Female and male infertility: everything we need to know

What does it mean to be infertile? We will talk here about infertility in women, men and couples.

Infertility is the inability to conceive within a year of trying to conceive (or within 6 months if the woman is over 36). By targeted attempts we mean intercourse in conjunction with ascertained and monitored ovulation (by observing symptoms, using ovulation tests, monitoring basal temperature, etc.).

Infertility also includes those situations in which conception occurs but the pregnancy is not carried to term.

A woman who has never been able to get pregnant will be diagnosed with primary infertility. If a woman has had at least one pregnancy and a baby in her arms, this is referred to as secondary infertility .

Infertility is not just a female problem. Nowadays, although the numbers and statistics clearly state that infertility affects men and women equally, it is always the woman who generally starts first to make checks and to blame herself for the non-arrival of pregnancy.

About 40% of infertility cases can be attributed to female infertility while men’s problems account for another 40% of infertility.

The remaining percentage may be due to a combination of male and female infertility, or there may be no known cause, in which case it is referred to as idiopathic/unexplained infertility .

Causes of male infertility

In general, infertility in men is mainly linked to problems in terms of:

• sperm concentration in semen
• sperm motility
• sperm morphology

There are a variety of risk factors, medical conditions, and medications that can affect male fertility

Risk factors

The main risk factors associated with male infertility are represented

• old age
• cigarette smoke
• alcohol abuse
• overweight and obesity
• exposure to toxins, such as pesticides, herbicides, and heavy metals
• sexually transmitted diseases
• heat

Medical conditions

The main medical conditions causing male infertility are: retrograde ejaculation, varicocele, cryptorchidism, anti-sperm antibodies, hormonal imbalances, hypogonadotrophic hypogonadism…)

Medicines and drugs

Taking some medicines or drugs can cause infertility

These include: drugs for chemotherapy or radiation, drugs for rheumatoid arthritis or ulcerative colitis, drugs for high blood pressure, tricyclic antidepressants, anabolic steroids, marijuana and cocaine.

Any of these factors or a combination thereof can cause infertility.

Causes of female infertility

The causes of female infertility are many, and they interfere with the following processes:

• ovulation
• conception

Risk factors

Risk factors for female infertility include:

•  old age
• cigarette smoke
• alcohol abuse
• overweight, obese or significantly underweight
• have certain sexually transmitted infections   that can harm your reproductive system

Medical conditions

The main medical conditions that affect the female reproductive system and can cause infertility are:

• ovulation disorders, which can be caused by polycystic ovary syndrome (PCOS) or hormonal imbalances such as hyperprolactinaemia
• pelvic inflammatory disease (PID): an infection affecting the female genital tract;
• endometriosis
• uterine fibroids
• early menopause
• scars and adhesions from a previous surgery

Medicines and drugs

Among the drugs and narcotics that can affect female infertility we find:

• chemotherapy drugs or for radiation therapy
• prolonged use of high-dose nonsteroidal anti-inflammatory drugs (NSAIDs).
• antipsychotic drugs
• drugs like marijuana and cocaine

Very irregular menstrual cycles and the absence of menstruation are two symptoms of non-ovulatory cycles.

What to do if pregnancy does not come?

If you have been trying to conceive for several months but without success, there are diagnostic investigations that become necessary.

If you have been trying to become pregnant for 12 months (or 6 months if you are over 36) it is advisable to consult a gynecologist who specializes in couple infertility.

It also becomes necessary to consult an andrologist if one of the following conditions occurs in the male:

• erectile dysfunction (ED)
• problems with ejaculation, such as delayed ejaculation or retrograde ejaculation
• decreased sexual desire
• pain or swelling in the genital area
• previous surgery in the genital area
• suboptimal semen analysis

Depending on your history and the results of your spermiogram, your doctor may want to perform additional tests which may include: hormone testing, testicular ultrasound, genetic testing

female fertility

A woman’s fertility begins to decline markedly after the age of 35-36 . Women under the age of 36 should see an infertility gynecologist after 12 months of targeted attempts, or just 6 months if you are over 36 years of age. This is because the time factor after the age of 36 becomes very important.

The gynecologist will probably want to check whether ovulation occurs regularly, by monitoring ultrasound or specific hormone dosages and asking the woman to monitor her cycles with ovulation tests and/or basal temperature.

What are the treatments for infertility?

Treatment depends a lot on the problem encountered (if it is known), how much pregnancy is being sought, the age of the woman, the couple’s health, and the couple’s treatment preferences.

Treatments for male infertility

The treatment is linked to the type of problem encountered. Options for men may include surgery, medications and assisted reproduction.

Surgery can correct any blockages that prevent ejaculation or correct conditions such as varicoceles. In some cases, the spermatozoa can be recovered directly from the testicles to then be used in a treatment of ART ( ICSI in this case).

Medications can be used to manage hormonal imbalances . They can also be used to treat other conditions that can affect male fertility, such as erectile dysfunction, infections that decrease the quality of semen.

Finally, assisted fertilization allows fertilization to take place either via IVF, or via ICSI, with sperm collected in the ejaculate or surgically extracted from the testicles or donated by a donor in heterologous fertilization .

Treatments for female infertility

As in males, treatments can include surgery, drugs and the use of assisted reproduction

While surgery can sometimes be used to treat female infertility, it has become rarer due to advances in other fertility treatments. Surgery can improve fertility in the following cases:

• to correct an abnormally shaped uterus
• to make the fallopian tubes patent
• to remove fibroids

Surgical treatment of endometrioma is indicated when the symptoms are or become resistant to medical therapy, or when the size increases or exceeds 3 cm in diameter in infertile patients (ASRM 2014; ESHRE 2014).

There are countless drugs that can help women regulate the activity of hormones related to reproduction. There are treatments for the thyroid, to stimulate follicle growth and induce ovulation, and to support the luteal phase.

Obviously, if the infertility problem is linked to weight problems (excess or serious lack) the therapy in this case will concern a path to reach, together with a nutritionist and in some cases a psychotherapist, the healthiest weight.

The assisted reproduction treatments are the classic treatments represented by IVF , IUI, and ICSI.

Are there alternative treatments?

There are three main natural ways that could help improve fertility. They are yoga, acupuncture and nutrition.

Obviously none of these can do anything when for example the problem is tubal obstruction, or obstructive azoospermia.

According to a 2018 review,  at least 29% of couples try some form of natural or alternative infertility treatment, either alone or to complement traditional treatments.

Acupuncture
Acupuncture involves inserting small, fine needles into various points on the body. These points are believed to help stimulate the body’s energy flows.

There is no definitive evidence to support acupuncture as a treatment for infertility.

A recent review of clinical trials found limited evidence that acupuncture could improve both ovulation and menstruation in women with PCOS.

Yoga
Yoga includes postures and breathing techniques to promote relaxation and decrease stress levels.

Studies of yoga as an infertility treatment are limited. However, it is believed that the practice of yoga can be helpful in relieving the stress that can be associated with fertility treatments.

Supplements
The market offers an infinite number of supplements for fertility. Most of these supplements contain folate, zinc, vitamin C, vitamin E and iron.

There is a question mark about their effectiveness.

To rebalance the bacterial flora, probiotics are useful , which can promote healthy digestion and improve general well-being.

The importance of the vaginal bacterial flora and the understanding of the complex balance that allows protection from infections has been the subject of studies and research for some time. Recently, however, researchers have begun to turn their attention to the role that the vaginal microbiota plays in women’s fertility.

Fertility diet

What we eat can greatly affect hormonal balance and consequently also fertility.

For this reason we have written a book on the subject ( Fertility recipes ), to make people understand how nutrition can interfere with fertility and give ideas on what to eat on a practical level.

Some dietary tips to boost fertility include:

• choose carbohydrates wisely by focusing on foods high in fiber (such as vegetables and whole grains) while avoiding refined carbohydrates that are high in sugar
• avoid trans fats , found in many fried and processed foods
• replace some of the animal protein with vegetarian protein sources
• select high-fat dairy products (such as whole milk) instead of low-fat products

Eating healthy and getting regular moderate physical activity can help both male and female fertility.

Monitor fertility

Women are only fertile 5-6 days per menstrual cycle. These are the 3-4 days before ovulation, the day of ovulation and the day after.

Monitoring ovulation and then concentrating intercourse on fertile days (intercourse every other day is sufficient during the fertile period) can increase the chances of conception.

An oocyte that is released from the follicle at the time of ovulation can be fertilized within 12-24 hours at the latest, then it degenerates. Spermatozoa can live in a woman’s body for up to 3-5 days, increasing the chances of conception even with intercourse far from ovulation. Because of this, the woman is actually fertile for about 5-6 days per menstrual cycle.

Ovulation doesn’t happen at the same time every month, so it’s important to recognize the symptoms of ovulation.  

Infertility numbers

In Italy, 1 out of 5 couples have difficulty getting one naturally

The decrease in male fertility and the increase in the average age of seeking the first pregnancy have led to an increase in the number of cases of infertility.

Fertility decreases with age in both men and women, but the effects of age are greater in women. In their 30s, women are about half less fertile than they were in their 20s, and women’s chances of conceiving decrease significantly after age 35-36. Male fertility also declines with age , but more gradually

Do not give up

Receiving an infertility diagnosis does not mean that your desire for parenthood cannot be fulfilled. It may take some time, but a number of couples suffering from infertility are eventually able to have a child. Some will manage on their own, while others will need medical assistance.

The right treatment for you and your partner will depend on many factors, including your age, the cause of your infertility and your personal preferences.

In some cases, a fertility problem may not be fixable. Depending on your circumstances, your doctor may suggest that you consider gamete donation ( non-fertilization ) or adoption.

The support of family, friends, mutual aid groups and specialized professionals is essential for the couple. Psychological support for couples who resort to PMA is essential.

The group, on the other hand, represents a space for sharing and support , allows you to let yourself go by talking about your own experience, implements  mutual collaboration and emotional support.