INFERTILITY: CAUSES, DIAGNOSIS, RISKS, TREAMENTS

10+ Ways to Boost Your Fertility

It's an aspect of our health that most of us take for granted: Have sex, get pregnant, right? In reality, even minor stressors can throw your body out of whack. If you're trying to conceive, these simple health moves can help protect your fertility. 

Eat Well

Here's good news: Staying well nourished boosts your odds of conceiving! Make sure to include enough protein, iron, zinc, vitamin C, and vitamin D in your diet, because deficiencies in these nutrients have been linked to lengthened menstrual cycles (and therefore less frequent ovulation) and a higher risk of early miscarriage. Ask your doctor if you should take a daily multivitamin supplement. And be sure to eat protein-rich foods, such as meat, fish, low-fat dairy products, eggs, and beans.

Think Before Drinking

A growing body of research has linked alcohol consumption with a decreased ability to get pregnant (it can also harm a developing fetus). Alcohol alters estrogen levels, which may interfere with egg implantation, although pouring an occasional glass of Pinot with your dinner is unlikely to harm fertility. You should also consider cutting back on caffeine while you try to conceive and during your pregnancy. Although study results have been mixed, research suggests that caffeine affects female hormone levels and may affect how long it takes to get pregnant. The bottom line: If you're thinking about getting pregnant, be a teetotaler and limit your daily java fix to 200 mg of caffeine per day. (That's about one to two cups or 12 ounces of coffee.)

Watch Your Weight

Aside from the other risks it poses to your health, excess body fat can lead to an overproduction of certain hormones that disrupt ovulation. Your cycles may be less regular, you may ovulate less often, and you lower your chances of getting pregnant. On the flip side, too little body fat means your body may not produce enough hormones to ovulate each month or to sustain a pregnancy if you do conceive. Exercise can help you maintain a healthy weight. Just don't overdo it, says Christopher Williams, M.D., a reproductive endocrinologist at the University of Virginia, in Charlottesville, and author of The Fastest Way to Get Pregnant Naturally. Talk to your doctor or midwife about your workout routine before trying to get pregnant.

Steer Clear of Pesticides

Many pesticides and herbicides -- chemicals used to kill insects and weeds that threaten crops -- decrease male fertility and may affect female fertility by inhibiting ovarian function and disrupting the menstrual cycle. Most of the studies done to date deal with how occupational exposure affects fertility, but a study published in the March 2015 issue of Human Reproduction is the first to show how eating fruits and vegetables with pesticides can affect sperm count. The study revealed that men who ate the most pesticide-treated foods had both a lower sperm count and lower-quality sperm. So if you're looking to get pregnant, it's always a good idea to eat organic fruits and vegetables, wash those with residues carefully, and avoid applying pesticides to your lawn or garden.

Watch Workplace Issues

According to the Centers for Disease Control (CDC), radiation, nitrous oxide, jet fuel, and certain common industrial chemicals can disrupt menstrual cycles and decrease fertility. Needless to say, be careful if you have a job working with hazardous chemicals. Rotating work shifts can also affect fertility: One study of nearly 120,000 women found that those who work rotating shifts had an 80 percent higher rate of fertility problems than those who worked steady day shifts. (Straight night shifts were better than rotating shifts, too.) So remember to maximize your fertility by asking for a steady shift, if possible, and always use personal protective gear if you work in environments with certain chemicals.

Kick Butt (Cigarettes, That Is)

As if you needed another reason to quit smoking: Cigarette toxins not only damage a woman's eggs, interfering with the fertilization and implantation process, but also cause the ovaries to age. That means that the ovaries of a 35-year-old smoker function as though they belonged to a 42-year-old and are therefore less fertile

Know Your Cycle

A normal menstrual cycle lasts about 21 to 35 days (start counting on the first day of your period). If your cycle is noticeably longer -- say, 42 days -- you can assume you're ovulating less often and may want to see your ob-gyn or midwife, says Michael Soules, M.D., past president of the American Society for Reproductive Medicine and managing partner of Seattle Reproductive Medicine, a fertility clinic in Seattle. When you're ready to conceive, find your fertile window, during which you should have intercourse regularly.
A woman's fertile days are usually the day of ovulation and the four of five days before. But don't assume that you automatically ovulate on day 14 of your cycle: A study from the National Institute of Environmental Health Sciences found that ovulation varies dramatically from woman to woman, occurring as early as day 6 and as late as day 21 of a cycle. How can you determine when you're ovulating? Urine- or saliva-based ovulation test kits are available over the counter; both types check for the presence of hormones that indicate ovulation is imminent. You can also note daily changes in your basal body temperature.

, says Robert Barbieri, M.D., head of obstetrics and gynecology at Brigham and Women's Hospital, in Boston, and coauthor of 6 Steps to Increased Fertility. "Smoking does permanent damage to your fertility, but when you cut out cigarettes, you get some ovarian function back."

Get Busy in the Bedroom

If the demands of your hectic life have dampened your sex drive, it's a good idea to start having sex more often. Some research suggests that women who engage in regular (at least weekly) intercourse are more likely to have predictable menstrual cycles and normal ovulation than women who have sporadic sex. One theory: Your husband emits sex hormones that influence your reproductive system. Weekly sex may also cause you to produce more estrogen. And there's no question that frequent sex helps when you're actually trying to conceive. According to the American Society for Reproductive Medicine, having sex every one to two days during your fertile window is associated with the best chance of pregnancy. But because mandatory sex on certain days can become a chore, you might also try making love every few days all month long.

Be Smart With the Slippery Stuff

Some sexual lubricants actually make it harder for sperm to reach their goal of fertilizing an egg. But even certain natural lubes (like saliva and olive oil) should be avoided. Instead, opt for better choices such as canola, peanut, vegetable, baby, or mineral oils. Or consider using Pre-Seed, an over-the-counter lube that's designed to be sperm-friendly.

Don't Douche

Douching can wipe out normal, protective bacteria in the vagina, shifting the balance and putting you at risk for bacterial vaginosis (BV), a common but often overlooked vaginal infection. A fishy odor and grayish discharge are often the only signs. Untreated BV has been linked to preterm labor and may be associated with higher risk of miscarriage and infertility. See your health-care provider if you notice any new vaginal symptoms (itchiness, burning, unusual discharge, or sores). A reproductive-tract infection is unlikely, but it's best to be safe when your fertility is at stake.

Protect It with the Pill

Yes, the birth-control pill may actually enhance your fertility. "I suspect that oral contraceptives, which halt ovulation, quiet down your reproductive system, protecting your ovaries from aging," Dr. Barbieri says. For some women, the pill can be critical in preserving fertility because it keeps two common conditions, endometriosis and uterine fibroids, under control by slowing uterine-tissue growth. (With endometriosis, uterine tissue grows outside the uterus, causing painful cramps and often harming the fallopian tubes or other organs. Uterine fibroids are benign growths that can make pregnancy difficult or impossible.) Once you go off birth-control pills, your cycle will return to its pre-pill pattern in about a month.

Seek Serenity

Stress may hamper your fertility. An American study that followed 401 couples who were trying to get pregnant found that women with the highest levels of alpha-amylase, a stress biomarker, had a 29 percent lower probability of pregnancy than did women with the lowest levels of the stress biomarker. Experts suspect that stress, like heavy exercise, may throw off your body's hormone production, making your menstrual cycle less reliable. But learning to manage stress through relaxation techniques (such as mindfulness meditation or yoga) or support from a counselor or a group, can get your hormones back on track, Dr. Barbieri says.

Don't Overlook His Health

The same things that harm your fertility can do a number on your husband's reproductive health too. Cigarettes, alcohol, a poor diet -- any of these can contribute to lower sperm production or motility (ability to swim). Studies have also traced chromosomal damage in sperm to cigarette smoke and heavy alcohol intake. Getting enough nutrients every day -- particularly vitamins E and C and the mineral selenium -- will help him produce healthy sperm. Taking a daily multivitamin is a good step, Dr. Williams says. "It takes almost three months for a man to make new sperm, so he needs to think ahead too."

 

7 Fertility Aids – Secret Tips from Moms

Fertility Aids from Other Moms

When you’re trying to conceive, who better to take advice from than other women who are now moms? There are some fertility aids that these women swear by when it comes to getting pregnant faster and easier. The following are 7 of the top fertility aids most recommended by other moms.

1) Castor Oil for Your Fertility

If you’re having some trouble getting pregnant then give castor oil a try. The basic concept behind castor oil and your fertility is that it helps in the stimulation of your lymph system. Using castor oil will help to get the blood moving to your uterus and then into your ovaries. This is ideal if you’re experiencing any blockages in your fallopian tubes or if you have poor circulation that might be affecting your reproductive organs. Castor oil should also be used by those women who are suffering from uterine or ovarian cysts which can be a factor in infertility. Keep in mind that castor oil is not taken orally but rather is rubbed onto your belly once a day and left on for about 60 to 90 minutes.

2) Softcup as a Fertility Aid

Softcup is a fertility aid that is used as a reservoir that keeps your partner’s sperm close to your cervix. Softcup is easy to use. After you and your partner have had intercourse just insert the cup up into your vagina to ensure that his sperm stays up close to your cervix. You can as well put your partner’s ejaculate into the cup and then insert it into your vagina and up near the cervix. Many women believe that using Softcup helped them get pregnant in the first three months of trying to conceive. This fertility aid is safe to use and is readily available at your pharmacy.

3) Evening Primrose Oil

Evening primrose oil is very rich in Vitamin E. It’s also full of GLA (gamma linolenic acid which is an essential fatty acid. Many moms believe that evening primrose oil boosts fertility by stimulating the production of your cervical mucus so that it’s more fertile friendly. It also has anti-inflammatory properties which act as a blood thinner and can increase blood flow to your uterus.

4) Use “Preseed” and Get Pregnant Fast

Preseed is a personal lubricant that women use to relieve their symptoms of vaginal dryness. The reason Preseed is so popular to use is that it’s considered to be sperm friendly unlike other personal lubricants that can damage and kill your partner’s sperm. Preseed is also thought to enhance your cervical mucus naturally and this can help you conceive that much faster. Since Preseed is perfectly safe to use, it certainly can’t hurt to add to your list of fertility aids! In fact, Preseed is the only personal lubricant recommended by fertility specialists.

5) Electro Acupuncture

Electro acupuncture is a stronger type of acupuncture that many women have used to get pregnant. Small electrodes are placed on certain acupressure points of your body. Small electrical pulses are then applied to the surface of your skin. These pulses are intended to aid your body in releasing natural endorphins into your body just by triggering the pituitary gland. This in turn will increase your estrogen levels and help to regulate those hormones that are necessary for healthy fertility and ovulation.

6) The Missionary Position

Women who are now moms will tell you of all the sexual positions the missionary position is the best when you’re trying to get pregnant. This is because using this position allows your partner’s sperm to gather around your cervix better than any other sexual position. It can also be helpful to stay on your back for about 10 to 20 minutes after sex to give his sperm ample opportunity to swim up into your cervix.

7) Yoga as a Fertility Aid

It’s been well documented that yoga is ideal for managing a wide variety of emotional and health problems. This includes help with your fertility. Yoga is great for detoxifying your body while at the same time tightening your muscles. You’ll want to focus on doing poses that improve circulation and blood flow to your pelvic, groin, hip, and lower back regions. This can then improve the function of your reproductive system. Yoga is also important for reducing stress. There are many studies proving that stress will decrease your fertility. When you’re stressed the cortisol levels in your body will rise and cortisol can then impede hormones that are essential to getting pregnant. There are many yoga studios around that now offer classes that are specifically targeted to women who are trying to conceive.

Boosting Your Fertility

Using one or more of these 7 fertility aids can help boost your fertility so that you get pregnant that much easier. After all, who better to listen to about what things can help you conceive than women who have been right where you are? Take control of your own fertility and do what it takes to safely increase your chances of conception!

10+ Ways to Boost Your Fertility

It's an aspect of our health that most of us take for granted: Have sex, get pregnant, right? In reality, even minor stressors can throw your body out of whack. If you're trying to conceive, these simple health moves can help protect your fertility.

Eat Well

Here's good news: Staying well nourished boosts your odds of conceiving! Make sure to include enough protein, iron, zinc, vitamin C, and vitamin D in your diet, because deficiencies in these nutrients have been linked to lengthened menstrual cycles (and therefore less frequent ovulation) and a higher risk of early miscarriage. Ask your doctor if you should take a daily multivitamin supplement. And be sure to eat protein-rich foods, such as meat, fish, low-fat dairy products, eggs, and beans

Think Before Drinking

A growing body of research has linked alcohol consumption with a decreased ability to get pregnant (it can also harm a developing fetus). Alcohol alters estrogen levels, which may interfere with egg implantation, although pouring an occasional glass of Pinot with your dinner is unlikely to harm fertility. You should also consider cutting back on caffeine while you try to conceive and during your pregnancy. Although study results have been mixed, research suggests that caffeine affects female hormone levels and may affect how long it takes to get pregnant. The bottom line: If you're thinking about getting pregnant, be a teetotaler and limit your daily java fix to 200 mg of caffeine per day. (That's about one to two cups or 12 ounces of coffee.)

Watch Your Weight

Aside from the other risks it poses to your health, excess body fat can lead to an overproduction of certain hormones that disrupt ovulation. Your cycles may be less regular, you may ovulate less often, and you lower your chances of getting pregnant. On the flip side, too little body fat means your body may not produce enough hormones to ovulate each month or to sustain a pregnancy if you do conceive. Exercise can help you maintain a healthy weight. Just don't overdo it, says Christopher Williams, M.D., a reproductive endocrinologist at the University of Virginia, in Charlottesville, and author of The Fastest Way to Get Pregnant Naturally. Talk to your doctor or midwife about your workout routine before trying to get pregnant.

Steer Clear of Pesticides

Many pesticides and herbicides -- chemicals used to kill insects and weeds that threaten crops -- decrease male fertility and may affect female fertility by inhibiting ovarian function and disrupting the menstrual cycle. Most of the studies done to date deal with how occupational exposure affects fertility, but a study published in the March 2015 issue of Human Reproduction is the first to show how eating fruits and vegetables with pesticides can affect sperm count. The study revealed that men who ate the most pesticide-treated foods had both a lower sperm count and lower-quality sperm. So if you're looking to get pregnant, it's always a good idea to eat organic fruits and vegetables, wash those with residues carefully, and avoid applying pesticides to your lawn or garden.

Watch Workplace Issues

According to the Centers for Disease Control (CDC), radiation, nitrous oxide, jet fuel, and certain common industrial chemicals can disrupt menstrual cycles and decrease fertility. Needless to say, be careful if you have a job working with hazardous chemicals. Rotating work shifts can also affect fertility: One study of nearly 120,000 women found that those who work rotating shifts had an 80 percent higher rate of fertility problems than those who worked steady day shifts. (Straight night shifts were better than rotating shifts, too.) So remember to maximize your fertility by asking for a steady shift, if possible, and always use personal protective gear if you work in environments with certain chemicals.

Kick Butt (Cigarettes, That Is)

As if you needed another reason to quit smoking: Cigarette toxins not only damage a woman's eggs, interfering with the fertilization and implantation process, but also cause the ovaries to age. That means that the ovaries of a 35-year-old smoker function as though they belonged to a 42-year-old and are therefore less fertile, says Robert Barbieri, M.D., head of obstetrics and gynecology at Brigham and Women's Hospital, in Boston, and coauthor of 6 Steps to Increased Fertility. "Smoking does permanent damage to your fertility, but when you cut out cigarettes, you get some ovarian function back."

If you're trying to get pregnant, follow our expert's advice on what NOT to do to increase your chances of conceiving.

Know Your Cycle

A normal menstrual cycle lasts about 21 to 35 days (start counting on the first day of your period). If your cycle is noticeably longer -- say, 42 days -- you can assume you're ovulating less often and may want to see your ob-gyn or midwife, says Michael Soules, M.D., past president of the American Society for Reproductive Medicine and managing partner of Seattle Reproductive Medicine, a fertility clinic in Seattle. When you're ready to conceive, find your fertile window, during which you should have intercourse regularly.
A woman's fertile days are usually the day of ovulation and the four of five days before. But don't assume that you automatically ovulate on day 14 of your cycle: A study from the National Institute of Environmental Health Sciences found that ovulation varies dramatically from woman to woman, occurring as early as day 6 and as late as day 21 of a cycle. How can you determine when you're ovulating? Urine- or saliva-based ovulation test kits are available over the counter; both types check for the presence of hormones that indicate ovulation is imminent. You can also note daily changes in your basal body temperature.

Get Busy in the Bedroom

If the demands of your hectic life have dampened your sex drive, it's a good idea to start having sex more often. Some research suggests that women who engage in regular (at least weekly) intercourse are more likely to have predictable menstrual cycles and normal ovulation than women who have sporadic sex. One theory: Your husband emits sex hormones that influence your reproductive system. Weekly sex may also cause you to produce more estrogen. And there's no question that frequent sex helps when you're actually trying to conceive. According to the American Society for Reproductive Medicine, having sex every one to two days during your fertile window is associated with the best chance of pregnancy. But because mandatory sex on certain days can become a chore, you might also try making love every few days all month long.

Be Smart With the Slippery Stuff

Some sexual lubricants actually make it harder for sperm to reach their goal of fertilizing an egg. But even certain natural lubes (like saliva and olive oil) should be avoided. Instead, opt for better choices such as canola, peanut, vegetable, baby, or mineral oils. Or consider using Pre-Seed, an over-the-counter lube that's designed to be sperm-friendly.

Don't Douche

Douching can wipe out normal, protective bacteria in the vagina, shifting the balance and putting you at risk for bacterial vaginosis (BV), a common but often overlooked vaginal infection. A fishy odor and grayish discharge are often the only signs. Untreated BV has been linked to preterm labor and may be associated with higher risk of miscarriage and infertility. See your health-care provider if you notice any new vaginal symptoms (itchiness, burning, unusual discharge, or sores). A reproductive-tract infection is unlikely, but it's best to be safe when your fertility is at stake.

Protect It with the Pill

Yes, the birth-control pill may actually enhance your fertility. "I suspect that oral contraceptives, which halt ovulation, quiet down your reproductive system, protecting your ovaries from aging," Dr. Barbieri says. For some women, the pill can be critical in preserving fertility because it keeps two common conditions, endometriosis and uterine fibroids, under control by slowing uterine-tissue growth. (With endometriosis, uterine tissue grows outside the uterus, causing painful cramps and often harming the fallopian tubes or other organs. Uterine fibroids are benign growths that can make pregnancy difficult or impossible.) Once you go off birth-control pills, your cycle will return to its pre-pill pattern in about a month.

Seek Serenity

Stress may hamper your fertility. An American study that followed 401 couples who were trying to get pregnant found that women with the highest levels of alpha-amylase, a stress biomarker, had a 29 percent lower probability of pregnancy than did women with the lowest levels of the stress biomarker. Experts suspect that stress, like heavy exercise, may throw off your body's hormone production, making your menstrual cycle less reliable. But learning to manage stress through relaxation techniques (such as mindfulness meditation or yoga) or support from a counselor or a group, can get your hormones back on track, Dr. Barbieri says.

Don't Overlook His Health

The same things that harm your fertility can do a number on your husband's reproductive health too. Cigarettes, alcohol, a poor diet -- any of these can contribute to lower sperm production or motility (ability to swim). Studies have also traced chromosomal damage in sperm to cigarette smoke and heavy alcohol intake. Getting enough nutrients every day -- particularly vitamins E and C and the mineral selenium -- will help him produce healthy sperm. Taking a daily multivitamin is a good step, Dr. Williams says. "It takes almost three months for a man to make new sperm, so he needs to think ahead too."

Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. In many countries infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.
Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors.
According to The Mayo Clinic, USA:

• About 20% of cases of infertility are due to a problem in the man.
• About 40% to 50% of cases of infertility are due to a problem in the woman.
• About 30% to 40% of cases of infertility are due to problems in both the man and the woman.

According to the Department of Health and Human Services, USA, approximately 10% to 15% of couples in the USA are infertile - meaning they have not conceived after at least one year of regular, unprotected sex.
Many cases of apparent infertility are treatable. Infertility may have a single cause in one of the partners, or it could be the result of a combination of factors.
Use this page to learn what causes infertility. Also get an overview of risk factors and how infertility is diagnosed. We outline the treatment options available, including IVF and surgery, and the complications caused by infertility.

Chances of conceiving within one year

In Europe, North America and much of the world approximately 85% of couples will conceive within one year if they have regular unprotected sex. Averages in the UK are as follows (National Health Service):

• 20% will conceive within one month
• 70% will conceive within six months
• 85% will conceive within 12 months
• 90% will conceive within 18 months
• 95% will conceive within 24 months.

Therefore, doctors in the UK will not usually diagnose a couple as infertile until 24 months have passed without conception and regular unprotected sex. Most people will see their GP (general practitioner, primary care physician) if there is no pregnancy within 12 months.
According to the National Health Service, UK, a couple that has been trying to conceive for over three years has a maximum 25% chance of conceiving over the subsequent 12 months if they continue trying.

Risk factors of infertility

In medicine, a risk factor is something that raises the risk of developing a condition, disease or symptom. For example, obese people are more likely to develop diabetes type 2 compared to people of normal weight; therefore, obesity is a risk factor for diabetes type 2.
Age - a woman's fertility starts to drop after she is about 32 years old, and continues doing so. A 50-year-old man is usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40).

Smoking significantly increases your risk of infertility

Smoking - smoking significantly increases the risk of infertility in both men and women. Smoking may also undermine the effects of fertility treatment. Even when a woman gets pregnant, if she smokes she has a greater risk of miscarriage.
Alcohol consumption - a woman's pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
Being obese or overweight - in industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm.
Eating disorders - women who become seriously underweight as a result of an eating disorder may have fertility problems.
Being vegan - if you are a strict vegan you must make sure your intake of iron, folic acid, zinc and vitamin B-12 are adequate, otherwise your fertility may become affected.
Over-exercising - a woman who exercises for more than seven hours each week may have ovulation problems.
Not exercising - leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
Sexually transmitted infections (STIs) - chlamydia can damage the fallopian tubes, as well as making the man's scrotum become inflamed. Some other STIs may also cause infertility.
Exposure to some chemicals - some pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.
Mental stress - studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.

Causes of infertility in women

There are many possible causes of infertility. Unfortunately, in about one-third of cases no cause is ever identified.

Ovulation disorders

Problems with ovulation are the most common cause of infertility in women, experts say. Ovulation is the monthly release of an egg. In some cases the woman never releases eggs, while in others the woman does not release eggs during come cycles.
Ovulation disorders can be due to:

• Premature ovarian failure - the woman's ovaries stop working before she is 40.
• PCOS (polycystic ovary syndrome) - the woman's ovaries function abnormally. She also has abnormally high levels of androgen. About 5% to 10% of women of reproductive age are affected to some degree. Also called Stein-Leventhal syndrome.
• Hyperprolactinemia - if prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
• Poor egg quality - eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is the higher the risk.
• Overactive thyroid gland
• Underactive thyroid gland
• Some chronic conditions, such as AIDS or cancer.

Scientists discover gene that may explain infertility

Scientists from the University of Edinburgh reported in the Journal of Cell Science that they identified a gene that controls a vital process in the formation of healthy fertile eggs.
They say their breakthrough will help researchers better understand how cells divide during reproduction, which in turn will help explain low fertility and sterility.

Problems in the uterus or fallopian tubes

The egg travels from the ovary to the uterus (womb) where the fertilized egg grows. If there is something wrong in the uterus or the fallopian tubes the woman may not be able to conceive naturally. This may be due to:

• Surgery - pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
• Submucosal fibroids - benign or non-cancerous tumors found in the muscular wall of the uterus, occurring in 30% to 40% of women of childbearing age. They may interfere with implantation. They can also block the fallopian tube, preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may make the uterus' cavity bigger, increasing the distance the sperm has to travel.
• Endometriosis - cells that are normally found within the lining of the uterus start growing elsewhere in the body.
• Previous sterilization treatment - if a woman chose to have her fallopian tubes blocked. It is possible to reverse this process, but the chances of becoming fertile again are not high. However, an eight-year study showed tubal reversal surgery results in higher pregnancy and live birth rates and is less costly than IVF.

Medications

Some drugs can affect the fertility of a woman. These include:

• NSAIDs (non-steroidal anti-inflammatory drugs) - women who take aspirin or ibuprofen long-term may find it harder to conceive.
• Chemotherapy - some medications used in chemotherapy can result in ovarian failure. In some cases, this side effect of chemotherapy may be permanent.

Radiotherapy

If radiation therapy was aimed near the womans reproductive organs there is a higher risk of fertility problems.

Illegal drugs

Some women who take marijuana or cocaine may have fertility problems.

Causes of infertility in men

The following are common causes of infertility in men.

Semen

Semen is the milky fluid that a man's penis releases during orgasm. Semen consists of fluid and sperm. The fluid comes from the prostate gland, seminal vesicle and other sex glands.
The sperm is produced in the testicles. During orgasm a man ejaculates (releases semen through the penis). The seminal fluid helps transport the sperm during ejaculation. The seminal fluid has sugar in it - sugar is an energy source for sperm.
Abnormal semen is responsible for about 75% of all cases of male infertility. Unfortunately, in many cases doctors never find out why. The following semen problems are possible:

• Low sperm count (low concentration) - the man ejaculates a lower number of sperm, compared to other men. Sperm concentration should be 20 million sperm per milliliter of semen. If the count is under 10 million there is a low sperm concentration (subfertility).
• No sperm - when the man ejaculates there is no sperm in the semen.
• Low sperm mobility (motility) - the sperm cannot "swim" as well as it should.
• Abnormal sperm - perhaps the sperm has an unusual shape, making it more difficult to move and fertilize an egg.

Sperm must be the right shape and able to travel rapidly and accurately towards the egg. If the sperm's morphology (structure) and motility (movement) are wrong it is less likely to be able to reach the egg and fertilize it.

Causes of abnormal semen

• Testicular infection
• Testicular cancer
• Testicular surgery
• Overheating the testicles - frequent saunas, hot tubs, very hot baths, or working in extremely hot environments can raise the temperature of the testicles. Tight clothing may have the same effect on some people.
• Ejaculation disorders - for some men it may be difficult to ejaculate properly. Men with retrograde ejaculation ejaculate semen into the bladder. If the ejaculatory ducts are blocked or obstructed the man may have a problem ejaculating appropriately.
• Varicocele - this is a varicose vein in the scrotum that may cause the sperm to overheat.
• Undescended testicle - one (or both) testicle fails to descend from the abdomen into the scrotum during fetal development. Sperm production is affected because the testicle is not in the scrotum and is at a higher temperature. Healthy sperm need to exist in a slightly lower-than-body temperature. That is why they are in the scrotum, and not inside the body.
• Hypogonadism - testosterone deficiency can result in a disorder of the testicles.
• Genetic abnormality - a man should have an X and Y chromosome. If he has two X chromosomes and one Y chromosome (Klinefelter's syndrome) there will be an abnormal development of the testicles, low testosterone, and a low sperm count (sometimes no sperm at all).
• Mumps - this viral infection usually affects young children. However, if it occurs after puberty inflammation of the testicles may affect sperm production.
• Hypospadias - the urethral opening is at the underside of the penis, instead of its tip. This abnormality is usually surgically corrected when the male is a baby. If it is not the sperm may find it harder to get to the female's cervix. Hypospadias occur in about 1 in every 500 newborn boys.
• Cystic fibrosis - Cystic fibrosis is a chronic disease that affects organs such as the liver, lungs, pancreas, and intestines. It disrupts the body's salt balance, leaving too little salt and water on the outside of cells and causing the thin layer of mucus that usually keeps the lungs free of germs to become thick and sticky. This mucus is difficult to cough out, and it clogs the lungs and airways, leading to infections and damaged lungs. Males with cystic fibrosis commonly have a missing or obstructed vas deferens (tube connecting the testes to the urethra; it carries sperm from the epididymis to the ejaculatory duct and the urethra).
• Radiotherapy - radiation therapy can impair sperm production. The severity usually depends on how near to the testicles the radiation was aimed.
• Some diseases - the following diseases and conditions are sometimes linked to lower fertility in males: Anemia, Cushing's syndrome, Diabetes, Thyroid disease.
• Medications
  Sulfasalazine - this anti-inflammatory drug can significantly lower a man's sperm count. The drug is often prescribed for patients with Crohn's disease or rheumatoid arthritis. Usually this side effect goes away after the patient stops taking the medication.
  Anabolic steroids - often taken by bodybuilders and athletes; anabolic steroids, especially after long term use can seriously reduce sperm count and mobility.
  Chemotherapy - some medicines may significantly reduce sperm count.
  
• Illegal drugs - consumption of marijuana and cocaine can lower a man's sperm count.

Recent developments on infertility causes from MNT news High cholesterol linked to infertility
Prospective parents with high cholesterol levels could be in for a long wait to become pregnant, a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism states.
Could household detergents reduce fertility?
Two active ingredients commonly found in household detergents caused reproductive decline in mice, according to a new study published in the journal Reproductive Technology, prompting concerns about how these ingredients affect reproduction in humans.
Long-term acetaminophen use during pregnancy may affect boys' fertility
Research in mice has found that exposing fetal testicular tissue to the painkiller acetaminophen lowers production of testosterone. The lab work suggests that pregnant women taking the drug for one day would not affect their unborn boy - but several days of the analgesic could.
Active, passive smoking 'increases risk of infertility, earlier menopause'
Women exposed to first- and secondhand tobacco smoke may be at greater risk for infertility and earlier menopause, according to new research.

Diagnosing infertility

Most people will visit their GP (general practitioner, primary care physician) if there is no pregnancy after 12 months of trying. For anybody who is concerned about fertility, especially if they are older (women over 35), it might be a good idea to see a doctor earlier. As fertility testing can sometimes take a long time, and female fertility starts to drop when a woman is in her thirties, seeing the doctor earlier on if you are over 35 makes sense.
A GP can give the patient advice and carry out some preliminary assessments. As it takes two to make a baby it is better for both the male and female to see the doctor together.
Before undergoing testing for fertility it is important that the couple be committed. The doctor will need to know what the patients' sexual habits are, and may make recommendations regarding them. Tests and trials might extend over a long period. Even after thorough testing, no specific cause is ever found for 30% of infertility cases.
In some countries where universal healthcare cover does not exist, evaluation and eventual treatment may be expensive.

Infertility tests for men

1. General physical exam - the doctor will ask the man about his medical history, medications, and sexual habits. The physician will also carry out an examination of his genitals. The testicles will be checked for lumps or deformities, while the shape and structure of the penis will be examined for any abnormalities.
2. Semen analysis - the doctor may ask for some specimens of semen. They will be analyzed in a laboratory for sperm concentration, motility, color, quality, infections and whether any blood is present. As sperm counts can fluctuate, the man may have to produce more samples.
3. Blood test - the lab will test for several things, including the man's level of testosterone and other male hormones.
4. Ultrasound test - the doctor will determine whether there is any ejaculatory duct obstruction, retrograde ejaculation, or other abnormality.
5. Chlamydia test - if the man is found to have Chlamydia, which can affect fertility, he will be prescribed antibiotics to treat it.

Infertility tests for women

• General physical exam - the doctor will ask the woman about her medical history, medications, menstruation cycle, and sexual habits. She will also undergo a gynecological examination.
• Blood test - several things will be checked, for example, whether hormone levels are correct and whether the woman is ovulating (progesterone test).
• Hysterosalpingography - fluid is injected into the woman's uterus which shows up in X-ray pictures. X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If the doctor identifies any problems, such as a blockage, surgery may need to be performed.
• Laparoscopy - a thin, flexible tube with a camera at the end (laparoscope) is inserted into the abdomen and pelvis to look at the fallopian tubes, uterus and ovaries.
  A small incision is made below the belly button and a needle is inserted into the abdominal cavity; carbon dioxide is injected to create a space for the laparoscope. The doctor will be able to detect endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.
  
• Ovarian reserve testing - this is done to find out how effective the eggs are after ovulation.
• Genetic testing - this is to find out whether a genetic abnormality is interfering with the woman's fertility.
• Pelvic ultrasound - high frequency sound waves create an image of an organ in the body, which in this case is the woman's uterus, fallopian tubes, and ovaries.
• Chlamydia test - if the woman is found to have Chlamydia, which can affect fertility, she will be prescribed antibiotics to treat it.
• Thyroid function test - according to the National Health Service (UK) between 1.3% and 5.1% of infertile women have an abnormal thyroid.

Treatments for infertility

This will depend on many factors, including the age of the patient(s), how long they have been infertile, personal preferences, and their general state of health. Even if the woman has causes that cannot be corrected, she may still become pregnant.

Frequency of intercourse

The couple may be advised to have sexual intercourse more often. Sex two to three times per week may improve fertility if the frequency was less than this. Some fertility experts warn that too-frequent sex can lower the quality and concentration of sperm. Male sperm can survive inside the female for up to 72 hours, while an egg can be fertilized for up to 24 hours after ovulation.

Fertility treatments for men

• Erectile dysfunction or premature ejaculation - medication and/or behavioral approaches can help men with general sexual problems, resulting in possibly improved fertility.
• Varicocele - if there is a varicose vein in the scrotum, it can be surgically removed.
• Blockage of the ejaculatory duct - sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
• Retrograde ejaculation - sperm can be taken directly from the bladder and injected into an egg in the laboratory.
• Surgery for epididymal blockage - if the epididymis is blocked it can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked sperm may not be ejaculated properly.

Fertility treatments for women

Ovulation disorders - if the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include:

• Clomifene (Clomid, Serophene) - this medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
• Metformin (Glucophage) - women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance.
• Human menopausal gonadotropin, or hMG, (Repronex) - this medication contains both FSH and LH. It is an injection and is used for patients who don't ovulate on their own because of a fault in their pituitary gland.
• Follicle-stimulating hormone (Gonal-F, Bravelle) - this is a hormone produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
• Human chorionic gonadotropin (Ovidrel, Pregnyl) - this medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate.
• Gn-RH (gonadotropin-releasing hormone) analogs - for women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
• Bromocriptine (Parlodel) - this drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems.

Risk of multiple pregnancies

Injectable fertility drugs can sometimes be the victims of their own success and cause multiple births - when the woman gets pregnant she has twins, triplets, or perhaps more babies in one go. Oral fertility drugs also raise the risk of multiple pregnancies, but much less so than injectable ones. It is important to monitor the patient carefully during treatment and pregnancy. The more babies the mother carries inside her the higher is her risk of premature labor.
If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless if the desire to become pregnant is very strong.
Multifetal pregnancy reduction is possible if too many babies are conceived - one or more of the fetuses is removed. Couples will have to consider the ethical and emotional aspects of this procedure.

Surgical procedures for women

• Fallopian tube surgery - if the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them.
• Laparoscopic surgery - a small incision is made in the woman's abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.

Assisted conception

The following methods are currently available for assisted conception.

IUI (intrauterine insemination)

A fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones.
IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction.

IVF (in vitro fertilization)

IVF in action

Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).
Louise Joy Brown, born in England in 1978, was the world's first IVF baby. Before IVF is done the female takes fertility drugs to encourage the ovaries to produce more eggs than normal.
Time-lapse imaging triples the chances of having a baby for couples undergoing IVF treatment, researchers reported in Reproductive BioMedicine Online (May 2013 issue). Described as a "major breakthrough", time-lapse imaging became available in 2013 in the UK for monitoring the development of IVF embryos before they are implanted in the womb.
In an Abstract in the journal, the authors wrote "Time-lapse imaging of human preimplantation IVF embryos has enabled objective algorithms based on novel observations of development (morphokinetics) to be used for clinical selection of embryos."
With this new technique, the scientists could develop a way of accurately identifying which embryos are more likely to have aneuploidy (abnormal chromosomes). Embryos with aneuploidy are much less likely to be successfully implanted.
The researchers, from CARE Fertility, said further large-scale studies are needed to confirm their findings.
Researchers from Mount Sinai Hospital in Toronto, Canada, reported in CMAJ that IVF is more successful if the woman has sufficient levels of vitamin D.
A study published in the Journal of Clinical Endocrinology & Metabolism (JCEM) found that women who are deficient in vitamin D are half as likely to conceive using IVF compared with women without vitamin D deficiency.

ICSI (Intracytoplasmic sperm injection)

A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.

Donation of sperm or egg

If there is either no sperm or egg in one of the partners it is possible to receive sperm or eggs from a donor. Fertility treatment with donor eggs is usually done using IVF. In the UK and a growing number of countries the egg donor can no longer remain anonymous - the offspring can legally trace his/her biological parent when reaching the age of 18.

Assisted hatching

This improves the chances of the embryo's implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant.

Electric or vibratory stimulation to achieve ejaculation

Ejaculation is acheived with electric or vibratory stimulation. This procedure is useful for men who cannot ejaculate normally, such as those with a spinal cord injury.

Surgical sperm aspiration

The sperm is removed from part of the male reproductive tract, such as the vas deference, testicle or epididymis.

Recent developments on fertility treatment from MNT news New IVF approach could boost success rates for older women
The likelihood of conceiving through in vitro fertilization reduces dramatically once women reach their early 40s. Now, researchers believe they may have shed light on why this is - opening the door to more effective fertility treatment for older women.
IVF: use of frozen eggs linked to poorer live birth rates
The use of frozen eggs, or oocytes, for in vitro fertilization leads to lower live birth rates than the use of fresh eggs. This is the finding of a new study published in JAMA.
Exercise, dieting found to improve fertility in women with polycystic ovary syndrome
Women who have the hormone disorder polycystic ovary syndrome may be able to improve their fertility through weight loss and exercise, according to the results of a new study published in the Journal of Clinical Endocrinology & Metabolism.
New IVF device will allow 'natural fertilization'
IVF patients in the UK are to be offered a groundbreaking treatment that allows fertilization to take place inside the body, rather than in a lab.

Complications of infertility treatment

The following are possible complications caused by infertility treatment.

Ovarian hyperstimulation syndrome

The ovaries become very swollen, leaking excess fluid into the body. The ovaries produce too many follicles (small fluid sacs in which an egg develops). OHSS usually occurs as a result of taking medications to stimulate the ovaries, such as clomifene and gonadtrophins, and can also develop after IVF. Symptoms can include:

• Bloating
• Constipation
• Dark urine
• Diarrhea
• Nausea
• Pain in the abdomen
• Vomiting.

In most cases symptoms are mild and easy to treat. On very rare occasions the patient may develop a blood clot (thrombosis) in an artery or vein, liver or kidney problems, and respiratory distress. In very severe cases OHSS can be potentially fatal.

Ectopic pregnancy

This is a pregnancy when the fertilized egg does not implant in the womb - in most cases the fertilized egg grows in the fallopian tube. If it stays in the fallopian tube the mother will usually miscarry before complications develop, such as the rupture of the fallopian tube. Women receiving fertility treatment have a slightly higher risk of having an ectopic pregnancy. An ultrasound scan can detect an ectopic pregnancy.

Coping mentally

As it is impossible to know how long treatment will go on for and how successful it will be, coping and persevering can be stressful. The emotional toll on both partners might be considerable and can have an impact on their relationship. Some people find that joining a support group helps - being able to talk to others who share similar problems, aspirations and anxieties can be uplifting. It is important to tell your doctor if you are suffering mentally and/or emotionally. Most fertility doctors have access to counselors, as well as other people and professionals who can offer helpful support.