Symptoms and treatment of Infertility

Description

If you and your partner are struggling to have a baby, you are not alone. Millions of people around the world face the same challenge. Infertility is the medical term for when you can't get pregnant despite having frequent, unprotected sex for at least a year for most couples.

Infertility can occur due to a health problem with either you or your partner, or a mixture of factors that prevent pregnancy. But many safe and effective treatments can increase your chances of getting pregnant.

Symptoms

The main symptom of infertility is not getting pregnant. There is perhaps no clear symptoms. Some women with infertility may have irregular menstrual periods or absent. And some men may have some signs of hormonal problems, such as changes in hair growth or sexual function.

Many couples will eventually conceive, with or without treatment.

When to see a doctor

It is likely that you don't need to see a member of your health care team about infertility unless you have been trying to get pregnant for at least a year. But women should talk with a health care professional before if you:

Are 35 years of age or older and have been trying to conceive for six months or more.
Are more than 40 years of age.
Do not have periods, or irregular or very painful periods.
You have infertility problems.
Has endometriosis, or a history of pelvic inflammatory disease.
Have had more than one miscarriage.
Have received treatment for cancer such as chemotherapy or radiation.

Men should talk with a health professional if:

A low number of sperm count or other problems with sperm.
A history of testicle, prostate or sexual conditions.
Had treatment for cancer such as chemotherapy.
I had hernia surgery.
The testes, which are smaller than the typical size of an adult, or inflammation of the veins in the pouch of skin that contains the testicles, called the scrotum.
Had infertility with a couple in the past.
Familiar with infertility problems.

Causes

All the steps during the ovulation and fertilization occur correctly in order to become pregnant. Ovulation is the release of an egg from the ovary. Fertilization is when the egg and sperm unite to form an embryo, which becomes a fetus during pregnancy. Sometimes, the problems that cause infertility in couples are present at birth. Other times, develop later in life.

The causes of infertility can affect one or both partners. In some cases, no cause can be found.

Causes of male infertility

These may include:

Conditions that can affect the amount of sperm, or sperm quality. These medical conditions can include undescended testicles, genetic defects, hormonal problems, and health problems such as diabetes. Infections such as chlamydia, gonorrhea, mumps or HIV can also affect the sperm. The enlargement of the veins in the scrotum, called a varicocele can affect the sperm quality.
Problems with the sperm to reach the female reproductive tract. These problems may be due to sexual conditions such as early ejaculation, certain genetic diseases such as cystic fibrosis, physical problems such as a blockage in the testicle, or damage or injury to the reproductive organs.
Certain factors in the environment. Exposure to pesticides, chemicals or radiation can affect fertility. So can drugs to treat bacterial infections, high blood pressure and depression. And if the testes are often exposed to heat, such as in saunas or hot baths, which may affect your ability to produce sperm.
Damage related to cancer and its treatment. Cancer treatments such as chemotherapy and radiation can affect the production of sperm.

Causes of female infertility

These may include:

Disorders of ovulation. These conditions affect the release of eggs from the ovaries. These include hormonal problems such as polycystic ovary syndrome. High levels of a hormone that is needed to make breast milk, called prolactin, which may also have an effect on ovulation. Too much thyroid hormone, called hyperthyroidism, or very little, is called hypothyroidism, can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, or tumors.
Conditions of the uterus. These include tumors called polyps in the uterus, the problems with the shape of the uterus, or problems with its lower end, which is called the cervix. The tumors in the wall of the uterus called uterine fibroids, also can be a cause of infertility, but are not cancer. Fibroids can block the fallopian tubes, where an egg and a sperm join together. You can also prevent a fertilized egg from attaching to the uterus, which must happen in order for a baby to develop.
Fallopian tube damage or blockage. Often, these problems are caused by the inflammation of the fallopian tube, called salpingitis. The swelling can occur due to an infection of the female reproductive organs called pelvic inflammatory disease.
The Endometriosis. With this condition, tissue similar to the lining of the uterus grows outside of the uterus. It can affect how well the ovaries, the uterus and the fallopian tubes of work.
Primary ovarian failure. This occurs when the ovaries stop working as they should, and menstrual periods end before 40 years of age. The cause is often unknown. But some of the factors that are associated with primary ovarian insufficiency, which include diseases of the immune system, genetic disorders such as Turner syndrome, and radiation or chemotherapy.
Pelvic adhesions. These are bands of scar tissue that attach to organs. You can form after pelvic infection, appendicitis, endometriosis, or surgery of the abdomen or pelvis.
Cancer and its treatment. Certain types of cancer, especially those that affect the reproductive organs — often reduce the fertility of the woman. Both radiotherapy and chemotherapy can affect fertility as well.

Risk factors

Many of the risk factors for male and female infertility are the same. They include:

Age. The fertility of the woman slowly decreases with age, especially in the mid-30's. Falls rapidly after age 37. Infertility in older women is probably due to the smaller amount and quality of the eggs, or health problems that affect fertility. Men over the age of 40 may be less fertile than younger men. The risk of birth defects and genetic problems also by the rise in children born to men over 40 years of age.
The consumption of tobacco. The smoking of tobacco by any of the parties can reduce the chances of pregnancy. You can also do that fertility treatments less effective. The risk of miscarriage may increase in women who smoke tobacco. When a pregnant person's partner smokes, which also increases the risk of abortion, even when the pregnant person is not a smoker. And the habit of smoking can increase the risk of erectile dysfunction and low sperm count in men.
The use of marijuana. Marijuana can impair fertility, but more research is needed. Use during pregnancy has been associated with negative health effects in unborn babies. It may also increase the risk of spontaneous abortion and fetal death.
The consumption of Alcohol. For women, there is no safe level of alcohol consumption when you are trying to get pregnant or during pregnancy. Alcohol can contribute to infertility. For men, excessive consumption of alcohol can reduce sperm count and affect the way sperm move.
The overweight. A sedentary lifestyle and being overweight or obese can increase the risk of infertility. Obesity is linked with a lower quality of semen, the fluid that contains sperm.
The deficit of weight. People at risk of fertility problems include those with eating disorders, such as anorexia or bulimia. Those who follow a very low-calorie or restrictive diet are also at risk.
The exercise of the problems. The lack of exercise play a role in obesity, which increases the risk of infertility. Less often, ovulation problems may be linked with frequent vigorous, intense exercise in women who are not overweight.

Prevention

Some types of infertility can't be prevented. But the following tips can increase the chances of pregnancy.

Couples

Have sex often shortly after the menstrual bleeding stops. One of the ovaries releases typically an egg in the middle of the cycle — half way between the menstrual periods — for the majority of people with menstrual cycles of 28 days apart. It is ideal to have sex all day from 5 to 7 days before the release of the egg. Continue until two days after ovulation.

Men

Most types of infertility are not preventable in men, but these tips can help:

Stay away from drugs, and tobacco, and not drinking too much alcohol. Doing illegal drugs, smoking or drinking too much can increase the risk of male infertility.
Do not take frequent baths in hot water. High temperatures can have a short-term effect on sperm production and movement.
Stay away from pollutants and toxins. These include pesticides, lead, cadmium, and mercury. Be exposed to them can affect the body's ability to produce sperm.
Limit the drugs that may affect fertility, if it is possible. Talk with your health care team about all the medications that you take regularly. Do not stop taking any prescription medications without the doctor's advice.
The work out. Regular exercise can improve the quality of sperm and increase the chances of a pregnancy.

Women

For women, the following tips can increase your chances of getting pregnant:

Stop smoking. Smoking has many negative effects on fertility. It's also terrible for your health and the health of an unborn baby. If you smoke and want to try to become pregnant, stop smoking now. You can ask your health care team for help.
Stay away from alcohol and street drugs. These substances may be less likely to conceive and have a healthy pregnancy. Do not drink alcohol or use recreational drugs, such as marihuana, if you are trying to get pregnant.
Limit the consumption of caffeine. Some women may need to cut back on the caffeine when you try to become pregnant. We ask your health care team for advice. During pregnancy, many experts recommend that no more than 200 milligrams of caffeine per day. That's about the amount in a 12-ounce cup of coffee. Check food labels for amounts of caffeine also. The effects of the caffeine is not clear to an unborn baby. But the effects of high amounts can include spontaneous abortion or premature labor.
Exercise safely. Regular exercise is the key to good health. But work out too intensely may cause your periods to occur less often, or it will disappear, and that it could affect fertility.
Getting to a healthy weight. Being overweight or underweight can affect your hormones and cause infertility.

Diagnosis

Before infertility testing, your health care team or clinic works to understand your sexual habits. They can make recommendations to improve your chances of getting pregnant. But in some infertile couples, no clear cause is found. That is called unexplained infertility.

Infertility testing may involve uncomfortable procedures. It can be very expensive. And some health plans do not cover the cost of fertility treatment. Also, there is no guarantee that you will get pregnant — even after all the testing and counseling.

The tests for men

Male fertility is based on the testicles from making enough healthy sperm. The sperm needs to be released from the penis into the vagina, where it has to travel to the waiting egg. Tests for male infertility trying to figure out if there are any problems treatable with any of these steps.

You can have a physical examination that includes a control of the genitals. Specific infertility tests can include:

Semen analysis. Your health care team may request one or more samples of your semen. Often, you collect the semen by masturbation or by the detention of sex to ejaculate into a clean container. Then, a laboratory check of your semen sample. In some cases, the urine may be tested to see if it contains sperm.
The hormone test. You can get a blood test to check the level of testosterone and other male hormones.
The genetic testing. This may be done to find out if a genetic defect is the cause of the infertility.
Testicular Biopsy. This procedure removes a small amount of testicular tissue for which a laboratory can be seen under a microscope. It is not common to need a biopsy for infertility testing. On rare occasions, can be done to find out if there is a blockage in the reproductive tract which prevents the sperm from leaving the body in the semen. Most of the times, this diagnosis can be made based on your history, physical examination, and laboratory tests. Other times, a biopsy may be done to find the conditions that contribute to infertility. Or it can be used to collect the sperm of the techniques of assisted reproduction such as in vitro fertilization (IVF).
The projection image. In some cases, your health care team may recommend tests that allow us to obtain images of the inside of your body. For example, the ultrasound can check if there are problems in the scrotum, in the glands that produce fluids that are converted in the semen or in the duct that carries sperm from the testicles. A brain mri can detect the presence of tumors of the pituitary gland, which are not cancer. These tumors can cause the gland to make too much of the hormone prolactin, which could lead the body to produce less sperm or none.
Other tests. In rare cases, other tests may be done to check the quality of your sperm. For example, a semen sample should be examined for problems with the DNA, which could damage the sperm.

The evidence for women

The fertility of women is based on the ovaries to release healthy eggs. The reproductive tract must stop an egg to pass through the fallopian tubes and sperm. Then, the fertilized egg must travel to the uterus and attach to the walls. Tests for female infertility trying to find problems with any of these steps.

You can have a physical examination, including a pelvic exam is normal. The infertility tests may include:

The ovulation tests. A blood test that measures levels of the hormone to find out if you are ovulating.
The thyroid function test. This blood test may be done if your health care team believes that their infertility can be due to a problem with the thyroid gland. If the gland produces too much of the thyroid hormone, which could play a role in fertility problems.
Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) check the condition of the uterus and fallopian tubes. Also, look for blockages in the fallopian tubes or other problems. Special dye is injected into the uterus, and an x-ray.
Ovarian reserve testing. This helps your care team to find out how many eggs you have to ovulation. The method often begins with the hormone of the assessment early in the menstrual cycle.
Other hormone tests. These check the levels of hormones that control ovulation. It also controls the pituitary hormones that control the processes involved in having a baby.
Imaging tests. Pelvic ultrasound looks for the diseases of the uterus or ovaries. Sometimes a test called a saline infusion ultrasound is used to view the details on the inside of the uterus, which can't be seen in an ultrasound. Another name for the saline infusion test is a sonohysterogram (son-or-your-ter-OH-gram).

Rarely, tests may include:

The hysteroscopy. Depending on your symptoms, your health care team may use a hysteroscopy (his-ter-os-ko-pee) to find a disease of the uterus. During the procedure, a thin, lighted device is placed through the cervix into the uterus to check the irregularities of the signs. It can also help to guide the minor surgery.
The laparoscopy. Laparoscopy (lap-u-ros-kuh-pee) is a small incision below the navel. Then, a thin display device is placed across the court to check the fallopian tubes, the ovaries and the uterus. The procedure can be found endometriosis, scarring, blockages or other problems with the fallopian tubes. You can also find treatable problems with the ovaries and the uterus. Laparoscopy is a type of surgery that can treat certain conditions. For example, can be used to remove growths called fibroids or endometriosis tissue.

It is not necessary for everyone to have all, or even many, of these tests before the cause of infertility is found. You and your health care team to decide which tests you will have and when.

Treatment

Treatment of infertility depends on:

The cause of the infertility.
How long you've been infertile.
Your age and the age of your partner, if you have a partner.
Personal preferences.

Some of the causes of infertility can't be corrected.

If pregnancy does not occur after one year of unprotected sex, couples often can you get pregnant through infertility treatments called assisted reproductive technology. But the treatment can result in large financial, physical, emotional and time commitments.

The treatment for men

The men of the treatment for sexual problems general or to a lack of healthy sperm can include:

Life-style changes. Your health care team may recommend that you take the following steps. Have sex more often and more near the time of ovulation. Get regular exercise. Drinking less alcohol or waive harmful substances such as tobacco. Stop taking medications that may affect fertility, but only if your health care team tells you to.
Drugs. Your computer may prescribe medications to improve sperm count and increase the chances of a successful pregnancy. These medications may help the function of the testes best.
Surgery. Sometimes, surgery may be able to reverse a sperm in the lock, and the restoration of fertility. In other cases, the repair of a large varicocele may improve the chances of pregnancy.
The sperm recovery procedures. These techniques may collect the sperm if you can't ejaculate, or if there is no sperm in the semen. The sperm recovery procedures can also be used when assisted reproductive techniques are planned and the sperm count is low or irregular.

The treatment for women

Some women need only one or two treatments to improve fertility. Others may need a couple of types of therapies to get pregnant.

Fertility drugs. These are the main treatments for infertility due to ovulation problems. They can help the ovaries release an egg if ovulation is irregular or stopped happening. Talk with your health care team about your options. Ask about the benefits and risks of each type of fertility medicine.
Intrauterine insemination (IUI). With IUI , the sperm is placed directly into the uterus at the time your ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, iui can be programmed with the menstrual cycle or with the use of fertility drugs. Your partner or a donor provides the sperm.
The surgery to restore fertility. Some conditions of the uterus can be treated with hysteroscopy. These include polyps, scar tissue, and some of the fibroids. The laparoscopic surgery, with small cuts or traditional surgery with a large incision in the abdomen may be necessary to treat conditions such as endometriosis, pelvic adhesions, and of greater size of the fibroids.

Assisted reproductive technology

The assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled.

In vitro fertilization (IVF) is the most common technique. Some of the key steps in a cycle of IVF include:

Fertility medications are used to help the ovaries to produce eggs.
Mature eggs are removed from the ovaries.
The eggs are fertilized with sperm in a dish in a laboratory.
The fertilized eggs, also called embryos are placed into the uterus. Embryos can also be frozen for future use.

Sometimes, other techniques are used in a cycle of in vitro fertilization, such as:

Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. Often, the ICSI is used when the semen quality or the quantity is low. Or it might be used if the fertilization of the attempts during prior cycles of IVF does not work.
Assisted hatching. This technique helps an embryo from attaching to the walls of the uterus. Opens the part of the outer covering of the embryo, which is why it is called hatching.
Donation of eggs or sperm. Often ART is made use of a couple's own eggs and sperm. But you have the option of using eggs or sperm from a donor. This is an option if you're single or in same-sex couples of the relationship. It is also done for medical reasons. These include poor egg quality due to the age and sperm problems such as a blockage in the reproductive tract. Donation of eggs or sperm, it can also be used if a person has a genetic disease that can be transmitted to a baby. An infertile couple can use donated embryos too. These come from other couples receiving infertility treatment, and there were remains of embryos that were frozen.
Surrogate motherhood. People who do not have a working uterus or for which the pregnancy poses a serious risk to the health could choose IVF using a carrier gestational. In this case, the couple's embryo is placed in the uterus of a person who undertakes to carry the pregnancy.
The genetic testing. The embryos made with IVF can be tested for genetic problems. This is called preimplantation genetic testing. The embryos that don't seem to have a gene problem that can be placed in the uterus. This reduces the risk of a father passing a genetic condition to a child.

Complications of treatment

Complications of the treatment of infertility may include:

Multiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. A greater number of unborn babies in the womb increases the risk of premature labor and delivery. It also causes problems during pregnancy are more likely, such as gestational diabetes. Babies who are born too early to face the worst odds of the health and development challenges. Ask your health care team about all the risks of a multiple pregnancy before starting treatment.
The ovarian hyperstimulation syndrome (OHSS). Fertility drugs can cause this condition in which the ovaries become swollen and painful. The risk of ovarian hyperstimulation syndrome increases with the use of assisted reproductive technologies like in vitro fertilization. Symptoms may include mild pain in the area of the stomach, bloating and upset stomach that lasts about a week. Nausea can last longer if you become pregnant. Rarely, a more severe form of ovarian hyperstimulation syndrome causes rapid weight gain and difficulty breathing. This is an emergency that must be treated in the hospital.
Bleeding or infection. The technology of assisted reproduction or reproductive surgery comes with a risk of bleeding or infection.

Coping and support

Coping with infertility can be very hard, because there are so many unknowns. The journey can take a serious emotional impact. These steps may help you cope:

Be prepared. The uncertainty of infertility testing and treatments can be stressful. Ask your doctor about fertility to explain the steps and prepare for each one.
Set limits. Before you start the treatment, decide which procedures and how much you can afford economically and accept emotionally. Infertility treatments can be expensive and often not covered by insurance companies. What's more, a successful pregnancy usually depends on more than an attempt at treatment.
Think of other options. You might need to use donor sperm or eggs, or a carrier gestational. You could also consider the adoption of a child or the choice not to have children. Think about these options as soon as possible in the evaluation of infertility. Can relieve anxiety during treatment, and feelings of hopelessness if you are not pregnant.
Seek support. You may want to join an infertility support group or talking with a counselor before, during or after the treatment. You can help carry you through the whole process and the ease of the penalty if the treatment does not work.

Manage stress during the treatment

Try these tips to help you take the stress load during the treatment of infertility:

Express yourself. Reach out to others. It can help you to deal with emotions such as anger, sadness or guilt.
Stay in touch with their loved ones. Talk with your partner, family or friends. The best support that often comes from the loved ones and those closest to you.
Finding ways to relieve stress. Some studies suggest that people who receive help to manage stress during infertility treatment with ART has slightly better outcomes than those who do not receive help. Take steps to reduce the stress in your life before trying to get pregnant. For example, you can learn meditation, practice of yoga, to keep a diary or make time for other hobbies that relax you.
Exercise, eat a balanced diet and getting enough sleep. These and other healthy habits can improve your outlook and stay focused on living your life.

The emotional management of the effects of the results

You can have emotional problems, regardless of their results:

Not getting pregnant or having a miscarriage. The stress of not being able to have a baby may be terrible, even in the most loving, supportive relationships.
Success. Even if the fertility treatment is correct, it is common that the stress and the fear of failure during pregnancy. If you have ever had depression or anxiety in the past, you are at greater risk of mental health disorders in the months after the birth of your child.
Multiple births. A successful pregnancy that results in multiple pregnancies can add stress during pregnancy and after childbirth.

Get the professional help of a therapist if the emotional impact of infertility treatment, pregnancy or motherhood becomes too heavy for you, or your partner.

Preparing for your appointment

Depending on your age and your medical history, your usual health professional may recommend a medical evaluation. A gynecologist, urologist or family doctor can help find out if there is a problem that requires a specialist or clinic that deals with problems of infertility. In some cases, you and your partner may need a complete infertility evaluation.

What you can do

To prepare for your first appointment:

Note the details about your attempt to get pregnant. Write down the details about when he started trying to conceive, and how often you have had sex, especially around the middle of your menstrual cycle — the time of ovulation.
Bring your key medical information. Include any other health condition that you or your partner has, as well as information on any previous version of infertility evaluations or treatments.
Make a list of all the medicines, vitamins, herbs, or other supplements that you take. Include the amount you take, called the dose and the frequency with which you take them.
Make a list of questions to ask your health care team. List of the most important questions first, in the case of time runs short.

For infertility, some basic questions to ask your care team include:

What kind of testing we need to find out why they have not been conceived yet?
What treatment do you recommend you try first?
What side-effects of the treatment of the cause?
What are the chances of having a multiple pregnancy with the treatment?
Many times we may need to attempt this treatment before conception?
If the first treatment does not work, what we recommend you try the following?
There are long-term complications associated with this or other infertility treatments?

Feel free to ask your healthcare provider to repeat information or to ask questions.

What to expect from your doctor

Be prepared to answer questions that your health care professional asks. Their answers may help your doctor determine what treatments and tests you may need.

Questions for couples

Some of the questions that you and your partner may be asked are:

How long have you been trying to get pregnant?
How often do you have sex?
Do you use any of the lubricants during sex?
Do you smoke?
Do any of you use alcohol or recreational drugs? What's the frequency?
Are you taking any medications, dietary supplements, or anabolic steroids?
Have any of you been treated for other medical conditions, including sexually transmitted infections?

Questions for men

Your health care professional may ask:

Do you have any difficulty to put on muscle, or taking any type of substances to increase muscle mass?
Have you ever noticed a feeling of fullness in the scrotum, especially after staying for a long time?
Do you have any testicle pain or pain after ejaculation?
Have you had any sexual challenges, such as difficulty in maintaining an erection, ejaculating too soon, not being able to ejaculate or have less sexual desire?
Has conceived a child with any of the above couples?
Do you usually take hot baths or steam baths?

Questions for the woman

Your health care professional may ask:

At what age did you get your menstrual period?
What are your cycles normally? How to regular, long and heavy they are?
Have you ever been pregnant?
Has been charting your cycles or ovulation tests? If so, in how many cycles?
What is the typical daily diet?
Do you exercise? What's the frequency?