Infertility – Causes, investigations and treatments

Infertility in women under 35 is the inability to become pregnant after regular unprotected sexual intercourse for 12 months or more. For women 35 and older, this time frame is shortened to six months.

Infertility affects men and women equally. In 30% of instances, the cause can be attributed to the male, in 30% to the female, with 30% of cases the cause of infertility is shared. In 10% of instances, the reason is unknown.

Infertility affects up to 15% of couples. In 90% of cases, infertility can be successfully overcome with lifestyle modifications, medication, and or surgery.

Primary infertility is when the individual has never conceived. With secondary infertility, the individual has biologically parented a child but currently cannot.

Unfortunately, many infertile couples suffer in silence because they are often too embarrassed to broach the subject of infertility with anyone, including their doctor.

Causes

The myriad of causes of infertility shall be reviewed under the following headings – Exclusively male causes, exclusively female causes, and causes that can affect both males and females.

Male Causes

● Low sperm count
● Abnormal sperm motility
● A high percentage of defective sperm
● Recurrent and protracted increase in testicular temperature – (e.g. hot work environment, varicocele, tight underwear, jockstraps, crossing legs, laptop)
● Undescended testicle(s)
● Antibodies to sperm
● Herbicides, pesticides, heavy metals
● Vasectomy
● Medicines – nitrofurantoin, some blood pressure medicines, certain antidepressants, anabolic steroids, sulfasalazine, ketoconazole
● Erectile dysfunction
● Retrograde ejaculation
● Mumps
● Testicular torsion
● Significant testicular trauma
● Diabetes

Female Causes

● Ovulation challenges
● Polycystic ovarian syndrome
● Fallopian tube pathology – blocked or scarred
● Uterine fibroids
● Uterine polyps
● Cervical stenosis
● Hypothalamic dysfunction
● Unusually thick cervical mucus
● Endometriosis
● Autoimmune – antiphospholipid syndrome
● Significantly underweight
● Pelvic radiation
● Clotting disorders
● Tubal ligation
● Pelvic infection
● Hypothyroidism
● Previous pelvic surgery
● Premature ovarian failure
● Medicines – nonsteroidal antiinflammatories (e.g. Diclofenac, ibuprofen, Aleve), antipsychotic
● Menopause

Causes that can affect both males and females

● Cigarette smoking
● Alcohol overuse
● Marijuana use
● Cocaine use
● Psychological and physical stress
● Being overweight
● Anatomical abnormalities of the reproductive tract
● Over exercise
● Advancing age
● Hormone imbalances
● STDs
● Previous chemotherapy

Investigating infertility

Generally, if a couple is experiencing challenges conceiving it is recommended that both partners visit their primary care physician. There is an equal chance that either partner or both could be the reason for infertility.

A detailed history and physical examination are initially performed.

Men

● Initially, a laboratory conducted seminal analysis is carried out. If this is abnormal other tests are done.
● Ultrasound examination of the scrotum to assess the testicles
● Transrectal ultrasound
● Post ejaculation urinalysis
● Blood testosterone levels
● Prolactin levels
● Genetic testing

Women

The doctor will decide which of the following tests should be done based on the medical history, physical examination findings, and previous test results and procedures.
● Tracking of basal body temperature
● Serial urine test for luteinizing hormone (LH)
● Oestrogen, progesterone, testosterone, prolactin, and FSH levels
● Thyroid hormones – TSH/ T3, T4
● Antiphospholipid antibodies
● Pelvic/ transvaginal ultrasound
● Sonohysterography
● Hysterosalpingography
● Hysteroscopy
● Laparoscopy

Treatment

Infertility treatment is tailored to the specific cause, once identified. Treatment also takes into account the person’s age, general health, personal preferences, and the length of time that one has been trying to conceive. Specific treatments may include medication and or surgery.

General recommendations
● Increased frequency of sex – starting five days before the likely day of ovulation
● Avoid using lubricants
● Cease smoking
● Reduce alcohol intake
● Stop marijuana use – recreational and medicinal
● Do not use illicit drugs
● Normalise weight
● Adhere to a healthy lifestyle – diet, exercise, sleep
● Current medications may need to be changed if they could possibly impact fertility
● Minimize physical and emotional stress.
For men, medications may be prescribed that stimulate the production and release of luteinizing hormone (LH) and follicular stimulating hormone (FSH) from the brain which in turn increases sperm production.
The most frequently prescribed medications for women are those which promote ovulation. It should be noted that taking such medications increases the odds of having a multiple pregnancy.

Surgery may be recommended for:

● Submucosal fibroids
● PCOS
● Endometriosis
● Blocked fallopian tubes or epididymis
● Varicocele

In Vitro Fertilization (IVF) – After a course of fertility medicine, approximately 10-20 eggs are harvested from the ovaries. These are fertilized by sperm in the laboratory. The fertilized eggs (embryos) are vetted and one is chosen to be implanted in the womb to develop.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376
(WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided.