What Is Infertility?
Infertility is defined by several key characteristics. It involves the inability to become pregnant based on a variety of circumstances, including a person’s medical, sexual, and reproductive history. For couples who have regular, unprotected intercourse without a successful pregnancy, it is recommended to consult with a fertility specialist after 12 months of trying for those under the age of 35, or six months for those over 35.
Infertility can be a complex and emotionally challenging journey for many couples and individuals and is a condition that affects people worldwide. Understanding the intricacies of infertility, from the biological processes involved to the various factors that can contribute to difficulties in conception, is crucial for those navigating this path.
How does egg quantity and quality impact fertility?
When it comes to infertility, women face a complex journey influenced by various factors, but perhaps none as significant as the egg factor. When they start their periods around the age of 13, they have around half a million egg follicles in their ovaries. These follicles are little sacs that each house an egg and represent the potential for future pregnancies.
This natural loss of egg follicles impacts the quantity and quality of your remaining eggs, referred to as ovarian reserve, and is an important factor in assessing a woman’s fertility potential. Ovarian reserve is evaluated through various tests such as ultrasounds and blood tests measuring hormones like anti-mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol (E2).
However, fertility isn’t solely determined by the number of eggs remaining; egg quality plays an equally important role. This refers to the egg’s ability to develop into a chromosomally normal embryo, which is important for a healthy pregnancy. Egg quality diminishes with age, which means women in their forties experience the lowest quality eggs. By age 45, the presence of quality eggs becomes rare, significantly reducing the chances of conception using one’s eggs.
Why is ovulation important when trying to get pregnant?
Ovulation is the release of a mature egg from the ovary. During ovulation, your body releases luteinizing hormone (LH) to help mature eggs in the ovaries. This typically occurs between days 12-16 of a woman’s menstrual cycle. Once an egg is mature, a surge of luteinizing hormone stimulates the mature egg follicle to release the egg. Once released, the egg travels into the fallopian tube, where it awaits fertilization by sperm.
On the male side, sperm production is a continuous process. Men produce millions of sperm each day within their testes. Following ejaculation, sperm travel through the male reproductive tract and into the vagina. Then, it needs to travel through the cervical mucus and into the fallopian tube to fertilize the egg.
While sperm can survive in the female reproductive tract for several days, the egg has a much shorter lifespan and has only about 24 hours after ovulation before it disintegrates. Therefore, the timing of intercourse is important for maximizing the chances of conception. Ovulation detection kits assist in identifying your fertile window and can help your conception efforts.
What causes infertility?
While many couples conceive without trouble, facing obstacles along the way is not uncommon. Infertility can be caused by various factors, from hormonal imbalances to medical conditions like polycystic ovarian syndrome (PCOS) or stress. Simple tests can help diagnose these issues, enabling targeted interventions to restore fertility.
Ovarian Reserve: One significant factor to consider is ovarian reserve, which refers to the quantity and quality of a woman’s remaining eggs. Ovarian reserve naturally diminishes over time, making conception more difficult. Tests such as ultrasounds and blood tests can assess ovarian reserve by measuring the number of remaining egg follicles and hormone levels. In addition to age-related decline in ovarian reserve, certain medical conditions can also impact fertility. Conditions such as polycystic ovarian syndrome (PCOS) and thyroid disorders can cause problems with ovulation and affect fertility.
Structural Problems: Fallopian tube health is another vital aspect of female fertility. Conditions like sexually transmitted infections (STIs) or endometriosis can lead to tube damage, which can hinder conception. Tests such as dye studies or hysterosalpingograms (HSG) can help doctors get a better idea of what your fallopian tubes look like and develop a treatment plan accordingly.
Recurrent pregnancy loss, a heartbreaking experience for many couples, can often be because of abnormalities in the uterus like fibroids, polyps, scar tissue, or uterine septums. However, advancements in surgical techniques offer hope for addressing these issues and improving pregnancy outcomes.
Male Infertility: Male factor infertility accounts for a significant proportion of infertility cases. Low sperm count, poor sperm motility, and abnormal sperm morphology can impair fertility. A semen analysis, a test that sheds light on sperm quality, is a standard diagnostic test for male infertility. Further evaluation may be necessary if any issues are detected in a semen analysis, including hormone testing, genetic testing, and imaging studies.
Lifestyle Factors: Lastly, lifestyle factors and environmental influences can play a significant role in fertility. Factors such as smoking, excessive alcohol consumption, obesity, and exposure to environmental toxins can negatively affect reproductive health and decrease fertility. Addressing these issues with lifestyle modifications and environmental changes can help improve fertility outcomes and increase the likelihood of conception.
Despite comprehensive evaluations, some couples receive the diagnosis of unexplained infertility. This frustrating label indicates a lack of identifiable causes despite normal test results. In such cases, assisted reproductive technologies like in vitro fertilization (IVF) offer a path forward, circumventing natural barriers to conception.
How is infertility treated?
For couples facing fertility challenges, the journey towards parenthood often involves exploring a range of treatment options, each tailored to address specific underlying issues.
Ovulation Induction: In cases where irregular ovulation hampers conception, medications such as clomiphene citrate or letrozole may be prescribed to stimulate egg production. These drugs help regulate the menstrual cycle and enhance the chances of successful ovulation.
Intrauterine Insemination (IUI): Also known as artificial insemination, IUI involves placing prepared sperm directly into the uterus during the woman’s fertile window. This procedure can bypass obstacles like cervical mucus issues and improve the chances of sperm reaching and fertilizing the egg.
In Vitro Fertilization (IVF): IVF remains one of the most advanced assisted reproductive technologies available. It involves stimulating the ovaries to produce multiple eggs, which are then retrieved and fertilized with sperm in a laboratory setting. The resulting embryos are subsequently transferred into the uterus, bypassing natural barriers to conception.
Intracytoplasmic Sperm Injection (ICSI): Often used in conjunction with IVF, ICSI involves injecting a single sperm directly into the egg to facilitate fertilization. This technique is particularly beneficial in cases of male factor infertility or when previous IVF attempts have yielded poor fertilization rates.
Preimplantation Genetic Testing (PGT): For couples at risk of passing on genetic disorders or those experiencing recurrent pregnancy loss, preimplantation genetic testing (PGT) offers a way to screen embryos for chromosomal abnormalities or specific genetic mutations before transfer. This ensures the selection of genetically healthy embryos, increasing the likelihood of a successful pregnancy.
Surgical Interventions: In cases where anatomical abnormalities such as uterine fibroids or polyps are identified, surgical procedures may be recommended to correct these issues. Hysteroscopic or laparoscopic surgeries can remove obstructions within the uterus or fallopian tubes, restoring optimal conditions for conception.
Donor Gametes or Embryos: For individuals or couples with severe fertility issues, utilizing donor eggs, donor sperm, or embryos may offer a viable pathway to parenthood. This approach enables individuals to achieve pregnancy when traditional methods prove unsuccessful.
Gestational Surrogacy: In situations where carrying a pregnancy to term is not possible due to medical reasons or uterine factors, gestational surrogacy provides an alternative option. A gestational surrogate carries the embryo created through IVF to term, allowing the intended parents to fulfill their dream of having a biological child.
Infertility is a multifaceted issue that can impact individuals and couples on physical, emotional, and psychological levels. By understanding the biological processes involved in conception, identifying potential obstacles to fertility, and exploring available treatment options, you can navigate your fertility journey with greater knowledge and empowerment. By working closely with fertility specialists and reproductive endocrinologists, you can explore the most appropriate treatment options tailored to your unique circumstances and personal preferences.
Our Practice
At Santa Monica Fertility, we offer the most advanced reproductive and fertility treatments in order to treat both common and complex causes of infertility. We work with patients from all over the world, to right here in our back yard in sunny Santa Monica, California, with a holistic approach coupled with comprehensive, customized care. Feel free to call us with questions, guidance or to check in and see if where you are is on track for the fertility journey – we are always happy to answer your questions.
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