Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year or for at least six months if the woman is age 35 or older. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found.
Fortunately, there are many safe and effective therapies for overcoming infertility. Drugs or surgery are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.
Causes of male infertility
A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. The most common causes of male infertility include:
Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects or repeated infections.
Problems with the delivery of sperm due to sexual problems, health issues, certain genetic diseases or structural problems.
General health and lifestyle issues, such as poor nutrition, obesity, or use of alcohol, tobacco and drugs.
Overexposure to certain environmental factors, such as pesticides and other chemicals. In addition, frequent exposure to heat can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
Damage related to cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility. Removal of one or both testicles due to cancer also may affect male fertility.
Age. Men older than age 40 may be less fertile than younger men.
Causes of female infertility
The most common causes of female infertility include:
Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis).
Endometriosis, which occurs when the uterine tissue implants and grows outside of the uterus – often affecting the function of the sperm, egg and ovaries, uterus, and fallopian tubes.
Ovulation disorders, which can prevent the ovaries from releasing eggs (anovulation). Underlying causes may include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.
Elevated prolactin, the hormone that stimulates breast milk production. High levels in women who aren’t pregnant or nursing may affect ovulation.
Polycystic ovary syndrome (PCOS), a condition in which your body produces too much of the hormone androgen causing ovulation problems. PCOS is also associated with insulin resistance and obesity.
Early menopause, which is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.
Uterine fibroids, which are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.
Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.
In vitro fertilization (IVF)/Microinjection
IVF/Microinjection is a procedure used to treat fertility problems and assist with the conception of a child. During IVF/Microinjection, mature eggs are retrieved from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of IVF/Microinjection takes about two weeks.
IVF/Microinjection is the most effective form of Assisted Reproductive Technology (ART). The procedure can be done using your own eggs and your partner’s sperm, donor eggs, donor sperm or donor embryos. In some cases, a gestational carrier – a woman who has an embryo implanted in her uterus – might be used.
Your chances of having a healthy baby using IVF/Microinjection depend on many factors, such as your age and the cause of infertility. In addition, IVF/Microinjection can be time-consuming, expensive and invasive. If more than one embryo is implanted in your uterus, IVF/Microinjection can result in a multiple pregnancy.
The chances of giving birth to a healthy baby after using IVF/Microinjection depend on various factors, including:
Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF/Microinjection. According to the Society of Assisted Reproductive Technologies (SART), the approximate chance of giving birth to a live baby after IVF/Microinjection is as follows:
• 41-43% for women under age 35
• 33-36% for women age 35 – 37
• 23-27% for women ages 38 – 40
• 13-18% for women over age 41
Embryo status. The live birth rate is lower when frozen embryos are used instead of fresh embryos. The use of fresh or frozen sperm, however, hasn’t been shown to affect success rates.
Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using IVF/Microinjection. Success rates are lower for women who’ve previously used IVF/Microinjection multiple times, but didn’t get pregnant.
Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant. Women who have endometriosis are less likely to be able to get pregnant using IVF/Microinjection.
Lifestyle factors. Smoking can lower a woman’s chance of success using IVF/Microinjection by 50 percent. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.
One of the most frustrating problems in infertility today is IVF/Microinjection failure – also called implantation failure. This refers to infertile patients who have undergone many IVF/Microinjection cycles and produced embryos but the embryos have consistently failed to implant for unexplained reasons.
A common reason for a failed IVF/Microinjection cycle is a poor ovarian response, which means patients get few eggs and few embryos. For these patients, two options are offered:
The option of aggressive superovulation, with high doses of HMG in order to help them grow more eggs.
The option of ZIFT (Zygote Intra-Fallopian Transfer) in which to transfer the embryos directly into the fallopian tubes by performing a laparoscopy.
This has a better pregnancy rate than IVF/Microinjection, because we put the embryos back where they belong – in the fallopian tubes, rather than in incubator.
Successful embryo implantation depends upon the health of the embryo, and one of the reasons embryos may fail to implant is that they may be chromosomally abnormal (even though they look normal). Research has shown that the incidence of chromosomal abnormalities even in good looking embryos is as high as 50%!
On an intellectual level, we understand that there are broadly only two groups of reasons for failure of implantation. One could be that the embryos are not of good quality; while the other is that there is a problem with endometrial receptivity.
Growing embryos to blastocyst stage (rather than transferring them on Day 2 or 3) is the best way we have today of ensuring that the embryos are competent. If the embryos do not grow up to the blastocyst stage in the incubator in vitro means that the problem for recurrent implantation failure is quite likely to be an embryo problem. This is especially true when patients with recurrent implantation failure have had multiple failed IVF/Microinjection cycles with only Day 2 or Day 3 transfers.