles to assess ovarian reserve.
• Hysterosalpingogram (HSG): An X-ray procedure using a special dye to visualise the inside of the uterus and fallopian tubes, checking for blockages, polyps, or fibroids
• Laparoscopy or hysteroscopy: A minimally invasive procedure that directly investigates the pelvis and uterine cavity.
• Genetic testing: Done in the case of severe sperm abnormalities to determine chromosomal causes.
• Semen analysis: This procedure will be performed to assess sperm morphology and motility.
• Scrotal Ultrasound: to determine if there is a varicocele or any other anomaly in the reproductive system.
• Hormonal analysis: FSH, LH, AMH, oestrogen, progesterone, prolactin, testosterone, and thyroid hormones.

Treatment Pathways for Infertility

Infertility affects more people than one can think, but luckily, there are many paths an individual or a couple can take if they are looking to start a family.

• Surgeries: For structural causes of infertility, such as blocked fallopian tubes, uterine fibroids or polyps, endometriosis, or varicocele in men. Surgery may improve natural fertility in many cases.
• Ovulation Induction: Utilises precise medical techniques in which the ovaries are stimulated to produce eggs. This may be necessary in cases of women with ovulation problems, such as polycystic ovary syndrome (PCOS).
• Intrauterine Insemination: Sperm that has been processed is directly inserted into the uterus during the ovulation period with the aim of increasing the chances of conception.
• In vitro fertilisation (IVF): Stimulates the ovaries to produce more eggs, retrieves the eggs, fertilises the eggs with sperm in a laboratory and transfers the embryo(s) back into the uterus.
• Intracytoplasmic sperm injection (ICSI): Used alongside IVF. A single sperm is injected directly into a single egg. It is particularly successful for severe male factor infertility.

When Should You Seek Help?

Instead of sitting around and waiting for things to resolve on their own, visit a healthcare provider if you are unable to conceive after 12 months (if under 35 years of age) or 6 months (35-39 years of age) or are trying. For those over 40, it is best to seek an evaluation immediately. It is advisable that you seek professional guidance from your doctor in case there is any existing medical condition which can affect your ability to conceive, for example, PCOS.

Conclusion

Infertility is one of the most common medical conditions of reproductive age, affecting 1 in 6 people globally. It is not a mark of personal worth, nor is it untreatable. In most cases, a cause can be identified with the right medical workup, and there are many options for treatment, ranging from surgical correction to assisted reproductive technologies like IUI and IVF. The first and most important step any couple can take is to speak with a qualified fertility specialist, receive a proper diagnosis, and know that help is available. Infertility is a medical condition, and like all medical conditions, it deserves proper medical treatment.