According to latest research published in scientific journal Fertility and Sterility, the principal investigator Elizabeth Hervey Stephen (1) suggested that by year 2025, almost 5.4-7.7 million women will experience primary or secondary fertility.
The expected rise in the rate of infertility is indicated because of the unhealthy lifestyle habits and improper dietary factors that affect the concentration and balance of reproductive hormones in the female body.
What Defines Infertility In Women?
Infertility refers to an inability to conceive despite frequent unprotected intercourse and mostly discussed as:
- Primary infertility in which a woman never conceived despite unprotected intercourse for a period of 1 year.
- Secondary infertility in which a woman is unable to conceive for a period of 2 years or more after successfully becoming pregnant once (regardless of live-birth/ miscarriage).
What Are The Major Causes For Infertility In Women?
Knowing the cause of infertility makes the management and the treatment easy, while increasing the chances of conception tremendously. Below are the most common causes of infertility in women.
Endometriosis refers to implantation of uterine cells outside the uterus producing characteristic pain, discomfort and sometimes infertility. Early identification and prompt management can restore fertility almost immediately. Research conducted by DS. Guzick (2) suggested that medical management (Danazol) and conservative surgery are equally effective in the treatment of infertility caused by endometriosis.
The most common cause of infertility in females is ovulation problems that may range from anovulatory cycles to irregular ovulation. This may or may not include the egg quality (in terms of chromosomal defects and genetic issues). Human body has a specialized system of discarding eggs (or zygote- after fertilization) that carries significant chromosomal or genetic aberrations. The result may be:
- Failure of conception
- Difficulties in implantation and loss of zygote
- Early miscarriage
Essentially the egg is the most important ingredient for a happy and healthy pregnancy. However, as a woman ages, the quality of eggs deteriorates. Other essential factors that determine quality of egg are:
- Exposure to toxins
- Improper or unhealthy diet
- Hormonal issues or aberrations
- Advanced age
Polycystic Ovarian Syndrome
Research indicates that the cystic ovaries are the primary cause of infertility (responsible for over 65% of all infertility cases). Other associated complaints in addition to infertility are weight gain, partial insulin resistance and hirsutism excessive growth of hair on face and other exposed parts of the body), male pattern baldness and thinning of scalp hair. The primary abnormality is the excessive production of androgens by the female ovarian cysts and treatments like weight reduction and metformin are associated with a promising prognosis. According to reports of CDC (Center for Disease Control) over 5 million US female population is suffering from PCOS and it affect girls as young as 11 years of age. The prevalence rate is about 1 in every 10 to 20 females.
Long standing pelvic infections or history of pelvic surgery (ectopic pregnancy, sexually transmitted infection like gonorrhea and Chlamydia, tubal tuberculosis and others) are associated with scarring of uterine tubes that significantly decreases the chances of healthy conception. After fertilization, the zygote (fertilized egg) transverses all the way from fallopian tubes to uterus for implantation; however, scarred tubes are less efficient at delivering the zygote to uterus resulting in either tubal pregnancy or loss of zygote. Contraceptive devices or IUCDs are notoriously known to cause pelvic inflammations if left in place for more than 5 years.
Other Unexplained Fertility Problems
Certain hormonal aberrations and autoimmune conditions are also associated with difficulties in ovulation, fertilization, implantation and development of zygote. This includes uncontrolled diabetes mellitus, thyroid disorders, uncontrolled hypertension, cardiac issues, valvular defects and autoimmune diseases like systemic lupus erythematous.
What Are The Treatments For Infertility In Women?
Infertility is not only an emotional bar on the couples but greatly affects the emotional and psychological aspects of the personality. It can also affect the quality of relationship if timely intervention and practical solutions are not sought. Luckily, as opposed to the common beliefs, most women can still conceive if both the partners are fertile. In case of a known and untreatable organic cause of infertility, alternative options are also available.
Correction Of Primary Metabolic Issues
One of the most common causes of fertility in women of all age groups is the hormonal aberrations or defects. Diseases like thyroid hormone disorder (hypothyroidism as well as hyperthyroidism both causes infertility). Same is true for uncontrolled diabetes, Cushing syndrome, uncontrolled high blood pressure and other similar issues that affect the woman’s ability to conceive.
In most cases, the correction of primary issue will restore the ability of female partner to conceive without necessitating any other treatment.
Certain hormonal disorders like Polycystic Ovarian Disease or Progesterone Insufficiency syndrome require the replacement of deficient hormone. In Polycystic Ovarian Disease, the imbalance of estrogen and progesterone hormone along with high secretion of androgen is the primary cause of infertility that interferes with the ovulation (release of egg). Best fertility treatment options in this case are:
- Weight loss therapies by moderate exercise and dietary modification helps in improving the imbalance of hormones.
- LH Hormone helps in ovulation by producing artificial LH surge.
- Clomiphene citrate is one of the most promising treatment that helps in inducing ovulation and in correction of abnormalities in sex hormones. The primary mode of action is to stimulate pituitary gland to enhance the secretion and release of FSH and LH hormones.
Other medical treatment for the management of infertility:
Deficiency of FSH release by pituitary gland is a common cause of infertility. Supplementation with FSH may help in restoring the normal balance. Besides replacement of insufficient hormones and ovulation induction by Clomiphene citrate, other helpful medical treatments that are widely used today are:
Bromocriptine (sold under the name of Parlodel)
Prolactinoma is a small prolactin secreting tumor of brain that increases the milk production after childbirth and is responsible for the contraception effect observed in nursing mothers. If the concentration of prolactin remains high in the body, normal ovarian cycles may not occur and lack of ovulation will lead to infertility. Bromocriptine antagonize the action of prolactin and helps in normalization of serum levels.
Metformin (also known as Glucophage)
It is an ideal and highly effective therapy in women with polycystic ovarian disease to help in normalization of androgens interfering with ovulation. Metformin is traditionally employed as a hypoglycemic drug to help normalize the blood sugar levels; however, besides blood sugar control, metformin can also be used in association with hormones like FSH (or Clomiphene citrate) to restore normal ovulatory activities.
Human Menopausal Gonadotropin (hmg)
Pre-mature ovarian failure is a condition that is observed in young females and characterized by lack of ovulation (and/ or lack of regular monthly menstrual cycles). Sometimes a prior injury or surgery of brain may also interfere with the release of essential reproductive hormones required for ovulation. In all such cases, this injectable medication helps as a stimulatory support for the induction of ovulation. The active ingredient is the proportional combination of LH and FSH.
This class of drug is used on women who don’t respond to Clomiphene citrate induced ovulation induction. Although traditionally employed for breast cancer, this drug has known efficacy in promoting ovulation in hormonally quiescent women.
Conditions like malignancy involving genital tract, tubal blockage or widespread endometriosis respond fairly to surgical intervention in situation where medical treatment has failed.
Despite correcting hormonal imbalance and ovulation induction, sometimes required results are not achieved. In all such situations, there are a number of other interventional treatments available. These include:
Assistive Fertilization Techniques
Assistive fertilization techniques are employed in cases in which medical or surgical correction of primary issues proves unrewarding. The cost of therapy is usually high (considering the fact that most insurance companies do not cover the cost of therapy) but results are promising especially if mother is in good health.
In all such cases where pelvic scarring is considered a cause of infertility, it is better to seek treatments like IVF (In-vitro fertilization). Other cases where IVF can also be employed include:
- When the cause of infertility is not clear
- When the cause of infertility is the advanced age of mother or lack of ovulation/ poor quality eggs
The technique deals with fertilization of a healthy egg (wither by an egg donor or from the female herself) with a sperm in laboratory and implantation of the zygote directly in the uterus of female on day 4 or 5. According to the research conducted by S.L Tan (2) in the scientific journal The Lancet, if performed under 34 years of age, almost 55% women get pregnant within 5 cycles of IVF and 45% give birth to healthy live babies. Statistics suggest that between 1985 and 2006, more than 500, 000 babies were born via IVF. The average cost of procedure is about 12,400 USD (according to reports of The Hastings Center (US government site associated with record keeping of ARTs).
Intracytoplasmic Sperm Injection (ICSI)
This technique involves direct injection of male sperm into the female ovum by a micromanipulation that is followed by in- vitro fertilization. It is employed in cases where the tubes are blocked or scarred, interfering with the transport of sperm to female genital tract.
Gamete Intrafallopian Transfer (GIFT)
This technique is fairly a facilitation procedure that involves transfer of a mature egg and healthy sperms in the fallopian tube and providing a feasible environment for the fusion of sperms and egg.
Tubal Embryo Transfer
The process or technique of Tubal Embryo Transfer (also known as Zygote intrafallopian transfer (ZIFT) is fairly similar to IVF and employed the fertilization of egg and sperm in the petri dish (in lab setting) and then transfer of the product of fertilization to the fallopian tubes (instead of uterine cavity).
There are a number of factors that determine the cost of procedure and a positive outcome. The cost of procedure is influenced by:
- Use of egg donors in cases when the couple lacks healthy eggs (or in women with a history of genetic aberration that may be transmitted to the offspring).
- Use of sperm donor in situations when the male genital tract is obstructed or blocked (or sperms are not functional).
Success Rate of ARTs
Research indicates that the success rate of ART (Assisted reproductive technology) is high if mother is young (younger than 35 years) and is in good health. The determinants of ART success depends on several other factors besides maternal age:
- Nature of ART employed
- The cause of ART
- The nature of egg used in the process
- The nature of embryo used in the process
According to statistics of U.S. Centers for Disease Control and Prevention (CDC), the rate of successful live births after ART in different age groups is as under:
- If woman is under 35 years of age, the success rate is 39%
- In the age range 35 to 37 years, the success rate is 30%
- In the age range of 37 to 40 years, the success rate is 21%
- In the age range of 40 to 42%, the success rate is 11%
Most of the assistive reproductive techniques cost anywhere between $10,000 to $35,000. Reportedly 11.2% of all ART procedures yield multiple pregnancies and a significant number of cases are associated with birth defects (most popular being cleft lip/ plate, gastro intestinal disorders and respiratory defects) and pre-term birth (4).
Surrogate mothers are the last options in mothers who are not physically stable or fit to bear pregnancy. It is employed in cases where either the woman has uncontrolled medical illness that may (or is likely) to get aggravated by pregnancy or medically unfit due to uncontrolled hypertension, cancer, cardiac illness or other issues that may interfere with getting pregnant. Surrogate mother is the woman who bears the pregnancy for another woman by donating her egg and harboring the zygote (formed after fertilization of the sperm from male partner) and after giving birth, allows the couple to adopt the baby legally. It accounts for less than 1% of all ART cases.
Once again, reserved for situations when the woman can’t become mother (or bear pregnancy) as a result of lack of functional uterus and is reserved in situations like:
- Woman has no uterus (due to hysterectomy)
- Woman is suffering from a serious organic pathology of uterus
It is different from surrogacy in terms of egg that is contributed by the woman herself that is fertilized in laboratory with the sperm from partner (or sperm donor) and resulting zygote is implanted in the womb of gestational carrier.
Before Infertility Drug Treatments or Artificial Insemination, What Other Options Do A Couple Have In Order To Have A Baby?
- Proper diet and nutrition is helpful in improving general health as well as reproductive health. It is indicated to consume a diet that is rich in healthy calories, anti-oxidants, all essential vitamins and minerals and along with other dietary nutrients.
- Maintenance of body weight in healthy range with a BMI in 20 to 25 kg/m2 range.
- Control of systemic issues and illnesses like high blood pressure, cardiac issues, diabetes, SLE and others.
- Absolute reduction of soda and aerated beverages that increase blood sugar levels and increase the production of free radicals.
- Improving lifestyle habits and activities helps in strengthening of the tissues and help in the correction of hormonal aberrations.
Fertility massages are an emerging mode of alternative therapy to enhance fertility. The aim of these massages is to re-position a tilted uterus and to enhance blood circulation that heals internal tissues and organs. Inquire your healthcare provider regarding the efficacy of self-fertility massage in your case. Other notable benefits of fertility massages are:
- Enhanced functioning of immune system
- Relaxation of the body and release of mental and physical stress
- Improvement in the functioning of endocrine system
- Strengthening of pelvic and abdominal muscles and other supporting tissues
Acupuncture For Enhanced Fertility
Acupuncture is an ancient method of stimulating certain points in your body for the enhanced flow of energy across different parts of the body. Various research studies have proved that acupuncture can enhance fertility by:
- Improving the flow of blood across different parts of the body.
- Improving the count and morphological appearance of sperms.
- Relieve stress that enhances the metabolism of the body and helps in getting rid of free radicals that may damage the eggs and sperms.
If you are looking to use acupuncture as a treatment aid for your fertility issues, consult an acupuncture specialist for best results.
Vitamins and Minerals
Multi-vitamin supplements are advised in females of reproductive age group. The sub-clinical deficiency of different vitamins and minerals is responsible for infertility by interfering with the production or release of hormones and in some cases by increasing the vulnerability of tissues to free radicals, environmental or endogenous toxins.
Herbs and Supplements
Different herbs and supplements are known to stimulate the normal ovulation by stimulating the release of hormones. Herbs like Red Raspberry Leaf supply essential vitamins and minerals that boost reproductive health. Nettles, another popular herb supply large amounts of iron and calcium to promote adrenal and ovarian health. It is also known to prevent birth defects and abnormal cell divisions in zygote (best supplement in mothers with a previous history of delivering a baby with birth defects). The powerful aphrodisiac Damiana increase sex drive and libido.
Consult your healthcare provider for fertility herbs.
Fertility herbs are natural ingredients that increase the chances of conception by supplying micro-nutrients that alleviate hormonal and systemic issues and enhance the health of egg and sperms. Fertility herbs are available for both men and women, but it is recommended not to start any supplement without discussing with your healthcare provider. This is primarily because some herbs can alter the level of reproductive hormones. Moreover, also make sure that:
- Some herbs cross-react with medications you may be taking for systemic issues. To avoid complications, discuss your personal and medical history with your doctor.
- Avoid taking too many herbs at the same time for fertility treatment and always read the ingredients on the cover before staring the therapy.
How To Know What Treatment Is Best For You?
It is important to seek professional assistance or advice in this regard. Your healthcare provider may refer you to a fertility specialist who can help you in knowing the best treatment options that are applicable or helpful in your case. Moreover, it also gives you choice and options to decide what is good for you.
Cause Of Infertility Due To Defects In Sperms
There are many cases (almost 33% of all infertility cases) where the primary cause of infertility is the defects in male sperm count or morphology. In all such cases, it is important to seek precise treatment by identifying the risk factors. If the cause is correctable (seen in certain conditions in which the transport of sperms in impeded as a result of herniation or Varicocele), the treatment of primary disorder may help in resuming fertility.
However, in case of permanent damage to sperm making machinery, the ideal option is to go for artificial insemination (or using sperm donors).
The success rate of fertility treatment generally varies depending upon the type of treatment needed, skill-set of your healthcare provider and overall health of you and your partner. However, if all conditions and cautions are met, infertility is treatable or at least manageable issue.
Infertility Treatments In Women FAQ
Research data suggest that almost 1/3 of all the reported cases of infertility can be primarily attributed to female reproductive issues, 1/3rd to primary male issues and in remaining 1/3rd cases both partners are responsible for an inability to procreate. The following are some of the frequently asked questions that trouble most women (or couples):
1. What things increase a woman’s risk of infertility?
This is perhaps the biggest concern of most women in reproductive age group. Certain life style habits like stressful jobs, long working hours, smoking and alcohol consumption are associated with a higher risk of infertility or delayed conception; however, the most common cause of infertility in women is PCOD (polycystic ovarian disease). Along with advanced age; menstrual irregularities, hormonal imbalance and physical changes in the female reproductive tract are other significant risk factors that increases the risk of infertility.
2. How exactly does obesity affect infertility in women?
Obesity (a body mass index of 28 and higher) is a significant risk factor that increases the risk of female infertility by interfering with normal and regular ovulation. Research suggest that morbid obese women (with a BMI higher than 40) encounter 43% more difficulty in getting pregnant. Research published in International journal of obesity (5) suggests that women with hirsutism and irregular menstrual cycles (with length over 36 days) are mostly obese. It is not yet clear how obesity interferes with normal ovulation but clinical data suggest that peripheral conversion of female hormones in the adipose tissue stores can be one possible explanation.
3. When should I start testing for infertility?
Although, most couples want instant results when they attempt to become pregnant, but in case of a positive history of previous miscarriage, intake of contraceptive pills or irregular menstruation; you may encounter a significant delay in getting pregnant. In most cases, healthcare providers suggest waiting for at least 1 year (with frequent unprotected intercourse on fertile days) before seeing a fertility specialist. In case of a known potential issue (for example large uterine fibroids, pelvic inflammatory disease and anovulatory cycles) an earlier intervention or assistance can be sought.
4. What to expect when a woman go see an infertility doctor?
You doctor will ask questions about personal health, physical and sexual health, questions about menstrual cycles and frequency of intercourse and other relevant information. This history will be followed by general physical examination and (may be a vaginal and anal examination to see for fibroids or any other local pathology). Lastly infertility doctor will advice some laboratory investigations relevant to the case that may help him in knowing more about the cycles and cause of infertility. It is always recommended to see the doctor with male partner so that he may also get an evaluation done.
5. What kinds of tests are done to determine infertility?
There is a huge variety of laboratory tests available that can determine infertility. The choice of test is dependent on your medical and sexual history. Most tests are serum hormonal assays to detect hormonal aberrations (Follicular Stimulating Hormone- FSH, Luteinizing Hormone- LH or human chorionic gonadotropin –hCG levels). Other tests include pelvic ultrasound to detect any pelvic pathology or large fibroids, biopsy of endometrium, hysterosalpingogram and hysteroscopy that are mostly employed when non- invasive tests are non- conclusive.
6. How long is the process for infertility testing before the doctor start treatment?
It primarily depends on the physician and nature of testing required. The doctor will start the treatment as soon as the primary pathology is known and appropriate treatment options are available.
7. Are there any health insurance that will cover infertility treatments?
The cost of infertility treatment is dependent on the nature of pathology. For Polycystic ovarian disease that is perhaps the most common cause of infertility, treatment options like Clomiphene citrate are available. Most insurance companies covers the cost of Clomid mediated ovulation induction. Most preliminary tests are also covered by insurance companies; however, specialized procedures like IVF and other interventional fertility treatments are generally not covered by many insurance companies. It also vary according to the policies of insurance company, the type of insurance you have and nature of treatment required. Speak to the insurance company representative to know more about coverage.
8. How can I have a baby when I can’t afford infertility treatments?
Most fertility treatments (like IVF) are very expensive and most couples can’t afford the cost of therapy. However, there are a number of options that are available. A few include:
- Looking for egg donors (you can reduce the cost by paying for medical costs and cost of procedure only).
- You can check online and get yourself enrolled in a fertility study program (you may be entitled for some compensation)
- There are a few local NGOs and organizations that may provide financial help to non- affording women.
9. Are there any natural infertility treatments proven to work?
There are a number of treatment modalities that helps in increasing the chances of getting pregnant. If both male and female partners are healthy and in good shape the outcome is generally positive. In a fertile woman with regular monthly cycles, simple diet modification and lifestyle changes can help tremendously. Proven natural infertility treatments are dietary supplements, multi- vitamin and herbal supplements and stress management. Latest research data suggest that chiropractic care and acupuncture helps in restoration of normal ovulatory cycles by correcting hormonal imbalances.
- Stephen, E. H., & Chandra, A. (1998). Updated projections of infertility in the United States: 1995–2025. Fertility and Sterility, 70(1), 30-34.
- Tan, S. L., Betts, J., Mason, B., Edwards, R. G., Campbell, S., Royston, P., & Jacobs, H. S. (1992). Cumulative conception and livebirth rates after in-vitro fertilisation. The Lancet, 339(8806), 1390-1394.
- Wang, J. X., Norman, R. J., & Kristiansson, P. (2002). The effect of various infertility treatments on the risk of preterm birth. Human Reproduction, 17(4), 945-949.
- Hartz, A. J., Barboriak, P. N., Wong, A., Katayama, K. P., & Rimm, A. A. (1979). The association of obesity with infertility and related menstural abnormalities in women. International journal of obesity, 3(1), 57