Infertility problems can be overwhelming. They affect couples worldwide. This article will shed some light on a multi-millennial myth associated with infertility. The myth? “Infertility is a woman’s problem”.
Why is this myth still engrained in so many people’s minds? Is it fueled by a superfluous society mindset that has been imbedded into many people’s minds for hundreds or even thousands of years? Is a man’s virility at stake?
If society continues to educate themselves and becomes familiar with the decades of sophisticated medical research, testing and education that have uncovered facts and figures to the contrary, that myth can finally be squashed, and more men will take responsibility in the baby game.
History has run a course that presented infertility as a women’s only issue, laying the burden solely on the woman’s shoulders. Dating back as far as the ancient Egyptians who believed it was exclusively the woman’s responsibility. Their early beliefs suggested women who could not get pregnant were possessed by a savage goddess, and could even be cast out of the family for her barren condition.
Fast forward to the new millennium. This is far from the truth when you look at the facts. The most recent research indicates that 35% of infertility problems are associated with women, while an equal 35% are associated with men. Another 20% are a combination of the two, and the remaining 10% are “unexplained”.
What Causes Infertility Problems in Women?
Some of the common infertility problems in women include blocked fallopian tubes, endometriosis, hormonal imbalance, and hypothyroidism, as well as things as simple as diet, exercise, stress and environmental toxins.
Pelvic inflammatory disease (PID) is the most common cause of blocked fallopian tubes. Often times, PID is the result of an STD, but that is not always the case. History of uterine infections, ruptured appendix, abdominal surgeries and endometriosis are other causes that may add to infertility issues.
Determining if tubes are blocked can be accomplished with a specialized x-ray called a “hysterosalpingogram” (HSG) that determines if tubes are open and the uterine cavity is normal. An HSG test consists of health care professionals injecting dye through the cervix and vagina into the uterine cavity. The dye will fill the patient’s fallopian tubes if they are unblocked. But if the dye does not enter the tubes, then it indicates the patient’s fallopian tubes are blocked. Blocked tubes are one of the more common causes of infertility and can oftentimes be corrected with a minor surgical procedure.
Endometriosis is a condition that causes tissue to grow outside the uterus. This is a painful condition that may be regulated or corrected with medications, and or, surgical procedures. This often times affects the ovaries, fallopian tubes and pelvic lining, and can lead to fertility issues.
Hormone level imbalances are a major factor that can lead to fertility issues. They can be caused by many things like infection, inefficient vitamin and mineral levels, drug use, alcohol consumption, exposure to unsafe levels of environmental toxins, and things as simple as stress and body fat. Maintaining a proper balance of estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormones (FSH) are essential for women of childbearing age.
Reproductive Problems in Men
On the other side of the gender fence, as we mentioned earlier, studies show that 35% of infertility issues with couples are due to infertility in the male partner. Male fertility problems include low sperm count, sperm motility and sperm morphology. In layman terms, these refer to the lack of semen quality.
Less common fertility issues men experience includes Varicoceles; enlarged veins in the scrotum that may lead to fertility issues. A man’s body can also develop anti-sperm antibodies that may lower motility or even destroy a man’s sperm. Additionally, ejaculation problems may occur when blockages in ejaculatory ducts hinder sperm from making their way into ejaculate fluid.
When testing for male infertility, having your health care professional perform a semen analysis is a great place to start. This test measures characteristics of the sperm and semen. The main indicator obtained from this test is the volume and sperm count, which is the number of sperm. Also included in this test are the morphology of sperm, which is the percentage and number of normal sperm and the motility that registers how active the sperm are and how they move.
But good news, more help for male infertility is on the way. You will learn about male infertility clinics later in this article.
Testing Infertility in Women
Testing infertility in women has come a long way over the years. These tests range from a pelvic ultrasound known as imaging tests, ovarian reserve which determines the quantity and quantity of a female’s eggs and hormone testing. Hormone tests are a great way to test your fertility. These tests determine the levels of ovulation hormones as well as the hormone levels in thyroid and pituitary glands.
The most common pelvic ultrasound testing is the HSG test we mentioned earlier that includes injected dye to determine if FTs are blocked.
A home urine test is also a simple test women can perform easily and inexpensively at home. This test is called a luteinizing hormone test (LHT) and determines a woman’s LH level. When the level is high, it normally indicates you are ready to ovulate and as we all know, timing is important and necessary when trying to get pregnant.
Genetic testing is making its way into the mainstream more often these days. They aid in determining infertility issues in the male or female and whether or not diseases can be passed on to an unborn child. In genetic testing, blood tests are performed on potential couples to confirm there are no abnormal genes.
If abnormal genes are found, not only can this be the culprit for infertility issues, but if a pregnancy does go full-term, this could lead to genetic disorders in a newborn such as infantile Tay-sachs disease, Sickle Cell anemia, Fragile X syndrome (FXS) or thalassemia.
Tay-sachs causes a progressive deterioration of nerve cells and physical and mental abilities. FXS is an incurable genetic condition that causes issues with mental development. Sickle Cell disease can lead to circulatory impairment, anemia and infections. In addition, a pregnant woman that has a history of Sickle Cell disease has a higher risk of miscarriage.
Genetic testing has become a much more common practice amongst reproductive endocrinologists to help provide more detailed answers for couples experiencing infertility issues.
Signs of Fertility Problems in Women
Physical signs of fertility problems can alert couples as they try to conceive. In women, for example, changes in your menstrual cycle, pain in pelvic area, weight gain and loss of or thinning of hair are signs to be aware of.
The most obvious in this group is the menstrual cycle, so close attention should be given to how your body is communicating with you each month. If bleeding is heavier or lighter than usual, this may be a sign worthy of mentioning to your health practitioner. Women who have irregular periods statistically have a more difficult time getting pregnant. Painful periods can be a sign of potential infertility issues and an indication of endometriosis, polycystic ovary syndrome (PCOS), or other matters.
Being excessively under or over weight is another sign. Barring any medical gland type issues, these can be addressed with a change in diet, and or, exercise. In fact, according to the American Society of Reproductive Medicine (ASRM), 70% of women with weight related infertility issues may get pregnant without sophisticated infertility treatments. So taking action and making changes in diet and exercise may be the healthiest and most affordable solution for some.
Another possible cause of infertility mentioned earlier is Pelvic Inflammatory Disease. PID is an infection in a woman’s reproductive organs, and if left untreated may have a direct affect on her ability to get pregnant.
Our body speaks to us through physical signs, and when it does, it gives us an opportunity to react and respond to correct many of the aforementioned issues. So remember to recognize these important signs. It may increase your chances of getting pregnant.
Signs of Fertility Problems in Men
In men, many of the physical signs of infertility issues are much less evident and difficult to ascertain. Like the quality of their sperm, for example. Without testing, there is no sure way to tell if the semen is fertile because it is not visible to the naked eye.
More obvious signs of infertility issues in men include pain and swelling in the testicles, erectile dysfunction, and even obesity.
Statistically, obese men have lower sperm counts and lower quality semen than men of a healthy weight. Carrying excessive weight can also reduce fertility due to causing lower testosterone levels that are many times associated with that excessive weight. Male obesity has nearly tripled over the past 30 years in reproductive aged men and those numbers run parallel with global male infertility numbers.
While many factors may lead to infertility, becoming familiar with these signs can help a couple identify problems they can then relay to their health care professional who can offer help to correct the issues.
Male Infertility Clinic
As we mentioned earlier in this article, 35% of couple’s fertility issues are related to the male and infertility affects approximately 7% of all men. With those numbers, more couples are opting to get male fertility clinics involved. Before covering the male infertility clinics, you should understand there are three groups of factors that affect a male’s fertility: Pre-testicular, testicular and post-testicular.
Pre-testicular factors: Pre-testicular infertility factors are conditions that hinder the function of the testes and include hormonal issues and poor general health condition and habits. These pre-testicular issues can many times be corrected with intervention to lower the risk. Pre-testicular factors include:
- Tobacco smoking
- Heavy alcohol and drug use
- High temperatures in testes (hot tubs)
- Heavy riding of bicycle or horseback riding
- Testosterone and steroid use
As you can imagine, these pre-testicular factors can easily be controlled with a healthy change in lifestyle, diet and habits.
Testicular factors: Testicular factors refer to testicles that have hormonal support but are producing semen of poor quality. Testicular factors include:
- Genetic defects
- Varicocele / varicose veins in the scrotum
- Chromosome disorders
- Testicular cancer
NOTE: Varicose veins in the scrotum are found in approximately 40% of infertile men.
Post-Testicular factors: Post-testicular factors negatively affect the male genital system after sperm is produced. This is normally caused by defects of the genital tract and issues with ejaculation. The Post-testicular list includes:
- Vas deferens defect or obstruction
- Epididymitis / Infections
- Retrograde ejaculation (when sperm redirects into bladder)
- Ejaculatory duct obstruction
- Physical birth defects
Treatment at the Male Infertility Clinic
More and more clinics that specialize in the treatment of male factor infertility are opening globally. Their specialty: men. Male infertility doctors and clinics offer a thorough physical examination that starts with an examination of the testicles, scrotum, ejaculatory ducts, urethra, bladder and more. An instrument consisting of a string of twelve various sized beads, called an orchidometer, is used to measure and document the volume of the testicles which may be relevant to sperm and hormones.
Following an introductory exam, a sperm sample is usually taken to determine and evaluate sperm count, morphology (shape) and motility (movement). Doctors will first document if the sperm exists, and if so, are they moving, and how are they moving.
Blood is also drawn for testing hormone and testosterone levels as well. The blood work is evaluated to determine if any issues are present that can affect fertility and ultimately the health of a child. The hormone test is important and telling because the hormones produced by the hypothalamus, testicles and pituitary gland are key factors in sperm production.
We mentioned testosterone and anabolic steroid use as a possible cause of infertility. Testosterone treatments have become more widespread in men of all ages. But there may be negative side effects to testosterone treatment. And one is infertility. Testosterone treatments can decrease sperm production by lowering the FSH in a user’s system and FSH is essential in sperm production. Infertility caused by testosterone treatment is normally reversible and falls under our pre-testicular list.
Epididymitis was mentioned under the post-testicular list. Epididymitis refers to the inflammation of the epididymis, which transports and stores the sperm cells produced in the testes. The vas deferens also known as the ductus deferens are tubes that the sperm travels through. Epididymitis may cause scar tissue build up that may block the vas deferens tubes, thus not allowing the sperm to leave the testicle. This can cause male infertility if both testicles are affected or if the man has a history of recurring infections. There is treatment for epididymitis that includes antibiotics.
In some cases, doctors may order an ultrasound of the scrotum to further evaluate a patient. This test creates images that allow the doctor to see if varicocele or other problems in the testes exist.
After a thorough examination and evaluation with a specialist at a male infertility clinic, doctors should have a clearer picture if a couple’s infertility is related to the male and be able to offer up suggestions on how to correct and proceed.
Remember, there are many simple habits and lifestyle changes that can help counter infertility in men. Not smoking, limiting alcohol use, avoiding high temperatures in genital areas (like hot tubs for example), proper diet and exercise, and of course the head-scratching suggestion of avoiding ejaculating too often while avoiding ejaculating not frequently enough.
There are many definitions of infertility, depending on how and where you research.
For example, the World Health Organization (WHO) which is the health organization of the United Nations, defines infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse when there is no other reason, such as breastfeeding or postpartum.”
The definition used by many reproductive endocrinologists in the United States begins at six months separating the age groups at 35 years old to determine when patients fit the criteria for intervention. When you read this, it may seem confusing but there is a warranted reason. Many reproductive specialists believe if a woman under 35 has not conceived after 12 months of intercourse she fits the infertility criteria. But when a woman over 35 has not conceived after only six months of intercourse, she falls into the same intervention category. Their conviction is that women under 35 do not hold the same urgency as a woman over 35 when the clock is ticking and every month can make a difference and create more challenges.
Squashing the Myth
With strong medical support from the latest research and current practices that tackle the issues from both sides of the gender fence, the “myth” has been debunked! And more and more men are not only taking responsibility in the baby game, but taking action to correct reproductive issues.
A couple’s main objective should be to get past the hurdles and get pregnant, no matter who has the issue. That said, discuss your personal situation with your health care specialist to determine if there is an infertility issue, and if so, what partner in the relationship is affected so the challenge can be addressed and remedied.