What does infertility mean ?

According to medical terminology, infertility refers to the inability of a couple to conceive despite having regular, unprotected sexual intercourse (approximately 3–4 times per week) for a period of one year without achieving pregnancy.

If a couple has difficulty conceiving and wishes to have children, it is advisable to assess potential risk factors that may contribute to infertility. These risk factors include irregular menstrual cycles, a history of accidents, or surgeries involving the reproductive organs, such as the fallopian tubes or testes. Consultation with a physician is recommended without waiting for a full year, particularly for women over the age of 35.

Causes of Male Infertility

Men may experience fertility problems related to a low sperm count, poor sperm motility, or abnormal sperm morphology. These issues may result from various factors, including:

• Genetic factors: Certain genetic conditions may lead to reduced sperm production or the complete inability to produce sperm.

• Medications: Some medications, such as chemotherapy drugs, radiation therapy, medications used for addiction treatment, as well as smoking and alcohol consumption, may negatively affect fertility.

• Chronic diseases: Conditions such as diabetes, thyroid disorders, or hormonal imbalances can impair male fertility.

• Severe trauma or surgery: Serious injuries or surgeries involving the reproductive organs may lead to fertility problems.

Causes of Female Infertility

• Increasing age: As women age, factors such as stress, weight-related issues, poor nutrition, smoking, alcohol consumption, or substance abuse may adversely affect fertility.

• Chronic diseases: Conditions such as diabetes, thyroid disorders, or hormonal imbalances can affect female fertility.

• Congenital abnormalities of the reproductive organs: Some women are born with structural abnormalities that affect their reproductive system.

• Fallopian tube blockage: Inflammation or previous surgeries may cause blockages in the fallopian tubes, preventing fertilization.

• Abnormal ovarian function: Irregular or absent ovulation, ovarian cysts, or poor egg quality can reduce fertility.

How Do Doctors Determine the Causes of Infertility?

• Doctors will obtain a detailed medical history from both partners.

• For women, this includes questions about menstrual cycles, menstrual pain, and medical history such as pelvic inflammatory disease or sexually transmitted infections.

• For men, doctors will inquire about past injuries, sterilization procedures, or infections involving the reproductive organs.

• A general physical examination is performed to assess overall health.

• Semen analysis is conducted for male patients.

• For female patients, internal examinations such as ultrasound are performed to evaluate abnormalities of the uterus, fallopian tubes, or ovaries. In some cases, a contrast dye may be injected into the uterus followed by an X-ray to assess the uterine cavity and fallopian tube patency.

Once the underlying causes of infertility are identified, doctors will address these issues first. For example, if uterine fibroids interfere with pregnancy, surgical removal may be recommended. If treating the underlying cause does not result in natural conception, physicians will provide counseling and consider assisted reproductive technologies.

Assisted Reproductive Technologies (ART)

If natural conception is not possible, doctors will select the most appropriate assisted reproductive technology based on success rates, costs, potential complications, and patient comfort.

1. Intrauterine Insemination (IUI)

This method is suitable for men with mild sperm abnormalities and women with a healthy uterus and unobstructed fallopian tubes. The procedure involves ovarian stimulation followed by the placement of prepared sperm directly into the uterus on the day of ovulation.

2. Gamete Intrafallopian Transfer (GIFT)

GIFT is an older technique that is now rarely used. It involves stimulating the ovaries, collecting eggs via laparoscopy, mixing them with prepared sperm, and placing them into the fallopian tubes to allow fertilization to occur naturally within the body.

3. Zygote Intrafallopian Transfer (ZIFT)

ZIFT is a commonly used assisted reproduction method. It is suitable for couples with fallopian tube blockage, hormonal disorders affecting fertilization, or poor sperm motility. The procedure includes ovarian stimulation, egg retrieval via laparoscopy, laboratory fertilization, embryo culture for 3–5 days, and transfer of embryos into the fallopian tubes. The success rate per cycle is approximately 30–40%.

4. Intracytoplasmic Sperm Injection (ICSI)

ICSI is a specialized technique within in vitro fertilization (IVF). It is used when the male partner has poor-quality sperm. A single healthy sperm is directly injected into the egg under a microscope. After embryo culture for 3–5 days, the embryos are transferred into the uterus. The success rate per cycle is approximately 30–40%.

Preparation for Assisted Reproductive Technology

• Women are advised not to delay pregnancy until after the age of 35 due to increased risks of chromosomal abnormalities and miscarriage.

• Smoking cessation and avoidance of alcohol are strongly recommended.

• A comprehensive health examination should be performed to identify and treat any underlying medical conditions.

• Regular exercise, adequate rest, and stress management are essential.

Preparation for Sperm Collection

• Men should abstain from ejaculation for at least 3 days but no longer than 7 days before sperm collection.

• Avoid smoking and alcohol consumption.

• Maintain regular exercise and sufficient rest.

• Minimize stress.

Menstrual Cycle Signs That May Indicate Difficulty Conceiving

• A normal menstrual cycle should be regular, lasting 21–35 days. Cycles that are shorter or longer may indicate ovulatory dysfunction, often associated with obesity or elevated androgen levels.

• Light menstrual flow may suggest thinning of the uterine lining or endometrial disorders.

• Heavy menstrual flow may indicate uterine fibroids or abnormal tissue within the uterus.

• Prolonged menstruation may be associated with a thickened uterine lining or fibroids.

• Non-menstrual symptoms such as frequent urination, constipation, or palpable lower abdominal masses may result from abnormal tissue pressing on nearby organs.

Women who suspect fertility-related abnormalities should consult a physician promptly to identify and treat underlying causes before fertility declines further. These conditions affect overall health, not only fertility.

Tips to Increase the Chances of Pregnancy Before Consulting a Specialist

• Timing of ovulation: Ovulation typically occurs around days 14–16 of the menstrual cycle, counting from the first day of menstruation. This applies only to women with regular 28–30 day cycles.

• Men should abstain from sexual intercourse for 2–3 days before ovulation to allow adequate sperm accumulation.

• Some lubricants contain spermicidal agents and should be avoided.

• Increasing age in both partners may reduce fertility.

• Obesity in men can decrease sperm count and quality.

• Obesity in women is commonly associated with menstrual irregularities and ovulatory dysfunction.

• Alcohol consumption, smoking, certain medications, and exposure to toxins can negatively affect sperm quality and quantity. Nicotine may also reduce sexual desire.

• Stress and lack of physical activity can disrupt hormonal balance and libido.

• Excessive heat exposure, such as hot baths, hot tubs, or prolonged motorcycle riding in hot weather, may impair sperm production and should be avoided.