INFERTILITY

The main symptom of infertility is not getting pregnant. You may not have or notice any other symptoms.

Infertility in Women

In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Infertility may be caused by:

• Ovulation disorders. This include polycystic ovarian syndrome (PCOS), and hyperprolactinemia. Other causes may be due to excessive exercising, eating disorders, injury or tumors.
• Uterine or cervical abnormalities. This include problems with opening of the cervix or the production of cervical mucus, or abnormalities in the shape of the uterus.
• Fallopian tube blockage or damage. Due to inflammation of fallopian tube or salpingits from pelvic inflammatory disease, sexually transmitted infection, endometriosis, or adhesions.
• Primary ovarian insufficiency. This is also called early manopause when menstruation ends before 40.
• Thyroid problems. Due to hyperthyroidism (too much thyroid hormones) or hypothyroidism (too little hormones).
• Cancer and its treatment. Due to female reproductive glands cancer and the treatment with chemotherapy and radiation therapy.
• Medical conditions. These conditions are associated with delayed puberty or absence of menstruation (amenorrhea). These are the celiac disease, Cushing’s disease, sickle cell disease, kidney disease or diabetes.

Symptoms include:

• Abnormal periods. Bleeding is heavier or lighter than usual.
• Irregular periods. The number of days in between each period varies each month.
• No periods. You have never had a period, or periods suddenly stop.
• Painful periods. Back pain, pelvic pain, and cramping may happen.
• Skin changes, including more acne
• Changes in sex drive and desire
• Dark hair growth on the lips, chest, and chin
• Loss of hair or thinning hair
• Weight gain
• Milky white discharge from nipples unrelated to breastfeeding
• Pain during sex

Infertility in Men

Infertility symptoms in men can be vague and may go unnoticed until a man tries to have a baby.

Symptoms depend on what is causing the infertility and can be evaluated through semen analysis. Causes of infertiliyu in men include:

• Varicoceles. When the vein on man’s testicles are too large and causes it to heat. Heat can affect the number and shape of sperm.
• Abnormal sperm production. Medical conditions such as diabetes and prior infection may affect the sperm:
• Problems with delivery of the sperm. This is because sperm may go to the bladder, testicle is being blocked, or there are damage to the reproductive organ. This may be caused by premature ejaculation, cystic fibrosis, those who had vasectomy.
• Overexposure to certain chemicals. Due to pesticides, radiation, tobacco smoke, alcohol, marijuana, and steroids (including testosterone). In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate the testicular temperature, impairing sperm production.
• Damage related to cancer and its treatment. Due to chemotherapy, radiation therapy or the removal of one testicle.

Symptoms of male infertility manifest as:

• Changes in hair growth
• Changes in sexual desire
• Pain, lump, or swelling in the testicles
• Problems with erections and ejaculation
• Small, firm testicles

DIAGNOSIS

If you are infertile, your doctor will go over your health history, medications, sexual history, and your sex habits, like how often you have sex. Tests depends on the condition the doctor suspects the patient has.

In about 80% of couples, the cause of infertility is either an ovulation problem, blockage of the fallopian tubes, or a sperm problem. In 5%-15% of couples, all tests are normal, and the cause is not known.

Tests for men

You may have a general physical exam. This includes an examination of your genitals. Specific fertility tests may include:

• Semen analysis. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen.
• Hormone testing. Determine the level of testosterone and other male hormones.
• Transrectal and scrotal ultrasound.
• Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
• Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy will tell if sperm production is normal.
• Other testing. In some cases, other blood or semen tests may be recommended to try to determine why the sperm may not be able to effectively fertilize the egg.

Tests for women

You may have a general physical exam. This includes a regular gynecological exam. Specific fertility tests may include:

• Ovulation testing. A blood test is performed to measure hormone levels to determine whether you’re ovulating, if you have not had positive home ovulation tests.
• Hysterosalpingography. Hysterosalpingography evaluates the condition of your uterus and fallopian tubes.
• Ovarian reserve testing. This testing helps determine the quality and quantity of the eggs available for ovulation.
• Other hormone testing. Other hormone tests check levels of ovulatory hormones, as well as thyroid and pituitary hormones that control reproductive processes.
• Imaging tests. Pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography is used to see details inside the uterus that are not seen on a regular ultrasound.

RECOMMENDED MEDICATIONS

In men, fertility is treated with:

• Surgery, if the cause is a varicoele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
• Antibiotics to treat infections in the reproductive organs.
• Medications and counseling to treat problems with erections or ejaculation.
• Hormone treatments if the problem is a low or high level of certain hormones.

In women, infertility is treated with:

• Fertility drugs and hormones to help the woman ovulate or restore levels of hormones
• Surgery to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes

Infertility in men and woman can also be treated with assisted reproductive technology, or ART. There are several types of ART:

• IUI (intrauterine insemination): Sperm is collected and the placed directly inside the woman’s uterus while she is ovulating.
• IVF (in vitro fertilization): The sperm and egg are collected and brought together in a lab. The fertilized egg grows for 3 to 5 days days. Then the embryo is placed in the woman’s uterus.
• GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer): The sperm and egg are collected, brought together in a lab, and quickly placed in a fallopian tube. With GIFT, the sperm and eggs are placed into the fallopian tube. With ZIFT, a fertilized egg is placed into the tube at 24 hours.