Infertility | 7 Frequently Asked Questions and Answers

1. Will Infertility go Away?

Treatment options for infertility in both women and men vary. Fertility specialists employ drugs, surgical procedures, and assisted reproductive technology.

Ovulation induction involves using medications to stimulate ovulation in women. Surgical interventions can address infertility in women by repairing obstructions in fallopian tubes, addressing endometriosis, and removing uterine polyps or fibroids. In men, surgery can treat varicoceles, which are enlarged veins in the scrotum that commonly cause infertility.

Assisted reproductive technology (ART) facilitates the fertilization process by bringing sperm and egg together, typically through in vitro fertilization. This procedure increases the likelihood of fertilization by placing the egg and sperm in close proximity in a laboratory dish.

ART is beneficial for women whose surgical interventions were ineffective in correcting fallopian tube issues, or who suffer from severe endometriosis, premature ovarian failure, or unexplained infertility. Additionally, ART can assist couples dealing with male infertility factors like low sperm count or poor sperm motility.

Adopting lifestyle changes such as achieving a healthy weight and abstaining from tobacco, illicit drugs, and alcohol can also aid in reversing infertility.

For more detailed guidance on reversing infertility, it’s advisable to seek consultation with a fertility clinic. Many couples successfully overcome infertility through these treatments and ultimately conceive.

2. Can I become Pregnant on Infertile Days?

At the gynecology clinic, a common inquiry from patients revolves around the possibility of conceiving during infertile days. To grasp this concept, it’s essential to comprehend the workings of the female reproductive cycle. Typically, a menstrual cycle spans 28 to 30 days, although variations ranging from 21 to 24 days or up to 35 days can be normal.

The cycle commences on the first day of menstruation. During this phase, the body initiates hormone production, stimulating the growth and maturation of an egg within the ovary. Around the midpoint of a 28-day cycle, typically day 14, ovulation occurs. The mature egg is released into the fallopian tube, where it remains viable for roughly 24 hours. At this juncture, two outcomes are possible:

Fertilization transpires when the egg meets a sperm cell, leading to the potential for pregnancy.
If fertilization doesn’t occur, the body expels the egg, triggering menstruation and initiating another menstrual cycle.

In reality, the window of fertility is limited to a few days within each cycle, known as “fertile days.”

3. Can an Infertile man become Fertile again?

While treatments cannot directly enhance the quality of a man’s sperm, several techniques can enhance the chances of conception utilizing the existing sperm quality.

In many instances, couples grappling with male factor infertility can find assistance through assisted reproductive technologies (ART).

The reproductive technologies accessible to men facing infertility includes:

• Surgical interventions
• Hormone therapy
• Artificial insemination
• In-vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI).

4. What causes Infertility in Women?

Infertility in women often arises from issues with ovulation, the monthly release of an egg from the ovaries.

Some factors inhibit the release of an egg altogether, while others hinder release during certain cycles but not others.

Ovulation problems may stem from:

1. Polycystic ovary syndrome (PCOS): Thyroid issues, including both overactive and underactive thyroid glands, which can disrupt ovulation. Premature ovarian failure, occurring when the ovaries cease functioning before the age of 40
   
2. Surgical scarring: Operations in the pelvic region can lead to scarring of the fallopian tubes, crucial in connecting the ovaries to the womb. Similarly, cervical surgeries may result in scarring or shortening of the cervix.
3. Cervical mucus complications: During ovulation, cervical mucus typically becomes thinner to aid sperm movement. Abnormalities in mucus consistency can hinder conception.
4. Fibroids: Non-cancerous growths called fibroids, situated in or around the womb, may impact fertility by hindering egg attachment or blocking fallopian tubes.
5. Endometriosis: This condition involves the growth of tissue resembling the uterine lining outside the womb, potentially damaging ovaries or fallopian tubes and causing fertility issues.
6. Pelvic inflammatory disease (PID): PID, an infection affecting the upper female reproductive tract, often results from sexually transmitted infections (STIs). It can scar fallopian tubes, impeding egg passage to the womb.
7. Sterilization: Some women opt for sterilization to prevent further pregnancies by blocking fallopian tubes. Reversing sterilization is rarely successful, and even if achieved, pregnancy is not guaranteed.
8. Medications and drugs: Certain medicines and drugs can affect fertility and includes;

• Non-steroidal anti-inflammatory drugs (NSAIDs) may hinder conception with long-term or high-dosage usage.
• Chemotherapy drugs may induce ovarian failure, impairing ovarian function.
• Neuroleptic medicines, commonly used for psychosis treatment, might disrupt menstrual cycles or fertility.
• Spironolactone, a diuretic, can impact fertility temporarily.
• Illegal drugs like marijuana and cocaine can also affect fertility and ovulation.

5. What causes Infertility in Men?

Semen and Sperm: A prevalent cause of male infertility is substandard semen quality, the fluid containing sperm ejaculated during intercourse.

Potential factors contributing to abnormal semen include:

1. A scarcity of sperm, characterized by a very low sperm count or complete absence of sperm.
2. Impaired sperm motility, hindering their ability to navigate toward the egg.
3. Abnormal sperm morphology, where irregularities in shape impede movement and fertilization.
4. Many instances of abnormal semen remain unexplained.
5. Elevated scrotal temperature has been associated with diminished semen quality, though the impact of wearing loose-fitting underwear on fertility remains uncertain.

Testicles: Testicles are responsible for sperm production and storage. Damage to these organs can significantly impair semen quality.

Damage can occur due to:

• Testicular infections
• Testicular cancer
• Testicular surgeries
• Congenital defects affecting the testicles
• Undescended testicles (cryptorchidism)
• Testicular injuries

Sterilization: Vasectomy, a procedure involving the severing and sealing of the tubes transporting sperm from the testicles, is an option for men seeking to prevent future pregnancies. While vasectomies can be reversed, success rates for reversals are typically low.

Ejaculation Disorders: Some men encounter ejaculation difficulties, complicating the release of semen during intercourse.

Hypogonadism: Hypogonadism denotes an abnormally low testosterone level, a hormone crucial for sperm production. Potential causes include tumors, illicit drug use, or Klinefelter syndrome, a genetic disorder involving an extra X chromosome.

Medications and Drugs: Certain medications may contribute to infertility:

• Sulfasalazine, an anti-inflammatory drug, can temporarily reduce sperm count.
• Anabolic steroids, often misused to enhance muscle growth and performance, can diminish sperm count and motility with prolonged use.
• Chemotherapy medications may severely impair sperm production.
• Herbal remedies, such as extracts from Tripterygium wilfordii, could affect sperm production or testicular size.
• Illicit drugs like marijuana and cocaine can also impact semen quality.

6. What do I do in the case of Unexplainable Infertility?

Unexplained infertility, constituting approximately 25% of infertility cases in the UK, occurs when no identifiable cause is found in either partner. If no underlying cause for fertility issues has been determined, it’s advisable to discuss further steps with your doctor.

The National Institute for Health and Care Excellence (NICE) suggests that women with unexplained infertility, who have not achieved pregnancy after two years of regular unprotected intercourse, should be offered IVF treatment.

7. Is Infertility Genetic?

Around 10 to 15 percent of couples face infertility, with over half of these cases attributed to an underlying genetic anomaly. In these instances, the genetic issue might have been inherited. Nevertheless, infertility is intricate, and the majority of cases don’t have a known genetic cause. Roughly one-third of infertility cases stem from both male and female factors each, while the remaining third arises from unknown causes or a combination of male and female factors.

Female Infertility and Genetics

Genetic factors implicated in female infertility include inherited chromosomal abnormalities or single-gene variations passed from parent to child. Moreover, a family history of certain medical conditions, like early menopause or endometriosis, may increase an individual’s susceptibility to similar health issues.

Specific genetic conditions and chromosomal anomalies linked to female infertility include:

1. Turner Syndrome: This condition involves partial or complete absence of one copy of the X chromosome, leading to ovarian insufficiency.
2. Fragile X-Associated Primary Ovarian Insufficiency (FXPOI): Carriers of Fragile X syndrome, a genetic alteration on one of the X chromosomes, have an elevated risk of
   
3. Primary ovarian insufficiency (POI): where ovaries cease normal function before age 40. This not only affects fertility but also increases the likelihood of having children with Fragile X-associated intellectual disabilities.
4. Congenital Adrenal Hyperplasia (CAH): A genetic disorder affecting both genders, CAH causes hormonal imbalances in women due to adrenal gland changes, potentially disrupting menstrual cycles and fertility.
5. Chromosomal rearrangements: Carriers of chromosomal rearrangements are more prone to passing on excess or insufficient chromosomal material, which can affect fertility, increase pregnancy loss risk, or result in offspring with birth defects or intellectual differences.

Male Infertility and Genetics

Specific genetic conditions and chromosomal anomalies linked to male infertility include:

1. Klinefelter syndrome (KS): Individuals with KS possess an extra X chromosome (XXY), leading to reduced testosterone production and consequent low or absent sperm production.
2. Kallman Syndrome: This disorder results in the inability to produce certain hormones crucial for sexual development, thereby impacting fertility.
3. Cystic fibrosis (CF): While primarily affecting the lungs and digestive system, specific genetic mutations in the CF gene can disrupt the development of the vas deferens, obstructing sperm transport and affecting fertility.
4. Y chromosome microdeletions: Missing sections of the Y chromosome, which contain genes vital for sperm growth and development, can result in minimal or no sperm production.
5. Chromosomal rearrangements: Carriers of chromosomal rearrangements may transmit excess or insufficient chromosomal material, affecting the ability to conceive, increasing the risk of pregnancy loss, or causing birth defects or intellectual disabilities in offspring.