Overview of Fertility

What Causes Infertility?

Causes of infertility can vary greatly between men and women, and in many cases, the underlying factors may involve a combination of physiological, environmental, lifestyle, and genetic factors.

Factors such as high levels of stress, smoking, excessive alcohol consumption, sedentary lifestyle, obesity and poor nutrition can lead to male infertility and female infertility.

Infections, cancer, autoimmune disorders, diabetes or prior surgeries are some of the medical conditions that can affect fertility in both males and females. Even treatment for certain medical conditions such as cancer can impact fertility negatively in some cases.

Below is a comprehensive list of factors contributing to infertility in both women and men:

Causes of Infertility in Women:

- Age:As women grow older, particularly those aged 35 or above, their fertility decreases significantly due to both a qualitative and quantitative decline of eggs.

- Ovulation Disorders:Dysfunction of the hypothalamus or pituitary gland, disorders such as polycystic ovary syndrome (PCOS) and Hormonal irregularities like thyroid issues are known to disrupt ovulation patterns, potentially leading to irregular or absent ovulation and impacting fertility negatively.

- Fallopian Tube Blockage or Damage:Injury or obstruction of the fallopian tubes due to infections like pelvic inflammatory disease, endometriosis, adhesions or previous surgeries can impede the fertilization process or the egg's journey to the uterus.

- Endometriosis:This refers to a condition where tissue with characteristics similar to the uterine lining develops in locations outside the uterus. It causes inflammation, scarring and adhesions which could impair fertility.

- Uterine or Cervical Irregularities:Abnormalities of the uterus including fibroids, polyps, congenital malformations and abnormalities of the cervix such as cervical stenosis can interfere with implantation or conveyance of the sperm.

In some rare cases, causes of infertility in women can go unexplained despite a thorough evaluation.

Causes of Infertility in Men:

Sperm Disorders:Problems with sperm production, function or motility can lead to male infertility. These may include:

• oligospermia - low sperm count
• Asthenospermia - poor sperm motility
• Teratospermia - abnormal sperm morphology
• Azoospermia - absence of sperm

Varicocele:This is a condition which occurs when veins that drain the testicle are swollen. This affects blood flow and can impair sperm production or function.

Testicular Factors:Testicular trauma, surgery, or conditions such as cryptorchidism (undescended testicles) can impair sperm production and male fertility.

Hormonal Imbalances:Disorders of the hypothalamus, pituitary gland or testes which affect hormone production can disrupt sperm production and affect fertility in men negatively.

Genetic Factors:Genetic abnormalities such as Y chromosome microdeletions and other chromosomal defects can affect sperm production or sperm quality

Pollutants and Harmful Substances:Exposure to environmental toxins, excessive radiation, pollutants or certain medications can impact sperm quality and fertility. It is important to understand that infertility is a complex issue which can be caused by a combination of multiple factors. Evaluation and timely interventions by a fertility specialist can help identify the underlying causes and improve outcomes.

How is Infertility Diagnosed?

Diagnosing infertility in both men and women typically involves a comprehensive evaluation that may include medical history, physical examination, and various diagnostic fertility tests.

Here's is a breakdown of fertility testing for women and men:

Fertility tests for women:

Ovulation Assessment:Methods to assess ovulation include tracking menstrual cycles, monitoring basal body temperature, ovulation predictor kits and hormonal blood tests (such as measuring serum progesterone levels).

Hormonal Testing:Blood tests may be done to measure hormone levels in women. Some of the tests include follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, thyroid hormones and prolactin to evaluate ovarian function and detect hormonal imbalances.

Ultrasound:Transvaginal ultrasound or pelvic ultrasound imaging may be used to visualize the ovaries and uterus. They can help identify structural abnormalities such as fibroids or ovarian cysts and assess ovarian reserve (the quantity and quality of eggs).

Hysterosalpingography (HSG):This imaging examination involves the administration of contrast dye into the uterus and fallopian tubes, then utilizing X-ray images to examine tubal patency and identify any uterine irregularities.

Laparoscopy:In certain instances, a minimally invasive surgical procedure called laparoscopy may be undertaken to visually examine the pelvic organs, investigate for endometriosis and assess the patency of the fallopian tubes.

Sonohysterogram (SHG):A sonohysterogram is also referred to as saline infusion sonography (SIS). It is a diagnostic imaging procedure which is used to evaluate the uterine cavity and detect abnormalities. It involves the insertion of a small catheter into the uterus, through which saline solution is injected to expand the uterine cavity. An ultrasound is then performed to visualize the lining of the uterus and detect any abnormalities such as polyps, fibroids, adhesions or uterine anomalies.

Hysteroscopy:Utilized as a minimally invasive surgical method, hysteroscopy is employed to inspect the inner lining of the uterus (known as the endometrial cavity) and to diagnose or address abnormalities. This procedure involves the insertion of a narrow, illuminated tube referred to as a hysteroscope through the vaginal opening and cervix into the uterus. Equipped with a camera, the hysteroscope enables doctors to visualize the uterine lining on a monitor.

Ovarian Reserve Test (ORT):Ovarian reserve tests are a set of assessments particularly useful in gauging the quantity and quality of a woman's remaining egg reservoir or ovarian reserve. Among the common ovarian reserve assessments are blood tests to evaluate levels of hormones including luteinizing hormone (LH), anti-Müllerian hormone (AMH), estradiol and follicle-stimulating hormone (FSH). The quantity of antral follicles (tiny fluid-filled sacs in the ovaries) can also be assessed using Transvaginal ultrasounds.

Diagnosis of Infertility in Men:

Semen Analysis:It is pivotal in the assessment of male infertility. It involves analyzing a semen sample for sperm count, motility, morphology (shape), and other parameters.

Hormonal Testing:Blood tests can be performed to gauge hormone levels, encompassing testosterone, FSH, LH, and prolactin, aiding in the assessment of testicular function and the detection of hormonal anomalies.

Genetic Testing:In certain cases, men may need to be screened for chromosomal abnormalities or specific genetic conditions that affect sperm production or function.

Karyotyping (Genetic testing):Analyzing chromosomal abnormalities in peripheral blood samples is a routine procedure, often done to evaluate fertility related issues. Detecting abnormal karyotypes in these blood samples can hint at potential similar abnormalities in sperm cells, highlighting potential concerns regarding fertility. This indirect correlation underscores the importance of thorough genetic screening in assessing reproductive health. This connection emphasizes why it's crucial to conduct comprehensive genetic tests to evaluate reproductive health effectively.

Sperm DNA fragmentation index:The sperm DNA fragmentation index (DFI) is used to evaluate the integrity and damage of sperm DNA. It serves as a vital marker for semen quality and aids in the assessment of sperm fertility.

Anti Sperm Antibodies:Antisperm antibodies (ASAs) are antibodies or immune system proteins that target and attack sperm cells. They mistakenly identify sperm cells as foreign substances and cause harm or destruction.

Semen culture and sensitivity testing:Culture and sensitivity testing is conducted to eliminate the possibility of infections in semen. This is crucial because various bacterial infections can alter sperm morphology and motility. This test is primarily used to test the sensitivity of aerobic bacteria, which can infect testicles and cause infertility.

Dehydroepiandrosterone (DHEA) is an important hormone in the body, mainly because it's the most abundant steroid hormone circulating in the bloodstream. While it doesn't exert significant biological effects on its own, its conversion into other hormones such as sex steroids can have profound impacts

Imaging Studies:In some cases, imaging tests such as scrotal ultrasound may be performed to evaluate the testes, epididymis and vas deferens for structural abnormalities or obstruction.

How is infertility treated?

Implementing lifestyle modifications such as reducing weight, coping with stress effectively and avoiding or limiting smoking and alcohol consumption can improve fertility outcomes in both men and women. In most cases, people with infertility will be treated using a combination of lifestyle modifications, medications, conventional therapies or surgery in certain cases. If all else fails then doctors may recommend Assisted Reproductive Techniques (ART).

Treatment for Infertility in Women:

Ovulation Induction:Medications such as clomiphene citrate, letrozole, or gonadotropins may be recommended for women with ovulation disorders to stimulate ovulation.

Hormone Therapy:Hormonal medications may be prescribed to regulate menstrual cycles, treat hormonal imbalances, or support the early stages of pregnancy.

Surgical Interventions:Surgical procedures may be performed to correct structural abnormalities of the reproductive organs, such as removing fibroids, repairing blocked fallopian tubes, or treating endometriosis.

Hysteroscopy is one such common surgical procedure done commonly to remove fibroids or polyps in the uterus.

Assisted Reproductive Technologies (ART):For cases of severe male factor infertility or unsuccessful prior treatments, advanced methodologies such as intracytoplasmic sperm injection or ICSI, egg donation and preimplantation genetic testing or PGT could be explored.

- Intrauterine Insemination (IUI):During Intrauterine Insemination (IUI), washed and concentrated sperm are directly inserted into the uterus around ovulation to increase the probability of fertilization.

- In Vitro Fertilization (IVF):During IVF, eggs are harvested from the ovaries, fertilized with sperm in a controlled laboratory environment and then placed into the uterus for implantation. It is often recommended for women with tubal factor infertility, endometriosis or unexplained infertility.

- In Vitro Maturation (IVM):It is an assisted reproductive technology (ART) procedure similar to in vitro fertilization (IVF), but with a key difference in the timing of egg maturation. In In Vitro Maturation, immature eggs (oocytes) are retrieved from the ovaries before they have fully matured naturally. These immature eggs are then matured in a laboratory setting before they are fertilized with sperm.

Infertility Treatment for Men

Medications:Medications such as clomiphene citrate, anastrozole, or human chorionic gonadotropin (hCG) may be prescribed to stimulate sperm production or improve sperm quality in men with hormonal imbalances or low sperm counts.

Surgical Interventions:Surgical procedures may be performed to correct structural abnormalities of the reproductive tract, such as varicocele repair or vasectomy reversal.

Sperm Retrieval:In instances of obstructive azoospermia or the inability to retrieve sperm through ejaculation, sperm can be directly collected from the testicles or epididymis to be utilized in Assisted Reproductive Technologies or ART procedures.

Assisted Reproductive Technologies (ART):Strategies like Intracytoplasmic Sperm Injection (ICSI) can be employed to address significant male factor infertility by directly injecting a single sperm into an egg during the IVF process

Donor sperm or eggs may also be considered for use in cases of severe male infertility or female infertility, provided the couple consents to it.

Genetic counseling may also be recommended for couples with known genetic conditions or a family history of genetic disorders to assess the risk of passing on genetic abnormalities to their offsprings.

Who should consider fertility testing?

Infertility testing may be considered for individuals or couples who have been unable to conceive after actively trying to conceive for a certain period of time.

Women with known risk factors for infertility including:

- Women with history of chemotherapy or radiation therapy

- Women with heavy or irregular menstrual cycles (more than 35 days between consecutive periods)

- Women with polycystic ovary syndrome (PCOS), endometriosis or pelvic inflammatory disease (PID)

- Women who have had pelvic surgery previously

- Women who have been diagnosed with issues in the ovaries, uterus or fallopian tubes.

- Women who have had multiple or recurrent miscarriages

- Women whose male partners are suspected or identified with fertility issues

Women under the age of 35 who have been trying to conceive for 12 months without success and women aged between 35 and 40 who have been trying to conceive for 6 months without success should consider fertility testing.

Women over 40 who are trying to conceive should actively seek fertility testing as fertility declines significantly after this age.

There is no specific timeline for men to consider infertility testing, as male fertility does not decline as sharply with age as female fertility does. However, men with known risk factors for infertility or those who are experiencing symptoms such as erectile dysfunction, testicular pain, a history of sexually transmitted infections, previous groin or testicular surgery, hormonal imbalances or abnormalities in semen or sperm quality should seek evaluation promptly.

If you are wondering where you can find an affordable and reliable diagnostic center for fertility testing near me then look no further than Vijaya Diagnostics. With over 140+ NABL accredited and ISO compliant labs across 20+ cities, you’re sure to find a Vijaya Diagnostic center near you!

Embark on the journey to parenthood with Vijay Diagnostic's holistic infertility panel, catering to both male and female fertility concerns, complemented by our detailed PCOD package tailored for women. Our thorough evaluations are customized to address your unique concerns, empowering you with personalized insights and solutions to make well-informed decisions.

What’s more? Experience the convenience of 5000+ diagnostic tests, instant appointment booking, home sample collection and enjoy exclusive discounts, cashbacks and more on the Vijaya Diagnostic app!

Frequently Asked Questions

1. What factors can affect fertility in both men and women?

Ans - Various factors can impact fertility in both men and women including:

- Age: Fertility naturally declines with age (especially for women in their late 30s or above).

- Lifestyle factors such as smoking, excessive alcohol consumption and obesity can impact sperm and egg quality

- Hormonal imbalances

- Medical conditions such as polycystic ovary syndrome or PCOS (in women) or erectile dysfunction (in men). Chronic health conditions such as diabetes and thyroid disorders can impact fertility significantly

- Environmental factors: Exposure to toxins, radiation or certain chemicals can impact fertility

- Genetic factors

2. Are there any risks or side effects associated with fertility treatments?

Ans - Fertility treatments, such as assisted reproductive technologies (ART) like in vitro fertilization (IVF) and medication-based interventions, may carry risks and side effects. Common risks include multiple pregnancies, ovarian hyperstimulation syndrome (OHSS), ectopic pregnancy, and emotional stress. Side effects of fertility medications may include mood swings, hot flashes, and abdominal discomfort.

3. What lifestyle factors can impact fertility?

Ans - Lifestyle choices can significantly impact fertility.Maintaining a healthy weight, avoiding smoking and alcohol consumption, managing stress levels, getting regular exercise, consuming a balanced diet rich in nutrients, and avoiding exposure to environmental toxins can all improve fertility in both men and women.