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OVERVIEW

What is infertility?

Infertility means a couple isn’t able to become pregnant after 1 year of having regular, unprotected sex. Infertility can affect both women and men. A woman is considered infertile if she has tried for 1 year to get pregnant and hasn’t used birth control. A man is considered infertile if he has too few sperm or his sperm are too unhealthy to combine with a woman’s egg. Many couples don’t have trouble becoming pregnant. Unfortunately, there are factors that can make it difficult for some.

SYMPTOMS

The main symptom of infertility is not being able to get pregnant. There may be no other symptoms. Sometimes women can have problems relating to their period such as pain or abnormal bleeding.  Some men can have problems with erectile disfunction. However, most couples will have no other symptoms other than not getting pregnant.

CAUSES & RISK FACTORS

What causes infertility?

Making a baby (getting pregnant) is complex. Multiple things have to go right for both the man and the woman. Therefore, there are many causes of infertility that make it difficult to get pregnant.

A woman’s fertility can be affected by:

• Problems with ovulation. This is the process by which the egg leaves the ovary and travels to meet the sperm. Some women don’t ovulate every month.
• Problems with your reproductive system, including your fallopian tubes, cervix, uterus, or ovaries. This might include a blockage, growths, scarring, enlarged ovaries, or an abnormal opening of the cervix.
• Early-onset menopause. This would occur before the age of 40. It may be tied to an immune system disease, cancer treatments, or a genetic syndrome.
• Diseases and disorders, including endometriosis, pelvic inflammatory disease, cancer, diabetes, autoimmune diseases (when your body attacks itself), lupus, and celiac disease.
• Delayed puberty or absence of a period.
• Smoking and substance abuse.
• Being overweight or underweight. Even too much or too little exercise can affect the chances of getting pregnant.
• After age 35, it gets harder to get pregnant.

A man’s fertility can be affected by:

• Unhealthy or poorly functioning sperm. This includes the quality of the sperm as well as how quickly they move.
• Bacterial infection. This can be an infection inside the testicles. It can also be a sexually transmitted infection.
• A varicocele. This is an enlargement of the veins inside the loose skin that surrounds the testicles. It can cause low sperm count.
• Retrograde ejaculation. This means sperm goes into his bladder rather than outside the penis.
• Undescended testicles. One or both of the testicles remain in the abdomen. Testicles are supposed to drop down from the abdomen into the scrotal sac at birth.
• Smoking and substance abuse.
• Sexual dysfunction. This can include erectile dysfunction or problems ejaculating too soon or not at all.
• Overheating the testicles. This can occur by wearing underwear or pants that are too tight. It can also happen by using a hot tub for extended periods.

DIAGNOSIS & TESTS

Your healthcare provider will conduct a medical exam. They will ask you questions about your general health and how long you’ve been trying to get pregnant. While your healthcare provider will decide what additional testing is necessary, it will likely begin with blood tests. These will check hormone levels and genetics and egg quality.

Women may have additional tests. These could include:

• Transvaginal ultrasound. A medical technician will insert a small wand, covered with latex, into your vagina. The wand is connected to a screen, where the technician can view images of the inside of your uterus and fallopian tubes. The technician will send the images to your healthcare provider to review.
• An X-ray that involves injecting dye into your uterus to look for blockages inside your fallopian tubes. It doesn’t require anesthesia.
• Pelvic laparoscopy. This surgical procedure is performed in a hospital. A thin, flexible scope is inserted into your abdomen to give your healthcare provider a better look at your uterus and fallopian tubes. It helps look for polyps, growths, and blockages.

For men, the first test may be to collect a sample of semen (the fluid that is ejaculated from the penis). This is used to examine his sperm count, quality, and movement.

Men may undergo further physical exams, which would look for:

• Past injury to his testicles or penis
• Discharge, a fluid that shouldn’t be in the penis
• A swollen or enlarged prostate
• A varicocele
• Recent high fevers
• A history of mumps
• A biopsy of the testicles may be necessary to get a better sperm sample.

PREVENTION

Can infertility be prevented or avoided?

Some causes of infertility can’t be prevented or avoided. But both men and women can take steps to increase their chances of pregnancy.

Women should:

• Quit smoking.
• Avoid alcohol and street drugs.
• Exercise moderately, but not so much that it interferes with your periods.
• Maintain a healthy weight.

Men should:

• Avoid tobacco, drugs, and excessive alcohol use.
• Avoid high temperatures, such as hot tubs or saunas.
• Avoid industrial or environmental toxins.
• Exercise regularly.

TREATMENT

Infertility treatment is based on the cause of your infertility. For women, treatment may include medicine or surgery. The most common medicines used to treat female infertility stimulate the ovaries. This helps the ovaries produce more eggs and increases the chances of getting pregnant. Surgery can be done if there are blockages or problems with the fallopian tubes. It also is used to remove areas of endometriosis, fibroids, polyps, or scarring, which all can affect fertility.

Men can be treated with medicine and surgery. If they have erectile dysfunction or problems ejaculating, medicine may be prescribed. If they have varicoceles in the testicles or issues with blockages in the tubes that carry sperm, those can be repaired with surgery.

Assisted Reproductive Technology (ART)

ART uses technologies to help a couple get pregnant. It may help people who have gone through various infertility treatments but still can’t get pregnant. Some options include:

• Intrauterine insemination (IUI). This procedure inserts healthy sperm into the woman’s uterus around the time of ovulation. It uses a long, narrow tube to insert the sperm.
• In vitro fertilization (IVF). It requires stimulating the ovaries with hormones and removing eggs from the woman. The eggs are fertilized with sperm in a laboratory. Once an embryo develops, it is placed into the woman’s uterus. While they can be successful, there is no guarantee that IUI or IVF will result in a pregnancy.
• Third party-assisted ART. This is when another person helps a couple get pregnant. They can help by donating sperm, donating eggs, or donating embryos. They may also serve as a surrogate or gestational carrier. This means another person actually carries the baby for you.

Living with infertility

Living with infertility is emotionally difficult. The disappointment of not becoming pregnant after trying each month can be hard on relationships. It can also be hard on your emotional health. It’s difficult to see friends, family, and even strangers have babies when you cannot. For those women who try IVF treatment, the hormones and egg-stimulating medicines can affect your emotional health. Long-term studies suggest they can impact your physical health as well (with possible links to breast cancer and ovarian cancer).

FOR MORE INFORMATION

Nova Scotia Health

https://www.nshealth.ca/pre-pregnancy-and-fertility

Atlantic Assisted Reproductive Therapies

https://aart.ca/

Health PEI

https://www.princeedwardisland.ca/en/information/health-pei/sexual-health-options-reproductive-services-shors