The Most Common Causes of Infertility and How They are Treated

Historically, when a couple was unable to build their family naturally, this would primarily be attributed to a female partner. She would be declared ‘barren’, implying a dried up state of the reproductive system, similar to a desert, unable to sustain life in any capacity. In the same vein, male factor infertility was never questioned. In many communities around the world, this still remains so.

With terminology such as ‘barren’ in play, it is only natural that infertility was not considered treatable. As a result, many people did not look to medical science for a solution. As medical science has made strides in reproductive solutions, it has emerged that male factor infertility contributes to about 50 percent of infertility. Which makes sense, as it requires both female eggs and male sperm for pregnancy to occur. 

While this may be so, causes of infertility are varied and often influenced by factors such as lifestyle and medical history. According to the World Health Organization, infertility is a disease characterized by being unable to conceive after 12 months of regular unprotected sex. While there is debate regarding the use of terms i.e. whether infertility is a disease or a medical condition, what is factual is that infertility can be remedied through medical intervention in a majority of cases. 

Female Fertility Issues

Female fertility issues have a number of causes, from lifestyle habits to the impact of medical conditions and their treatment. For a female to be able to conceive, they must have a regular menstrual cycle, a good ovarian reserve, fallopian tubes with no blockage, and nothing hampering their uterine lining from developing as it should for implantation.

All the functions of reproduction are influenced by the production of hormones in the body.However, medical conditions such as polycystic ovarian syndrome (PCOS), endometriosis, and a lowered ovarian reserve have a direct impact on a woman’s fertility. If one desires to build their families and has challenges with any of these, there are family building options available through assisted reproductive technologies (ART) such as in vitro fertilization (IVF). Let us look at what the impact of these conditions are and how ART can remedy them. 

PCOS and Infertility

In order to understand PCOS, it may help to review how cysts are formed in the ovaries. The ovarian reserve consists of immature eggs contained within fluid filled sacs known as antral follicles. Antral follicles house the eggs until they mature and are released into the fallopian tube resulting in either a pregnancy, or menstruation. Sometimes, when the mature egg is released the antral follicle may close up, fill up with fluid, and continue to grow. Another way that a cyst could be formed is when the follicle does not release the egg within, but continues to grow. 

When a person has PCOS, they will have hormonal imbalances which can prevent pregnancy from occuring naturally. PCOS can be managed through lifestyle changes, diet, exercise routines. Medications can also be prescribed to regulate the menstrual cyce, insulin and blood sugar in the body. In the case of infertility caused by PCOS, ART interventions such as IVF have been effective in helping people build their families.  

Endometriosis and Its Impact on Conception

Endometriosis is a condition whereby the tissue that forms the uterine lining develops outside of the uterus. While menstruation typically allows the body to clear this tissue from the uterus, tissue that develops outside the uterus has no outlet. As well, endometriosis will result in hormonal imbalances. 

The typical treatment for endometriosis is surgical intervention. In the course of healing, scar tissue forms around the surgical sites, which can block the fallopian tubes, preventing the sperm from reaching the egg and fertilizing it. As well, endometriosis can interfere with the implantation of the embryo. 

When a person who has endometriosis desires to build a family, typically ART interventions are recommended. The type of ART intervention varies from case to case, depending on the extent and severity of the endometriosis. Therefore consultation with a fertility specialist is vital to determine the way forward. 

Low Ovarian Reserve and Age-Related Decline

Women are born with all the eggs they will produce in their reproductive years, stored within their ovaries in the form of undeveloped eggs called oocytes. Each menstrual cycle, several of these are released and triggered for development by the hormones produced in the body. 

Apart from natural ageing, there are other reasons why a person may have a low ovarian reserve. Some of these are genetic disorders, conditions such as endometriosis, smoking, autoimmune conditions, and treatments such as chemotherapy or surgery among others.  

While time cannot be frozen, and treatments for some conditions and diseases have their side effects, IVF has been one of the more successful treatments for infertility caused by lowered ovarian reserves.

Male Fertility Issues

Male fertility contributes to the other half of the reproduction equation, thus male factor infertility plays a significant role when people are facing challenges in natural family building. Unlike women, men produce fresh sperm regularly, with a sperm cell taking about three months to mature, ready for conception.

Sperm production is regulated by hormones and the capacity for a man to make a woman pregnant is determined by whether the sperm can leave the body through ejaculation, and swim from the vagina to the fallopian tube. Low sperm count and poor sperm motility are some of the common reasons why men are unable to make a woman pregnant. Let us look at these common causes of male infertility in a little more detail. 

Low Sperm Count and Poor Motility

Low sperm count and poor motility are usually the result of hormonal imbalances in the body. Testosterone is the main hormone that regulates male primary and secondary characteristics, as well as reproductive function. When normal hormonal function is disrupted, it can result in poor sperm production, resulting in low sperm count and sperm that have issues with motility. The main causes of disruption in male sexual function are lifestyle, diet, stress, genetic conditions, medical issues, and some medical treatments.

Ideally, sperm should be produced in a particular quantity within a single volume of ejaculated semen. When this quantity is low, it reduces the chances of fertilization. As well, of the sperm produced, sperm cells should be able to move independently, as well as in a forward direction. Typically, lifestyle changes, sufficient rest, managed stress and exercise can improve the quality and quantity of sperm. Where this does not work, ARTs have been used to help men build their families.

Varicocele and Its Impact on Sperm Health

Varicoceles is a condition whereby the blood vessels supplying oxygen and nutrients to the testicles, become enlarged to the degree that it somewhat ‘chokes’ the testicle. When this occurs, it inhibits the testicles from draining the sperm within efficiently, resulting in challenges when trying to build families. As well varicoceles can have a negative impact on sperm health, resulting in lowered sperm production and poor motility of sperm. Varicoceles can be reversed through various surgical and minimally invasive procedures. 

Unexplained Infertility: What It Means

Unexplained infertility is infertility that cannot be explained medically, has no known cause or symptoms that can be diagnosed. Typically, when a person or couple seek professional medical help for infertility, the first consultation will typically consist of a collection of health, medical, and lifestyle data. From this information, a professional healthcare provider will then proceed to run some diagnostic testing in order to establish what the possible cause of infertility could be. These fertility tests are done on both partners in order to get the best possible understanding. 

After fertility testing, it is usually possible to determine some probable causes of infertility. When the results of fertility testing show that all reproductive parameters are normal, but the individual or couple are still facing challenges in building their family, fertility experts will declare the infertility as unexplained. Whereas the causes of infertility may not be medically explained, it is possible for medical interventions to be applied to assist these people in building their families. The typical options include lifestyle and dietary changes, as well as ART interventions.

Fertility Treatment Options for Every Condition

Most causes of infertility have fertility treatment options. However, this depends on the cause of infertility and the degree to which it has impacted fertility. Each treatment is determined on a case by case basis, and would require consultation with a professional healthcare provider. There are some cases whereby fertility treatments may not work, perhaps due to extensive damage, or other reasons. In such cases, alternative family building options may be recommended. 

FAQs:

What are the top causes of female infertility?

Female infertility can result from various factors, including ovulatory disorders such as PCOS, age-related decline of the quality and quantity of eggs, endometriosis, blocked or damaged fallopian tubes, anomalies in the uterus such as fibroids and polyps, and hormonal imbalances. 

What is unexplained infertility?

Unexplained infertility is diagnosed when standard fertility tests do not identify a clear cause of infertility. It could be linked to subtle hormonal imbalances, dysfunction in the immune system, issue with eggs and sperm not detected by the standard tests, and issues with the endometrium preventing successful implantation once the egg is fertilized. About 10-20% of couples experience unexplained infertility and treatment on a case by case basis typically involves lifestyle changes, fertility medications, IUI, or IVF.

Can infertility be cured?

The "cure" for infertility is dependent on the cause to begin with. Some conditions can be managed with medications, surgery or lifestyle changes. Other conditions may require ART interventions such as IVF to bypass the issue. Sperm retrieval, ICSI or lifestyle improvements can address male factor infertility, while IVF using donor eggs can be used in the case of diminished ovarian reserves. 

How do I know if I need IVF?

A fertility specialist is best placed to determine whether IVF is the best course of treatment for you. It may be recommended if your fallopian tubes are blocked or damaged, if you have a diminished ovarian reserve, have not responded to ovulation-inducing medications for the treatment of PCOS, require genetic testing to screen for hereditary conditions, have severe male factor infertility, have had multiple failed rounds of IUI, or a simply facing unexplained fertility.

What are my options if I have low ovarian reserve?

Low ovarian reserves only mean that you have a reduced number of eggs, not that you are incapable of becoming pregnant. This is usually addressed using aggressive ovarian stimulation, egg freezing or  embryo banking (where it is an option), using donor eggs, or supplementing with CoQ10 or DHEA.