Important to know the Underlying Cause
What is infertility?
The definition of infertility differs based on the age of the female trying to conceive because age is the single most influential factor when it comes to fertility. It is generally regarded that female fertility begins to decline after about age 30. This is because females have all of their eggs at birth and over time the reserve of eggs dwindles resulting in a lower number and quality of eggs available. Infertility is defined as not being able to get pregnant after trying for a year. However, this definition is amended to a window of trying for 6 months if a woman is 35 years or older.
What causes infertility?
Infertility is a mixed bag and can be a result of female factors, male factors, or unknown. Roughly one-third of cases are attributed to female causes, one-third to male causes, and about one-third are in a frustrating bucket where no known cause can be found.
It is important to note that each family is unique and can be made up of persons anywhere on the gender spectrum. When discussing the creation of an embryo we talk about male factors relating to sperm and male reproductive organs and female factors relating to eggs, female reproductive organs, and pregnancy. However, this process can be achieved through a range of options based on each family’s unique make up.
Common female factors:
Female fertility is complex because it pertains not only to the health of ovaries, fallopian tubes, uterus, and the egg but also to the ability of first the sperm and then the embryo to navigate through the female reproductive system and ultimately implant in the uterus. Let’s break this down based on location:
Ovarian factor infertility pertains to elements that can alter ovarian function and ovulation. Without regular ovulation there will be no egg to meet with the sperm to create an embryo. Conditions that result in altered hormone function like polycystic ovarian syndrome (PCOS), thyroid disorders, hyperprolactinemia, and hypothalamic disorders (often caused by too much exercise or disordered eating) can all disrupt ovulation. Additionally, diminished ovarian reserve or primary ovarian insufficiency (POI), a condition where the ovaries stop functioning and the person enters early menopause (before age 40) may play a role in ovarian factor infertility. POI may be due to a history of pelvic radiation or chemotherapy, Turner’s syndrome, Fragile X syndrome, or may be unknown.
Uterine or cervical troubles can complicate the sperm’s ability to travel through the female reproductive tract in order to join with the egg. The shape of the uterus due to genetic conditions or the presence of growths like polyps or fibroids can block the opening of the cervix, preventing sperm from entering the uterus. They can also disrupt the lining of the uterus making it difficult for a fertilized egg to implant.
The fallopian tubes on one or both sides can become damaged from inflammation making it very difficult for sperm to pass or for the egg to travel. The tubes can also become blocked from adhesions, which are bands of scar tissue that can develop from conditions like pelvic inflammatory disease (often caused by sexually transmitted infections), endometriosis (a condition where the uterine lining grows in areas of the body outside of the uterus), abdominal surgeries, or appendicitis.
Common male factors:
Male infertility relates more to problems with sperm production or function as well as troubles with delivery of sperm. Sperm themselves can be negatively impacted by infections like gonorrhea, chlamydia, HIV, and mumps. Additionally, diabetes, genetic conditions, or vascular changes (varicoceles) within the testicles can hinder sperm production. Environmental factors also play a role. Activities like frequent bicycle riding, exposures to high heat environments like hot tubs or saunas, and frequent use of toxins like alcohol, tobacco products, and steroids can damage sperm. Pelvic radiation or chemotherapy often related to cancer treatment can significantly damage sperm and sperm production. Ejaculatory troubles like premature ejaculation and structural issues or damage to the testicles can impede the ability to get sperm from the testicles to the female genital tract.
This is just a simple overview of common causes of infertility and is by no means an exhaustive list. Each individual and family is different and can have their own unique set of challenges when it comes to fertility. Because of this it is important to work with a provider or team of providers who are knowledgeable and able to evaluate and personalize fertility treatments. Knowing the cause and then targeting that issue with natural and/or conventional medicine is the key to success.