Definition
Infertility is the failure of a couple to conceive a pregnancy after trying to do so for at least one full year. In primary infertility, pregnancy has never occurred. In secondary infertility, one or both members of the couple have previously conceived, but are unable to conceive again after a full year of trying.
Infertility is the failure of a couple to conceive a pregnancy after trying to do so for at least one full year. In primary infertility, pregnancy has never occurred. In secondary infertility, one or both members of the couple have previously conceived, but are unable to conceive again after a full year of trying.
Description
Approximately 20% of couples struggle with infertility at any given time. Infertility has increased as a problem over the last 30 years. Some studies blame this increase on social phenomena, including the tendency for marriage and starting a family to occur at a later age. For women, fertility decreases with increasing age:
Approximately 20% of couples struggle with infertility at any given time. Infertility has increased as a problem over the last 30 years. Some studies blame this increase on social phenomena, including the tendency for marriage and starting a family to occur at a later age. For women, fertility decreases with increasing age:
Male factors
Male infertility can be caused by a number of different characteristics of the sperm. To check for these characteristics, a sample of semen is obtained and examined under the microscope (semen analysis). Four basic characteristics are usually evaluated:
Male infertility can be caused by a number of different characteristics of the sperm. To check for these characteristics, a sample of semen is obtained and examined under the microscope (semen analysis). Four basic characteristics are usually evaluated:
Sperm count refers to the number of sperm present in a semen sample. The normal number of sperm present in just 1 ml of semen is over 20 million. A man with only 5–20 million sperm is considered subfertile and a man with fewer than 5 million sperm is considered infertile.
Sperm are also examined to see how well they swim (sperm motility) and to be sure that most have normal structure.
Not all sperm within a specimen of semen will be perfectly normal. Some may be immature, and some may have abnormalities of the head or tail. A normal semen sample will contain no more than 25% abnormal forms of sperm.
Volume of the semen sample is important. An abnormal amount of semen could affect the ability of the sperm to successfully fertilize an ovum.
Any number of conditions result in abnormal findings in the semen analysis. Men can be born with testicles that have not descended properly from the abdominal cavity (where testicles develop originally) into the scrotal sac, or may be born with only one instead of the normal two testicles. Testicle size can be smaller than normal. Past infection (including mumps) can affect testicular function, as can a past injury. The presence of abnormally large veins (varicocele) in the testicles can increase testicular temperature, which decreases sperm count. History of having been exposed to various toxins, drug use, excess alcohol use, use of anabolic steroids, certain medications, diabetes, thyroid problems, or other endocrine disturbances can have direct effects on the formation of sperm (spermatogenesis). A study published in late 2001 linked certain organic solvents that men encounter in the workplace as possible causes of low sperm count. The types of solvents are most likely encountered in such occupations as those of professional printers, painters, and decorators. Theories suggest solvents like glycol ethers, which are know to affect animals' reproductive systems, are the most harmful.
Sperm are also examined to see how well they swim (sperm motility) and to be sure that most have normal structure.
Not all sperm within a specimen of semen will be perfectly normal. Some may be immature, and some may have abnormalities of the head or tail. A normal semen sample will contain no more than 25% abnormal forms of sperm.
Volume of the semen sample is important. An abnormal amount of semen could affect the ability of the sperm to successfully fertilize an ovum.
Any number of conditions result in abnormal findings in the semen analysis. Men can be born with testicles that have not descended properly from the abdominal cavity (where testicles develop originally) into the scrotal sac, or may be born with only one instead of the normal two testicles. Testicle size can be smaller than normal. Past infection (including mumps) can affect testicular function, as can a past injury. The presence of abnormally large veins (varicocele) in the testicles can increase testicular temperature, which decreases sperm count. History of having been exposed to various toxins, drug use, excess alcohol use, use of anabolic steroids, certain medications, diabetes, thyroid problems, or other endocrine disturbances can have direct effects on the formation of sperm (spermatogenesis). A study published in late 2001 linked certain organic solvents that men encounter in the workplace as possible causes of low sperm count. The types of solvents are most likely encountered in such occupations as those of professional printers, painters, and decorators. Theories suggest solvents like glycol ethers, which are know to affect animals' reproductive systems, are the most harmful.
Problems with the male anatomy can cause sperm to be ejaculated not out of the penis, but into the bladder; and scarring from past infections can interfere with ejaculation.
Studies continue to uncover reasons for male infertility. In 2001, researchers reported that a certain protein lacking in the sperm could prevent formation of the structure on the head of the sperm that contains enzymes that help penetrate the egg, allowing conception. The finding should lead to further study of the molecular basis of male fertility.
Ovulatory problems
The first step in diagnosing ovulatory problems is to make sure that an ovum is being produced each month. A woman's morning body temperature is slightly higher around the time of ovulation. A woman can measure and record her temperatures daily and a chart can be drawn to show whether or not ovulation has occurred. Luteinizing hormone (LH) is released just before ovulation. A simple urine test can be done to check if LH has been released around the time that ovulation is expected.
The first step in diagnosing ovulatory problems is to make sure that an ovum is being produced each month. A woman's morning body temperature is slightly higher around the time of ovulation. A woman can measure and record her temperatures daily and a chart can be drawn to show whether or not ovulation has occurred. Luteinizing hormone (LH) is released just before ovulation. A simple urine test can be done to check if LH has been released around the time that ovulation is expected.
Pelvic adhesions & endometriosis
Pelvic adhesions cause infertility by blocking the fallopian tubes and preventing the sperm from reaching the egg. Pelvic adhesions are fibrous scars. These scars can be the result of past infections, such as pelvic inflammatory disease, or infections following abortions or prior births. Previous abdominal surgeries can also leave behind scarring.
Pelvic adhesions cause infertility by blocking the fallopian tubes and preventing the sperm from reaching the egg. Pelvic adhesions are fibrous scars. These scars can be the result of past infections, such as pelvic inflammatory disease, or infections following abortions or prior births. Previous abdominal surgeries can also leave behind scarring.
Endometriosis is the abnormal location of uterine tissue outside of the uterus. When uterine tissue is planted elsewhere in the pelvis, it still bleeds on a monthly basis with the start of the normal menstrual period. This leads to irritation within the pelvis around the site of this abnormal tissue and bleeding, and may cause scarring. Endometriosis may lead to pelvic adhesions.
A hysterosalpingogram (HSG) can show if the fallopian tubes are blocked. This is an x-ray exam that tests whether dye material can travel through the patient's fallopian tubes. Scarring also can be diagnosed by examining the pelvic area through the use of a laparoscope that is inserted into the abdomen through a tiny incision made near the navel.
Cervical factors
The cervix is the opening from the vagina into the uterus through which the sperm must pass. Mucus produced by the cervix helps to transport the sperm into the uterus. Injury to the cervix or scarring of the cervix after surgery or infection can result in a smaller than normal cervical opening, making it difficult for the sperm to enter. Injury or infection can also decrease the number of glands in the cervix, leading to a smaller amount of cervical mucus. In other situations, the mucus produced is the wrong consistency (perhaps too thick) to allow sperm to travel through. In addition, some women produce antibodies (immune cells) that are specifically directed to identify sperm as foreign invaders and to kill them.
The cervix is the opening from the vagina into the uterus through which the sperm must pass. Mucus produced by the cervix helps to transport the sperm into the uterus. Injury to the cervix or scarring of the cervix after surgery or infection can result in a smaller than normal cervical opening, making it difficult for the sperm to enter. Injury or infection can also decrease the number of glands in the cervix, leading to a smaller amount of cervical mucus. In other situations, the mucus produced is the wrong consistency (perhaps too thick) to allow sperm to travel through. In addition, some women produce antibodies (immune cells) that are specifically directed to identify sperm as foreign invaders and to kill them.
Cervical mucus can be examined under a microscope to diagnose whether cervical factors are contributing to infertility. The interaction of a live sperm sample from the male partner and a sample of cervical mucus from the female partner can also be examined. This procedure is called a post-coital test.
Herbal and Chinese medicine
The following may be taken by women to treat infertility:
The following may be taken by women to treat infertility:
Dong quai (Angelica sinensis) has been used to regulate menstrual cycles and for infertility.
Licorice helps to balance levels of estrogen and testosterone and is used for infertility.
Red clover (Trifolium pratense) has a beneficial effect on the uterus, can calm the nervous system, and can balance hormone levels.
Nettle (Urtica dioica) supports the uterus and hormonal system.
Raspberry leaf strengthens the mucous lining of the uterus.
Chasteberry (Vitex agnus-castus) balances hormone production.
Ladies mantle (Alchemilla vulgaris) balances hormone production.
Shatavari (Asparagus racemosus) is an Ayurvedic remedy for infertility and works by balancing hormones.
Rehmannia is an Ayurvedic remedy for infertility.
Myrrh (Commiphora myrrha) is an Ayurvedic remedy for infertility.
False unicorn (Chamaelirium luteum) balances hormone levels.
Pomegranate essence balances the reproductive system.
The following may be taken by men to treat infertility:
Licorice helps to balance levels of estrogen and testosterone and is used for infertility.
Red clover (Trifolium pratense) has a beneficial effect on the uterus, can calm the nervous system, and can balance hormone levels.
Nettle (Urtica dioica) supports the uterus and hormonal system.
Raspberry leaf strengthens the mucous lining of the uterus.
Chasteberry (Vitex agnus-castus) balances hormone production.
Ladies mantle (Alchemilla vulgaris) balances hormone production.
Shatavari (Asparagus racemosus) is an Ayurvedic remedy for infertility and works by balancing hormones.
Rehmannia is an Ayurvedic remedy for infertility.
Myrrh (Commiphora myrrha) is an Ayurvedic remedy for infertility.
False unicorn (Chamaelirium luteum) balances hormone levels.
Pomegranate essence balances the reproductive system.
The following may be taken by men to treat infertility:
Ginseng may increase the formation of sperm, testosterone levels, and sexual activity.
Pygeum may help infertile men who have a reduced secretion of semen.
Pine bark extract improves sperm shape.
Chasteberry (Vitex agnus-castus) balances hormone production.
Shatavari (Asparagus racemosus) is an Ayurvedic remedy for infertility and works by balancing hormones. May increase sperm production.
Saw palmetto (Serenoa serrulata) increases the production of testosterone and strengthens the reproductive system.
Ashwaganda (Withania omnifera) is an Ayurvedic remedy that improves the quality of semen and sperm count.
Chinese herbals must be specifically designed and used to treat infertility in males.
Pygeum may help infertile men who have a reduced secretion of semen.
Pine bark extract improves sperm shape.
Chasteberry (Vitex agnus-castus) balances hormone production.
Shatavari (Asparagus racemosus) is an Ayurvedic remedy for infertility and works by balancing hormones. May increase sperm production.
Saw palmetto (Serenoa serrulata) increases the production of testosterone and strengthens the reproductive system.
Ashwaganda (Withania omnifera) is an Ayurvedic remedy that improves the quality of semen and sperm count.
Chinese herbals must be specifically designed and used to treat infertility in males.
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