Infertility is the inability to conceive after one year of sexual intercourse without contraception, or after six months if the woman is over the age 35.
One in six (15%) couples are unable to conceive within one year of unprotected sex. Some of these couples may eventually be able to achieve pregnancy without treatment, but others will need to undergo fertility treatments to successfully conceive. Though she is able to conceive, a woman who is unable to carry a pregnancy to full term may also be considered infertile.
Infertility in men accounts for approximately 20% of fertility-related problems in a couple, while 50% of cases are due to infertility issues with the woman. In remaining cases, both the man and the woman are experiencing some measure of infertility.
Race has not proven to be a factor in infertility across the globe, though prevalence of STDs and later-age pregnancies have been showed to affect rates of infertility in the general population.
Abnormal menstrual bleeding relates to unusual menstrual bleeding before, during or after a woman’s menstrual period. Abnormal menses can be caused by hormone imbalance, or by more serious conditions such as uterine growths or uterine cancer.
Age related infertility
The age-related decline of a woman’s fertility is known as age related infertility. Beginning in her mid-20s and accelerating after she reaches her mid-30s, a woman's fertility continuously declines, more so even after age 40. Middle-aged men are also less fertile than young men in their 20s.
When a woman’s ovaries do not develop and release eggs, this is known as anovulation. Accounting for approximately 25% of all infertility cases, anovulation is quite common. If a woman only has her period every few months, or none at all, she may not be ovulating or ovulating infrequently, thus causing infertility.
Cancer treatments including radiation and chemo therapy can have a major impact on fertility due to removal or damage to reproductive organs, eggs, and sperm. Prior to beginning cancer treatments or undergoing any surgery to your reproductive organs, both women and men should consult with our fertility specialists.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most times somewhere within the fallopian tube. This occurs when the fallopian tube is blocked or damaged. The fallopian tube of course cannot support the growing embryo, and the ectopic pregnancy may cause the tube to rupture and bleed, resulting in a potentially serious medical situation.
Endometriosis is a condition where the tissue that lines the inside of the uterus (endometrium) is found outside the uterus. Endometriosis may grow on the outside of a woman’s uterus, ovaries, fallopian tubes, bladder or even intestines, interfering with the fertilization process or an embryo’s implantation thus causing infertility.
Over exercising or lack of exercise are both linked to fertility problems in men and women.
Uterine fibroids are common and can affect embryo implantation and general fertility. Fibroids growing in the cavity of the womb (submucous) or distorting the lining of the womb (some intra mural) affect fertility. As many as 20% of women have fibroids during their childbearing years, and 50% of women will have fibroids by age 50.
Genetic causes of infertility in women
Many women are unable to conceive and deliver a healthy baby due to genetic factors as a result of inherited chromosome abnormalities or single-gene defects.
The process of ovulation and implantation of a fertilized egg depends upon a complex balance of hormones and their interactions with each other. Any disruption in this process can hinder ovulation or the implantation of the fertilized egg in the uterine lining.
In approximately 40% of infertile couples, male infertility is either the sole cause or a contributing cause of infertility. Problems with the sperm’s shape, numbers, health and movement can affect the ability to conceive. Infertility may also result when there is a blockage or obstruction in the man’s vas deferens (small tubes that connect the testes to the man’s urethra), blocking sperm from exiting the body.
Miscarriage & repeated pregnancy loss
Repeated pregnancy loss is defined as 3 confirmed lost pregnancies prior to 20 weeks. Although approximately 25% of all pregnancies result in miscarriages, fewer than 5% of women will experience two consecutive miscarriages, and only about 2% experience three or more miscarriages. Tests are normally done after 2 miscarriages to determine if any medical causes are responsible for the repeated miscarriages.
Obesity is a major risk factor for infertility. Ovulation may be affected by obesity and many eating-related disorders can alter the normal balance of hormones and affect fertility.
Polycystic ovarian syndrome (PCOS)
PCOS is a common cause of infertility. Severe hormonal imbalances cause eggs to remain immature, shrink and turn into cysts in the ovaries. The eventual buildup of cysts worsen hormonal imbalances.
There are two types of polyps that affect fertility: uterine polyps (which are also referred to as endometrial polyps) and cervical polyps. Uterine polyps are masses or lesions of the uterine wall (the endometrium). Cervical polyps are smooth, finger-shaped growths in the cervix, which is the passage between the vagina and uterus. Polyps can affect the fertilization or embryo growth process.
Sexually transmitted diseases
STDs, particularly Chlamydia, can damage a woman’s fallopian tubes and cause infertility. Men may also experience decreased fertility as a result of STDs.
Smoking and alcohol
Smoking and excessive alcohol consumption may effect fertility both in females and males.
Stress and infertility
Some studies indicate that mental stress may affect ovulation and sperm production, thus causing infertility.
Fertilization occurs in the woman’s fallopian tubes where sperm meets egg. This fertilized egg travels down the tube into the uterus, where it develops into a baby. Any blockage of the tubes is called tubal disease and will prevent sperm and egg from joining, or may cause ectopic pregnancy. Tubal disease accounts for about 35% of all infertility problems.
Unexplained infertility is the diagnosis if all fertility tests are normal and the cause of infertility cannot be defined. In practice it is said to occur if semen analysis is normal, the woman is ovulating and fallopian tubes are open. Couples with unexplained infertility have a very high success rate with fertility treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF).
Uterine abnormalities & malformations
Adhesions (also known as Asherman syndrome) are bands of scar tissue that form between or inside of abdominal organs. In very severe cases, adhesions may obstruct or distort the inside of the uterus to the point where a fertilized egg may not be brought to full term.