Infertility: causes, diagnosis, and treatment options

Infertility is an issue that is more common than one would expect, with around 15 per cent of couples worldwide struggling to conceive. Infertility can be due to issues that affect both hopeful mothers and fathers. In this article, a fertility specialist goes over the possible causes of infertility, methods of diagnosis, and treatment options to improve fertility.  

What is infertility and what causes it?

Infertility is defined as either:

• The inability to conceive after a year of unprotected sex for couples under 35 years old
• The inability to conceive after six months of unprotected sex for couples over 35 years old

Fertility issues can stem equally from the prospective mother or the prospective father. In women, infertility is often due to hormonal imbalances, structural dysfunction of the gynaecological organs, or complications from ageing. In men, infertility may be caused by poor sperm health, also structural dysfunction, and sometimes prostate disorders.

Women

Hormonal imbalances can disrupt the menstrual cycle and inhibit ovulation, meaning that eggs cannot consistently and properly mature and be deposited into the uterus. This can have many different causes, with common ones being:

• Thyroid dysfunction, where oestrogen and progesterone levels can be imbalanced to the point of interfering with ovulation.
• PCOS (Polycystic ovary syndrome), where cysts grow on the fallopian tubes and obstruct the egg implantation, or cause the womb lining (endometrium) to thicken and become unable to host an egg.
• Elevated prolactin levels, where the hormone that produces breastmilk is too high in the body- Its original purpose is to suppress ovulation for postpartum mothers to prevent another pregnancy too soon after birth, but even women who have never been pregnant can develop high levels of prolactin.
• Luteal phase defects, where the ovaries don’t produce enough progesterone, a hormone which prepares the endometrium for an egg.

Structural dysfunction means that the organs are physically unable to support either egg release, implantation, or can even prevent the sperm from entering the womb to infuse with the egg. This can include conditions such as:

• Endometriosis, where endometrium tissue grows outside the womb and can grow over the fallopian openings.
• Fibroids and cysts which grow over the fallopian tubes and obstruct the egg from leaving.
• Adhesions, which is scarring that forms between the pelvic organs.
• Cervical abnormalities like ectropion, polyps, and Nabothian cysts prevent sperm from entering the womb properly.

As women age, their periods naturally begin to decrease and will eventually stop altogether in a process called menopause. During this, their egg quality will deteriorate, making it more difficult to conceive healthy babies, if to conceive at all. While this is normal, it can still be upsetting for those who were still hoping to become pregnant.

Men

In men, issues with fertility are commonly due to poor sperm health, which can take the form of:

• Low sperm count
• Poor motility (the speed of the sperm)
• Deformed sperm (such as crooked tails or abnormal heads)
• Fragmented DNA

Other possible roadblocks in male fertility include varicocele, when the veins of the testicle are enlarged and blood pools in the testicles which deteriorates sperm, blocked ejaculatory ducts (ejaculatory duct obstruction), which prevent sperm from entering the womb, prostate problems, like an enlarged prostate, which can also obstruct sperm or cause erectile dysfunction, or infections, where invasive and pathogenic cells can kill sperm.

How are the causes of infertility diagnosed?

People struggling to conceive for unknown reasons are recommended to undergo fertility testing, which will include blood work to look at the hormone levels, semen analyses, structural evaluations like ultrasounds or laparoscopies of the uterus and ovaries, and genetic testing to see if any chromosomal or genetic abnormalities or undiscovered sexually transmitted infections could be preventing pregnancy.

A fertility doctor will also investigate medical history and inquire about lifestyle, sexual practices, and current and past medications.

How can infertility be treated?

There are three main kinds of fertility treatments: medicinal, surgical, and assisted conception.

Common medications include drugs that facilitate the ovulation stage for women who have issues with this stage of the menstrual cycle, such as clomifene, and metformin which is particularly beneficial for women who have PCOS. These should only be prescribed once the core of the issue is known, as they might not be effective for women undergoing specific conditions.

If the issue can be corrected with surgery, then options include surgery to repair or remove blockages in the fallopian tubes, and laparoscopic surgeries for those suffering from PCOS, endometriosis, and fibroids. For men, there is a procedure where the sperm is surgically extracted if ejaculation is disrupted (epididymal blockage) or after a vasectomy, and the sperm is then cryogenically preserved.

For those who opt for assisted conception, the options include intrauterine insemination (artificial insemination) where sperm is released into the womb via a catheter, and in vitro fertilisation (IVF) where the egg is extracted from the ovaries and fertilised with sperm and once the embryo is viable it is replanted into the womb for the rest of the gestation.

Some patients may plan ahead of expected infertility (such as before starting chemotherapy, or planning for children only after a certain age when fertility is lower), and will choose to freeze eggs, embryos, and sperm with cryopreservation, so that the option for children remains an available avenue for them in the future.

Hopeful mothers and fathers can also make adjustments to their diets and lifestyles to improve their chances of successful conception.

Eating healthily, having a good quality of sleep, staying physically active, and reducing stress will signal to the body that it is safe to conceive. Ensure that the body is fit and has the minerals, nutrients, and vitamins required to produce healthy eggs and sperm.

Ideally, the diet should include at least two litres of water daily, leafy greens like kale and spinach, whole grains like oats and lentils, healthy fats like fish and organic yoghurt or eggs, and plenty of fresh fruit like strawberries, grapefruit, or blueberries. It is recommended to avoid or limit the consumption of red meat, alcohol, tobacco, and caffeine.

Struggles with infertility can be emotionally taxing. Be sure to stay in open, honest dialogue with your partner about this journey and make decisions together about your options and health. If one person feels too burdened, then stress will increase which will be counterintuitive to your goals.

Managing infertility naturally requires a comprehensive approach that addresses physical, emotional, and environmental factors. Success often comes from combining multiple strategies and maintaining patience and consistency. While natural approaches can be effective, it's important to work with healthcare providers and know when to seek additional medical support. 

If you and your partner are struggling to conceive, you can consult with a specialist today on Top Doctors.