Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse (using no birth control methods).

Infertility affects men and women equally.

WHAT CAUSES INFERTILITY?

The normal reproduction process requires interaction between the female and male reproductive tracts. The woman ovulates and releases an egg from her ovaries to travel through the Fallopian tube to her uterus (womb). The male produces sperm. Both egg and sperm normally meet in the woman’s Fallopian tube, where fertilization occurs. The embryo then implants in the uterus for further development.

Infertility occurs when something in this pattern does not happen. The problem could be with the woman (female infertility), with the man (male infertility), or with both. Unknown factors cause infertility 10% of the time. For infertility with an unknown cause, all findings from standard tests may be normal. The actual cause of infertility may not be detected because the problem may be with the egg or sperm itself or with the embryo and its inability to implant.

Pelvic inflammatory disease (PID)

Sexually transmitted diseases, namely, gonorrhea and Chlamydia, may be associated with pelvic inflammatory disease (PID) and damage a woman’s Fallopian tubes.

Problems in the uterus or fallopian tubes can prevent the egg from traveling from the ovary to the uterus, or womb.

If the egg does not travel, it can be harder to conceive naturally.

Causes include:

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 occur in the muscular wall of the uterus. They can interfere with implantation or 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 normally occur within the lining of the uterus start growing elsewhere in the body.

Previous sterilization treatment: In women who have chosen to have their fallopian tubes blocked, the process can be reversed, but the chances of becoming fertile again are not high.

Environmental and occupational factors

Certain environmental factors may cause men to produce a less concentrated sperm. Exposure to lead, other heavy metals, and pesticides have been associated with male infertility. Many other factors, such as excessive heat exposure, microwave radiation, ultrasound, and other health hazards, are more controversial as to whether they induce infertility.

Toxic effects related to tobacco, marijuana, and other drugs

Smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown to block the production of sperm and decrease the size of a man’s testicles. In women, tobacco changes the cervical mucus, thus affecting the way sperm reach the egg.

Marijuana may disrupt a woman’s ovulation (release of the egg). Marijuana use affects men by decreasing the sperm count and the quality of the sperm.

Heroin, cocaine, and crack cocaine use induces similar effects but places the user at increased risk for pelvic inflammatory disease associated with risky sexual behavior.

In women, the effects of alcohol are related more to severe consequences for the fetus. Nevertheless, chronic alcoholism is related to disorders in ovulation and, therefore, interferes with fertility. Alcohol use by men interferes with the synthesis of testosterone and has an impact on sperm concentration. Alcoholism may delay a man’s sexual response and may cause impotence (unable to have an erection).

Exercise

Exercise should be encouraged as part of normal activities. However, too much exercise is dangerous, especially for long-distance runners. For women, it may result in disruption of the ovulation cycle, cause no menstrual periods, or result in miscarriages (loss of pregnancy). In men, excessive exercise may cause a low sperm count.

Inadequate diet associated with extreme weight loss or gain

Obesity is becoming a major health issue. Obesity has an impact on infertility only when a woman’s weight reaches extremes.

Weight loss with anorexia or bulimia can create problems with menstrual periods (no periods) and thyroid levels, thus disrupting normal ovulation.

Age

A woman becomes less fertile as she ages into her fifth decade of life (age 40-49 years). Among men, as they age, levels of testosterone fall, and the volume and concentration of sperm change.

Healthy couples younger than 30 years who have regular sexual intercourse and use no birth control methods have a 25% to 30% chance of achieving pregnancy each month. A woman’s peak fertility is early in the third decade of life. As a woman ages beyond 35 years (and particularly after age 40 years), the likelihood of becoming pregnant is less than 10% per month.

Cholesterol

High cholesterol levels may have an impact on fertility in women.

 

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