It is absolutely necessary to understand what is infertility, so that needless worries among couples who are trying for a baby can be avoided or the right medical intervention can be applied at the right time.
Infertility is defined in medical terms as the inability of a couple to get pregnant or to carry a pregnancy to full term. Infertility in a couple can be caused by male factors, female factors or both male and female factors. In some cases, exact cause of infertility may not be known (unexplained infertility).
What is Primary Infertility?
Primary infertility refers to a couple’s inability to get pregnant, even after trying to do so for one year by having regular sexual intercourse without contraception. It is advisable for a couple whose female partner is over 35 years of age to seek immediate medical help, if they are not able to conceive after 6 months of regular sexual intercourse without using any contraceptives. Special care should be taken to avoid any delay in medical diagnosis and treatment in such cases.
What is Secondary Infertility?
In secondary infertility, the couple had at least one child in the past (either with the same partner or with a different partner), but they are not able to get pregnant again, even after trying to do so for one year by having regular sexual intercourse without contraception.
Causes of primary and secondary infertility tend to be the same and same treatment methods are used for both.
Frequently Asked Questions (FAQS) About Infertility
What are the statistics about prevalence of infertility?
It is estimated that one in seven couples (globally) has issues with successful conception.
What is male factor infertility?
If infertility in a couple is caused by a problem with the male partner’s reproductive system, it is called male factor infertility. Click here for more information on factors that can cause infertility in men.
What is female factor infertility?
If infertility in a couple is caused by a problem with the female partner’s reproductive system, it is called female factor infertility. Click here for more information on factors that can cause infertility in women.
What is unexplained infertility?
If an exact cause of infertility cannot be diagnosed, it is called unexplained infertility.
What are the risk factors of infertility?
Factors that can contribute to infertility are: aging, infections of thyroid gland, autoimmune diseases, chemotherapy, use of anti psychotic medicines and illegal drugs such as marijuana or cocaine, being overweight or underweight, overly intense exercise or no exercise, stress, excessive drinking, smoking, sexually transmitted diseases (STD), infections in the reproductive tract, occupational and environmental factors such as exposure to harmful substances or temperature.
What are the causes of infertility?
Please click causes of infertility in women and causes of infertility in men for detailed information.
Testing of both male and female partners are recommended, if the couple is not able to get pregnant, even after trying to do so for one year by having regular sexual intercourse without using any contraceptives. Testing after 6 months is advisable for a couple, if the female partner is over 35 years of age.
Three most common methods of infertility treatment for women are:fertility drugs, surgical treatments and Assisted Reproductive Technology (ART). The main factor that determines chosen treatment method is the underlying cause of infertility (click for more information). If there is a need, the fertility specialist might recommend for a combination of any of these treatment methods.
Infertility treatment can be a lengthy and challenging process. Patience, commitment and mutual support of couple under treatment are important factors that can influence success of the treatment. It is advisable to discuss with the doctor or fertility specialist about the pros and cons of the treatment prescribed. Most common infertility treatments for women are explained in this article.
Fertility Drugs
Fertility drugs are usually used to treat infertility in women who suffer from ovulatory disorders. These drugs help to induce ovulation by functioning in the same way as natural hormones. Fertility drugs listed below are the most widely used ones:
Clomiphene Citrate (Clomid)
Clomiphene citrate (Clomid) tablets (taken orally) are usually used to treat women who suffer from poly cystic ovarian syndrome (PCOS). This drug stimulates the pituitary gland to produce more gonadotropins: follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones then help to induce ovulation.
Drugs that contain Follicle Stimulating Hormone (FSH)
These drugs are used to treat women whose ovaries are capable of producing eggs, but those eggs do not mature enough due to hormonal abnormalities. FSH drugs injected to a woman’s body stimulate a follicle (egg) to develop and mature.
FSH drugs can be also used to stimulate development of multiple eggs for in vitro fertilization (IVF).
Metformin (Glucophage)
Metformin is prescribed for women who suffer from insulin resistance. Insulin resistance can be one of the causes of polycystic ovarian syndrome (PCOS). Metformin is usually taken orally and it helps to boost ovulation. This drug is sometimes used in combination with Clomid or FSH drugs.
Gonadotropin releasing hormone (Gn-RH) analog drugs
Gn-RH drugs administered by injections or nasal spray, are used to treat irregular ovulatory cycles and premature ovulation. These drugs act on the pituitary gland to control ovulation.
Human Menopausal Gonadotropin (hMG) Drugs
This medicine is used to treat infertility in women who do not ovulate due to failure of pituitary gland. Human menopausal gonadotropin (hMG), which contains both follicle stimulating hormone (FSH) and luteinizing hormone (LH), directly stimulates ovaries for ovulation. hMG is administered by injections.
Bromocriptine (Parlodel)
Prolactin is the hormone that stimulates milk production in women. High levels of prolactin in body can cause irregular ovulation cycles. Bromocriptine drugs can help to control prolactin levels, resulting in regular ovulation cycles.
Surgical Treatments
The fertility specialist might choose surgery as a means of infertility treatment for women in following scenarios:
Damages or blocks to fallopian tube (click for more information) can cause infertility. These damages or blocks can be repaired through laparoscopic keyhole surgeries.
A surgery may be used to treat women suffering from endometriosis, if the medical treatment using drugs is ineffective. As in the case of fallopian tube repair, laparoscopy is the most common surgical method used to treat endometriosis.
As explained in fertility drugs section above, poly cystic ovarian syndrome (PCOS) can be treated with the aid of drugs. A surgery might be recommended, only if treatment using drugs is ineffective. The most common surgical procedure to treat PCOS is called laparoscopic ovarian drilling (LOD) which is a relatively non invasive procedure very similar to laparoscopy. Small surgical tools inserted through a key hole are used to burn away parts of ovarian follicles (which are malicious cysts). A less commonly used surgical method to treat PCOS is ovarian wedge resection which has very high risks associated with it, including scarring of ovary. It is advisable to get a second opinion, if the fertility specialist recommends for an ovarian wedge resection.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology (ART) is an advanced method used to treat infertility in both men and women. It is advisable to discuss with the fertility specialist about benefits and possible side effects of ART treatment. Most common ART treatments for women are explained below:
Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) is a process in which sperm collected from normal ejaculate of male partner, sperm retrieved from reproductive tract of male partner or donated sperm are directly placed into a woman’s uterus, close to the time of her ovulation. Doing so would increase chances of fertilization, since a concentrate of high quality sperm is placed into the uterus and it is relatively easier for sperm to travel from the uterus to fallopian tube and fertilize the egg, rather than travelling all the way from vagina to fallopian tube through the cervix. If the woman under treatment has ovulatory disorders, prior to IUI, fertility drugs may be prescribed for her to induce ovulation.
IUI is performed under any of the following scenarios:
female partner has healthy fallopian tubes (without any blocks or damages) but suffers from cervical mucus defect, endometriosis or sperm allergy
male partner suffers from sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction
Click herefor more detailed information about IUI such as: success rate of IUI, factors that can influence success of IUI, cost of IUI, risks of IUI, things to take care of after IUI treatment etc.
In Vitro Fertilization (IVF) and embryo transfer
In Vitro Fertilization (IVF) is one of the most effective ART treatments. In IVF, fertilization of multiple eggs by sperm take place in a laboratory setting and one or more embryos formed are then transplanted into mother’s womb (uterus). This method is used to treat infertility in women suffering from damaged or blocked fallopian tubes, cervical mucus defect, endometriosis, ovulatory disorders, sperm allergy or unexplained infertility. IVF is also used to treat infertility caused by male factors such as sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction.
In IVF, fertility drugs are used to stimulate production of multiple ovaries (eggs) in women. Once these eggs mature, the fertility specialist retrieves them from ovary through a minor surgical procedure. In a laboratory setting, each egg is then mixed with sperm collected from normal ejaculate of male partner or sperm retrieved from the reproductive tract of male partner. This would result in fertilization of multiple eggs and formation of multiple embryos. One or more healthy embryos are then transplanted into woman’s womb (uterus). A successful pregnancy is achieved when one or more of these transferred embryos gets implanted to the uterus lining and starts growing there. There is a possibility of having a multiple pregnancy (pregnancy with two or more foetuses); if more than one embryo is transferred to a woman’s womb by IVF. This has a few risks associated with it. It is advisable to discuss with the fertility specialist about it. Embryos that are left over from an IVF cycle can be freezed for future use, donated to other infertile couples or destroyed.
An advantage of IVF is that, it can also be performed using donated eggs and/or donated sperm. Click here for more detailed information on IVF such as: success rate of IVF, factors that can influence success of IVF, duration of IVF treatment, cost of IVF, how to finance IVF costs?, what are blastocyst transfer, assisted hatching and intracytoplasmic sperm injection (ICSI) in IVF?, risks of IVF, things to take care of after IVF treatment etc.
Gamete Intrafallopian Transfer (GIFT)
This treatment method is recommended under similar scenarios as in the case of in vitro fertilization (IVF). The difference is, to have a successful pregnancy through gamete intrafallopian transfer (GIFT); women should have healthy fallopian tubes without any damage or blocks. The process is similar to IVF. Mature eggs are retrieved from the female partner and eggs are then mixed with sperm collected from male partner, outside the body. Instead of allowing the fertilization to take place in a laboratory setting (as in the case of IVF), the mixed eggs and sperm are immediately transferred to woman’s one or both fallopian tubes where it fertilizes naturally. If the treatment works, the fertilized egg (embryo) will then travel down through the fallopian tube to the uterus and will get implanted to the uterus lining. GIFT can also be performed with donated eggs and/or donated sperm. However, GIFT is less commonly used than IVF for infertility treatment for women.
Zygote Intrafallopian Transfer (ZIFT)
Zygote intrafallopian transfer (ZIFT), also known as tubal embryo transfer (TET) is a process is similar to gamete intrafallopian transfer (GIFT). As in the case of GIFT, women should have healthy fallopian tubes in order to perform Zygote Intrafallopian Transfer (ZIFT). The difference between GIFT and ZIFT is that, in GIFT a mixture of eggs and sperm are placed into fallopian tubes and fertilization happens inside woman’s body, whereas in ZIFT a zygote (developing embryo which was fertilized in a laboratory setting) is placed into fallopian tube. If the treatment works, the zygote (embryo) will then travel down through the fallopian tube to the uterus and will get implanted to the uterus lining. ZIFT can also be performed with donated eggs and/or donated sperm.
Difference between in vitro fertilization (IVF) and ZIFT is: in IVF, embryo is transplanted into a woman’s uterus, where as in ZIFT, embryo is placed into a woman’s fallopian tube. ZIFT is not as commonly used as IVF.
Possible Adverse Effects of Infertility Treatment for Women
Multiple pregnancy (pregnancy with two or more foetuses) is considered to be a main risk associated with infertility treatments. Fertility drugs used for infertility treatment stimulate production of multiple ovaries. This would increase chances of fertilization of multiple eggs and formation of multiple embryos. Similarly, in treatment methods such as in vitro fertilization (IVF), one or more embryos may be transplanted into a woman’s uterus. This can result in multiple pregnancy. Multiple pregnancy can cause high blood pressure and diabetes in mother, premature labor and babies having low birth weight.
Other possible side effects of infertility treatments are: infections or damage to reproductive tract, ovarian hyper stimulation syndrome or over stimulation of ovaries (by fertility drugs), ectopic pregnancy (a condition in which a fertilized egg gets implanted to fallopian tube instead of uterus and starts growing there), allergic reactions to drugs, anxiety, sleep interruptions, mood swings, hot flushes andbirth defects in babies (chances of birth defects are very low).
Three most widely used methods of infertility treatment for men are:drugs, surgery and Assisted Reproductive Technology (ART). The main factor that determines chosen treatment method is the underlying cause of infertility (click for more information).
Infertility treatment can be a lengthy and challenging process. Patience, commitment and mutual support of couple under treatment have a great influence on the success of treatment. It is important to discuss with the fertility specialist about benefits and possible side effects of the treatment prescribed. Most common infertility treatments for men are explained in this article.
Treatment Using Drugs
Drugs are used to treat hormonal imbalances that harmfully affect sperm production and sperm quality, infections in reproductive tract and other problems such as retrograde ejaculation.
Clomiphene citrate (Clomid), human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) are the commonly used fertility drugs for men (Clomid and hMG are used to treat infertility in women too). All these drugs induce testes to produce more testosterone (male sex hormone) in order to increase sperm count and sperm quality. Clomid is administered in tablets, while hMG and hCG are administered by injections.
Infertility can also be caused by infections in reproductive tract or sexually transmitted diseases such as Chlamydia. Antibiotics can be used to treat these conditions.
Treatment for Retrograde Ejaculation
Retrograde ejaculation is a condition in which muscles of the bladder dysfunction and sperm is forced to flow backward into the urinary bladder instead of moving forward to the penis. This can result in low ejaculate volume, low sperm count, low sperm quality and cloudy urine after ejaculation.
Retrograde ejaculation can be treated using drugs such as pseudoephedrine or imipramine. These medications can help to keep bladder neck closed during ejaculation, preventing retrograde ejaculation. Some times retrograde ejaculation may be a side effect of a medication. In this case, stopping that medication or switching to another drug can prevent retrograde ejaculation.
If treatment using drugs is ineffective or if there is a severe damage to nerves or muscles of the bladder, it may not be possible to restore normal ejaculation. In such a scenario, a fertility specialist can help to retrieve sperm either from urine or from the reproductive tract through a minor surgical procedure. These retrieved sperm can be used for infertility treatment through assisted reproductive technologies such as: intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Surgical Treatments
Following surgical methods can be used for infertility treatment for men.
Varicocele Ligation or Varicocelectomy
Varicocele is enlargement of varicose veins around testes. This raises temperature in testes, causing reduced sperm count and abnormal sperm morphology. Varicocele ligation or varicocelectomy is a micro surgical procedure to treat varicocele by tying off distended veins.
Resection of Blockages in Vas Deferens or Ejaculatory Duct
Sperm is transported from testes to penis through vas deferens (a pair of tubes, one from each testicle) and ejaculatory duct. Blocks in vas deferens or ejaculatory duct can result in low sperm count or complete absence of sperm cells in semen. This condition can be corrected with the help of a relatively simple micro surgical procedure.
If the surgical treatment to remove blockage is not successful, next best option is to retrieve sperm from reproductive tract through a minor surgery and use these sperm for treatment through assisted reproductive technologies such as: intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Vasectomy Reversal
Vasectomy is a surgical procedure used to make a man sterile. In vasectomy, vas deferens (tubes through which sperm travels from testes to urethra) are severed and sealed, disrupting sperm flow.
Vasectomy can be reversed through a surgery to stitch together cut ends of vas deferens. This procedure would restore sperm flow and fertility.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology (ART) is an advanced method used to treat infertility in both men and women. It is important to discuss with the fertility specialist about pros and cons of ART treatment. Most common ART treatments for men are explained below:
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) can be performed in conjunction with in vitro fertilization (IVF). ICSI may be recommended for men who suffer from sperm disorders such as low sperm count, complete absence of sperm cells in semen, poor sperm motility or abnormal sperm morphology. These disorders prevent sperm from successfully penetrating and fertilizing an egg. ICSI can also be used to treat infertility in men caused by premature ejaculation, erectile dysfunction or if previous attempts of IVF failed to achieve a successful pregnancy.
Treatment starts with collection of sperm either from normal ejaculate of male partner or from the reproductive tract of male partner and retrieval of ovaries (eggs) from female partner. Donated sperm and/or ovaries can also be used for ICSI. In a laboratory setting, a selected single sperm is injected into the cytoplasm of an egg. This makes it easier for the sperm to penetrate the egg and fertilize it. Then another single sperm and egg are picked from the sample and same process is repeated (it is repeated a few times to increase chances of formation of multiple embryos). One or more healthy embryos formed are then transplanted into woman’s womb (uterus). There is a possibility of having multiple pregnancy (pregnancy with two or more foetuses), if more than one embryo is transferred to a woman’s womb. This has a few risks associated with it. It is advisable to discuss with the fertility specialist about it.
In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI)
In vitro fertilization (IVF) and intrauterine insemination (IUI) can be used to treat men suffering from sperm disorders, blocks in vas deferens or ejaculatory duct, retrograde ejaculation, premature ejaculation or erectile dysfunction. Sperm collected from ejaculate, sperm retrieved from reproductive tract through surgical procedures or donated sperm can be used for IVF and IUI. Click IVF procedureand IUI procedure for detailed explanation on how IVF and IUI work.
Possible Adverse Effects of Infertility Treatment for Men
One of the main risks associated with infertility treatment using assisted reproductive technology (ART) is multiple pregnancy (pregnancy with two or more foetuses). In treatment methods such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), one or more embryos may be transplanted into a woman’s uterus. This can result in multiple pregnancy. Multiple pregnancy can cause high blood pressure and diabetes in mother, premature labor and babies having low birth weight.
During an ART treatment, if sperm is not present in ejaculate of a man due to conditions such as retrograde ejaculation or blocks in vas deferens or ejaculatory duct, it might be needed to retrieve sperm from reproductive tract through a minor surgery (other option is to use donor sperm). This surgical procedure to retrieve sperm has a very low risk of infection and damage to testes.
Infertility treatment for men, using fertility drugs can cause side effects such as temporary blurred vision, breast enlargement, acne, weight gain, allergic reactions and damage to liver in rare cases.
Infertility treatments can also cause birth defects in babies, but chances for this to happen are very low.
There are a number of ways to perform infertility test for women. Some of the basic tests can be performed at home, while for others a visit to a medical practitioner or fertility specialist is essential. Infertility tests are recommended for both partners, since fertility problems can be with either female partner or male partner or both. (Click here for more information on infertility test for men)
Fertility testing and investigation can be a lengthy process. Hence, patience and commitment from the couple under investigation is absolutely important. The couple needs to support each other to go through this challenging process.
The video below explains basic infertility evaluations performed for women and men.
Most common methods of infertility test for women are explained below:
Home Tests
Following tests can be done at home. Taking a home test is no replacement for laboratory testing, but it can be considered as a first step in the right direction.
Follicle Stimulating Hormone (FSH) Home Test
Follicle stimulating hormone (FSH) is a hormone produced by the pituitary gland. Abnormal levels of FSH can be a cause of infertility in women.
FSH home test is taken on day 3 of menstrual cycle (follow up tests can be taken on day 4 and day 5 as well). The test measures FSH levels either through a mid-stream urine test or through a test strip that can be dipped in a urine sample.
If test results indicate elevated levels of FSH, it is important to visit a medical practitioner or fertility specialist. On the other hand, if test results show normal FSH levels, please understand that it is not an assurance of normal fertility health (since, a high FSH level is only one of the causes of infertility in women).
Basal Body Temperature (BBT) Home Test
Basal body temperature (BBT) test is another common home infertility test for women. BBT is the lowest temperature attained by human body during rest. It is usually measured immediately after one wakes up in the morning. BBT can be measured using special BBT thermometers or using normal thermometers.
After ovulation, BBT increases by one half to one degree Fahrenheit or one quarter to one half of a degree Celsius. If the basal body temperature does not rise during a menstrual cycle, or if the temperatures are irregular, it can be indicative of conditions such as anovulation (complete lack of ovulation). This can be a cause of infertility.
Luteinizing Hormone (LH) Home Test
A surge in luteinizing hormone (LH) level occurs prior to ovulation. If there is no surge in LH level during a menstrual cycle, then that can be a signal of infertility.
LH home test can be either a midstream urine test or a test strip that can be dipped in a urine sample. To detect rise in LH levels, the test needs to be carried out for several days starting from 11th day of a menstrual cycle, either till a surge in LH levels is detected or till 20th day of menstrual cycle.
OV Watch
OV watch can be worn by women on their wrists while they sleep. It measures chloride ion levels in sweat released by skin. Chloride ion levels in a woman’s sweat rises (usually up to 3 times) a few days prior to ovulation. OV watch detects this surge in chloride ions and predicts four fertile days before ovulation. The watch needs to be worn from 1st, 2nd or 3rd day of menstrual cycle, either till ovulation day or till 20th day of menstrual cycle. If no rise in chloride ion levels is detected, then that can be a signal of infertility.
Physical Examination
First steps in a medical infertility diagnosis are a detailed interview and a physical examination. The medical practitioner will gather information from the individual or couple under investigation about health history, sexual habits and history of sexual problems, birth control use, menstrual and pregnancy history, use of prescription medication, surgical history, exposure to chemicals, toxins or radiation, life style factors such as smoking, excessive drinking or use of illegal drugs, reports of prior infertility treatment, family history of reproductive problems etc. This would be followed up with an examination of thyroid, breasts, pelvis and hair growth. A pap smear test (click for more information) might be also done. After this, the doctor may recommend any of the tests listed below.
Laboratory Blood Tests
Following infertility tests for women are performed by collecting and analysing a blood sample of the individual under investigation.
Follicle Stimulating Hormone (FSH) Blood Test
FSH test is performed on a blood sample collected on the 3rd day of a woman’s menstrual cycle. This test verifies whether follicle stimulating hormone (FSH) level is normal. Abnormal FSH level indicates low fertility.
Progesterone Blood Test
Progesterone blood test, usually done 7 days after ovulation, checks for progesterone level in the body. Low progesterone level can cause infertility in women.
Estradiol Blood Test
Estradiol test performed on the 3rd day of menstrual cycle measures estradiol level in the body. A high level of estradiol can harmfully affect egg quality, causing infertility.
Luteinizing Hormone (LH) Blood Test
LH test measures luteinizing hormone (LH) level in the body. It is done on 3rd day of menstrual cycle. Abnormal LH level signals low fertility.
Inhibin B Blood Test
This test is done on 3rd day of menstrual cycle. High level of inhibin B hormone indicates a healthy ovarian reserve (ovarian reserve is the quantity of eggs remaining in a woman) and good fertility. Level of inhibin B usually decreases with age, indicating depletion of ovarian reserve.
Anti-Mullerian Hormone (AMH) Blood Test
AMH test is a modern and effective infertility test for women. Anti-mullerian hormone (AMH) is produced by cells in developing egg sacs (follicles) in the ovary. AMH levels do not vary with the menstrual cycle. Hence, the test can be performed on any day of the menstrual cycle. Normal AMH levels indicate a good ovarian reserve (healthy supply of eggs).
Abnormal (low or high) AMH levels are not desirable. Low AMH level implies less quantity of eggs remains in ovary. This point to a decline in fertility. Higher than normal AMH level can be a sign of polycystic ovarian syndrome (PCOS).
Measurement of AMH levels can be also helpful to determine the best dose of fertility drugs to stimulate ovaries during an in vitro fertilization (IVF) treatment.
Clomiphene Citrate Challenge Test (CCCT)
Clomiphene citrate challenge test (CCCT) also known as clomid challenge test is used to measure follicle stimulating hormone (FSH) and estradiol levels in the body. On day 3 of menstrual cycle, a blood sample is drawn from the individual under investigation and FSH and estradiol levels are measured. From day 5 to day 9 of the menstrual cycle, 100 mg (two 50 mg tablets) clomid is prescribed. Then, a blood sample is drawn again on day 10 or day 11 of the menstrual cycle and FSH and estradiol levels are measured. Higher than normal FSH and estradiol levels detected on day 3 and day 10 (or day 11) can be a signal of infertility. Results of CCCT can also be an indicator of an individual’s responsiveness to in vitro fertilization (IVF)treatment.
Post Coital Test (PCT)
Post coital test is not a commonly used infertility test for women. This test is usually performed when all other factors that can influence a successful pregnancy seem to be normal, and the doctor feels that problems with cervical mucus or immune system may be causing infertility. The test is done on a sample of woman’s cervical mucus taken within 8 to 12 hours after the couple had sexual intercourse. The test is usually performed 1 to 2 days before ovulation. It checks for normal sperm motility and presence of live sperm in cervical mucus, two important factors that influence successful conception. Post coital test can be useful to determine the need for Intrauterine Insemination (IUI).
Chlamydia and Thyroid Tests
Chlamydia (a sexually transmitted disease) and problems with thyroid gland can cause infertility. Hence, tests are performed to detect chlamydia or thyroid infection.
Advanced Infertility Test for Women
If the doctor or fertility specialist feels that there is a need for a more detailed diagnosis, he/she might recommend any of the following advanced infertility tests for women. Before performing these tests, it is important to confirm that the individual under investigation is not pregnant (as these tests can harmfully affect an embryo).
Pelvic Ultrasound Test
In this method, an ultrasound scan is used to check health of ovaries and uterus. Factors such as follicle development, antral follicle count, presence of fibroids or ovarian cysts and thickness of the lining of the uterus can be checked.
Sonohysterogram Test
If the pelvic ultrasound test (explained above) suggests that the uterus lining (endometrial lining) is thicker than normal, a sonohysterogram test might be recommended. Sonohysterogram test would help to confirm or rule out presence of fibroids and would also help to assess the size and contour of uterine cavity. The test is performed just after a menstrual period has finished (usually between day 7 and day 10 of a regular 28 day menstrual cycle). In this method, an ultrasound scan is performed after infusing a sterile saline solution (that aids in a better visualization of the uterus) into the uterus through a soft plastic catheter placed in the cervix.
Endometrial Biopsy
This advanced infertility test for women is particularly helpful for those who had one or more miscarriages. A small sample of tissue of the uterus lining (endometrial lining) is collected from the individual under investigation prior to menstruation (usually after 21st day of a regular 28 day menstrual cycle). The sample is then analysed to verify whether the uterus lining is thick enough for successful implantation of a fertilized egg.
Hysterosalpingogram (HSG) Test
This test is useful to find out whether there is any blockage in fallopian tubes and to evaluate the size and contour of uterine cavity. Test is performed after a menstrual cycle has finished (usually between day 6 and day 13 of a regular 28 day menstrual cycle). A special liquid dye is injected through cervix and vagina into the uterus and X rays of uterus and fallopian tubes are taken and analysed.
Hysteroscopy
If the fertility specialist identifies any abnormalities in a hysterosalpingogram (HSG) test explained above, he/she might suggest for a hysteroscopy. In hysteroscopy, a thin fiber optic telescope like instrument in inserted through the cervix and vagina into the uterus. This would help to have a more detailed look at the abnormalities, growths or scarring in the uterus and tissue samples can be collected if needed.
Falloposcopy
This is similar to hysteroscopy (explained above). A thin telescope like instrument inserted through cervix and vagina allows the fertility specialist to have a more accurate diagnosis of problems in fallopian tubes such as blockages. This test is helpful to determine a more precise treatment for problems related to fallopian tubes.
Laparoscopy
This procedure is a bit more invasive than other advanced infertility tests for women explained above. Laparoscopy is done under general anaesthesia. An illuminated fiber optic telescope is inserted through a small incision made beneath the navel of the individual under investigation. This would allow the doctor to have a detailed view of ovaries, fallopian tubes and uterus, to check for any scarring, blockages, endometriosis (click for more information) or other abnormalities. The main advantage is that, laparoscopy not only helps to identify problems more accurately, but also allows the doctor to fix these problems (with the aid of laser or other small medical tools).
Genetic Tests
Genetic tests are simple blood tests usually performed for both male and female partners. These tests are performed to check whether genetic problems in one or both partners are preventing successful conception or causing recurrent miscarriages. Genetic tests can detect problems such as DNA fragmentation, chromosomal defects etc.
Most common symptoms of infertility in women are explained below. It is recommended not to consider presence or absence of any of these symptoms as affirmations of fertility health of an individual. The best thing to do, if any one is in doubt, is to get tested. Referinfertility test for more information.
Abnormal Menstrual Cycle
This is characterized by one or more of the conditions described below:
Excessive bleeding or light bleeding
Irregular periods
No periods (never had a period or periods suddenly stop)
Cramping, pelvic pain or back pain
Hormonal Imbalances
Hormonal imbalances can lead to ovulatory disorders such as Polycystic Ovarian Syndrome (PCOS), resulting in infertility. Following symptoms of infertility in women are triggered by hormonal imbalances:
Frequent infections in reproductive system can be an indication of infertility in women. Infections can be caused by sexually transmitted diseases, weak immune system or post surgery complications. Seek immediate medical intervention if any of the following conditions are experienced:
Pain during sexual intercourse
Blisters or sores in the genital region
Unusual vaginal discharge or smell
Burning or itching sensation in genital area
Urinary tract or yeast infections
Pelvic pain in between menstrual cycles
High temperature
Other symptoms of infertility in women
Other symptoms include:
Irregular basal body temperature: Basal body temperature is the lowest temperature attained by human body during rest. It is usually measured immediately after one wakes up in the morning. Measurement of basal body temperature can be used to track ovulation in women. On normal days, there will not be much variation in basal body temperature. After ovulation, the temperature increases by one half to one degree Fahrenheit or one quarter to one half of a degree Celsius. If the basal body temperature does not rise during a menstrual cycle, or if the temperatures are irregular, it can be indicative of conditions such as anovulation (complete lack of ovulation). This can be a symptom of infertility.
Causes of infertility in women can vary, and in some cases a cause cannot be identified (known as unexplained infertility). Most common causes are explained in this article.
Damage to fallopian tubes (tubal infertility)
An egg released by the ovary during ovulation moves to the fallopian tube and remains there alive for about 24 hours. Fertilization happens when a single sperm meets the egg in the fallopian tube. The fertilised egg then slowly moves down the fallopian tubes and gets implanted to the lining of the uterus.
Blocked or damaged fallopian tube would prevent sperm from reaching an egg or it would block movement of fertilized egg to uterus, resulting in infertility. Main factors that can cause blocks or damages in fallopian tubes are: endometriosis, pelvic inflammatory disease, ectopic pregnancy (a condition in which a fertilized egg gets implanted to fallopian tube instead of uterus and starts growing there) and surgery in abdomen or pelvis.
Cervical blockage and cervical mucus defect
Cervix connects uterus to vagina. Cervical blockage, also referred to as cervical stenosis, is a condition in which cervical canal is partially or fully blocked. This could result in defective mucus production in cervix harmfully affecting sperm mobility. In worst cases, the blockage would even prevent sperm from entering the uterus.
Uterine Causes
Scarring in the uterus and presence of fibroids (benign non cancerous tumors) in or around uterus can block fallopian tubes or disrupt implantation of fertilized egg to uterus lining. Some women are born with uterine abnormalities that cause them problems in getting pregnant or remaining pregnant.
Ovulatory disorders
Ovulatory disorders are one of the most common causes of infertility in women. Two main types of ovulatory disorders are: Polycystic Ovarian Syndrome (PCOS) and Primary Ovarian Insufficiency (POI) also known as Primary Ovarian Failure.
Polycystic ovarian syndrome (PCOS) is a condition in which a woman’s sex hormones are out of balance. Ovaries in women produce a small amount of male sex hormone called androgen. PCOS occurs when ovaries produce higher levels of androgen causing a hormonal imbalance, interfering with the ability of ovary to produce mature eggs. Researchers think that family genetics and insulin resistance(insulin is a hormone which helps the body to convert sugar, starch and other forms of food to energy) are the main reasons of PCOS. Small ovarian cysts are formed in ovaries of those suffering from PCOS and hence the name.
Primary Ovarian Insufficiency (POI) is a condition in which ovaries stop producing eggs before a woman turns 40. POI is accompanied by high levels of Follicle Stimulating Hormone (FSH). Follicle Stimulating Hormone (FSH) is a hormone produced by the pituitary gland. A high level of FSH is an indication of poor egg quality and it is a signal that a woman’s egg supply is diminishing (also known as low ovarian reserve). POI and high FSH levels can be results of: aging (FSH levels start to rise naturally about 10 years before a woman enters menopause), hereditary factors, pituitary gland disorders, exposure to radiation or chemotherapy, Turner syndrome also known as fragile X chromosome, Graves disease, conditions affecting endocrine system such as Polycystic Ovarian Syndrome (PCOS), autoimmune disorders or genetic conditions such as Galactosemia.
Low Progesterone Levels
Low progesterone levels can cause infertility in women. Progesterone plays a crucial role in regulating the menstrual cycle and preparing the uterus for conception and pregnancy. Low progesterone level prevents implantation of fertilized egg to uterus lining or survival of the embryo, resulting in miscarriage.
Endometriosis
Endometriosis occurs when tissues (made of endometrial cells) that normally grows inside the uterus start growing outside the uterus in locations such as ovaries, fallopian tubes and lining of the pelvic cavity. These malformed tissue implants break down and shed during menstruation resulting in bleeding. Since these tissues are outside uterus, blood cannot flow out of the body through vagina (as it happens in the case of menstrual blood). This could result in scarring and cyst formation, thereby making it difficult for ovary to release an egg or for a fertilized egg to get implanted into the womb.
Exact causes of endometriosis are unknown. Theories about causes of endometriosis can be found here.
Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) infects a woman’s reproductive organs such as fallopian tubes, uterus, ovaries or cervix. PID usually occurs as a complication of sexually transmitted diseases such as chlamydia or gonorrhea. PID can lead to inflammation, scarring and blockage of fallopian tubes, causing infertility.
Poor egg quality
Poor egg quality can prevent successful fertilization from happening. Egg quality declines with age. Other factors that can lead to poor egg quality are: smoking, exposure to radiations or chemotherapy, health problems and genetics.
NSAIDS
Use of non-steroidal anti-inflammatory drugs (NSAIDS) can harmfully affect ability of women to conceive. NSAIDS can fail ovarian follicles from bursting and releasing eggs. Click list of NSAIDS for more information.
Other causes of infertility in women
Other factors that can cause infertility in women are: aging, infections of thyroid gland, autoimmune diseases, chemotherapy, use of anti psychotic medicines and illegal drugs such as marijuana or cocaine, being overweight or underweight, overly intense exercise, stress, excessive drinking, smoking, sexually transmitted diseases (STD), occupational and environmental factors such as exposure to harmful substances or temperature.
Infertility in a couple can be caused by male factors, female factors or both male and female factors. 40 percent of cases of infertility in couples are caused by infertility in women and another 40 percent cases are caused by infertility in men. In 10 percent of cases, both male and female factors cause infertility and for the remaining 10 percent cases, an exact cause is not identified (unexplained infertility).
In many of these cases, infertility can be cured if the right medical treatment is applied at the right time. The video below shows a couple who got pregnant after infertility treatment.
Causes of Infertility in Women
There are a number of factors that can cause infertility in women. Most common causes are ovulatory disorders, damages or blocks in fallopian tubes, cervical mucus defect, uterine problems, low progesterone levels, endometriosis, pelvic inflammatory disease (PID), poor egg quality and life style factors such as excessive drinking, smoking, use of marijuana or cocaine, sexually transmitted diseases (STD) etc. Please click causes of infertility in women for detailed explanation of each of these factors.
Symptoms of Infertility in Women
Common symptoms of infertility in women are: abnormal menstrual cycle, hormonal imbalances, infections in the reproductive tract, recurrent miscarriages etc. Please click symptoms of infertility in women for detailed information.
Infertility Test for Women
Most common methods of infertility test for women are: home tests, physical examination, laboratory blood tests, clomiphene citrate challenge test (CCCT), tests for sexually transmitted diseases and thyroid problems, post coital test and some advanced tests such as ultrasound test and laparoscopy. All these testing methods are explained in detail in the page: infertility test for women.
Infertility Treatment for Women
Fertility drugs, surgery and assisted reproductive technology (ART) are the three main treatment methods for infertility in women. Please view the page: infertility treatment for women for detailed information.
Infertility test for men can be performed in many ways. Laboratory tests are more credible than home tests, since they give more accurate results and help in determining the treatment method to be followed (if needed). Infertility tests are recommended for both partners, since fertility problems can affect either male partner or female partner or both. (Click here for more information on infertility test for women).
Testing and diagnosis of infertility can be a lengthy and challenging process. Hence, patience, commitment and mutual support of couples under investigation are very important.
The video below explains basic infertility evaluations performed for men and women.
Most common methods of infertility test for men are explained below:
Home Tests
Sperm disorders are one of the main causes of infertility in men. Many home infertility tests for men that perform semen analysis are medically approved and accurate. However, main drawback of these home tests is that, most of them measure only one factor: sperm count (sperm concentration). A few home tests measure both sperm count and sperm motility, but these tests are more expensive than others. In general, home tests available in the market at present are not capable of evaluating all sperm disorders (click for more information). Besides this, home tests do not look into causes of infertility (click for more information) other than sperm disorders. Nevertheless, taking a home test can be considered as a start in the right direction.
Physical Examination
First steps in a medical infertility diagnosis are a detailed interview and a physical examination. The fertility specialist will gather information from the individual or couple under investigation about health history, sexual habits and history of sexual problems, birth control use, use of prescription medication, surgical history, exposure to chemicals, toxins or radiation, life style factors such as smoking, excessive drinking or use of illegal drugs, reports of prior infertility treatment, family history of reproductive problems etc. This would be followed up with a physical examination of the scrotum, testes, penis and prostate gland to check for varicocele, undescended testes (cryptorchidism), absence or blockage of vas deferens, presence of cysts, warts or other physical abnormalities such as hypospadias. The fertility specialist may then recommend any of the following tests.
Laboratory Semen Analysis
This is the most common infertility test for men. A sample of semen collected from the individual under investigation is tested to evaluate sperm count, sperm motility and sperm morphology. It is recommended that the individual under diagnosis abstain from ejaculation for at least 2 days (but not more than 5 days) prior to semen collection. The semen sample can be collected at home or at doctor’s office. If the sample is collected at home, care should be taken to keep the sample warm at body temperature and deliver it as soon as possible (within an hour) to the laboratory. The collection procedure is also important, since initial portion of the ejaculate contains highest sperm concentration.
Testing of sperm motility and sperm morphology through semen analysis would also provide valuable indicators in predicting success of infertility treatments such as intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF).
Laboratory Blood Tests
Blood tests are performed to evaluate whether hormones: testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) are at normal levels. Tests to measure levels of other hormones such as prolactin and estrogen may be done if symptoms such as low sex drive and breast enlargement are present. Blood tests can also help to detect presence of infections and sexually transmitted diseases such as chlamydia.
Post Ejaculatory Urine Test
A sample of post ejaculatory urine is tested to check for the presence of sperm in urine. This would confirm or rule out retrograde ejaculation which is a cause of infertility in men. The urine test can also be used to check for infections.
Ultrasound Test
An ultrasound scan is performed to locate damages or blockages in the reproductive tract including the prostate, seminal vesicles and ejaculatory ducts. This test can also help to determine accurate size of testes and check for the presence of cysts, testicular cancer, abnormal blood flow or varicocele.
Vasography
In vasography, an x-ray examination of vas deferens (tubes that transport sperm from testes to penis) is performed to check for any blocks or leakage of sperm.
Testicular Biopsy
This is an advanced infertility test for men, performed only on rare occasions. In this test, a small sample of tissue is collected from one or both testicles through a minor surgical procedure to check for any abnormalities in sperm production.
Genetic Tests
Genetic tests are simple blood tests usually performed for both male and female partners. These tests are performed to verify whether genetic problems in one or both partners is preventing successful conception or causing recurrent miscarriages. Genetic tests can detect problems such as DNA fragmentation, chromosomal defects etc.
Symptoms of infertility in men may not be so obvious. Most common symptoms are explained below. It is recommended not to consider presence or absence of any of these symptoms as affirmations of fertility health of an individual. The best thing to do, if any one is in doubt, is to get tested. Refer infertility test for more information.
Hormonal Imbalances
Hormone imbalances can trigger following symptoms of infertility in men:
Changes in sex drive and sexual desire
Breast enlargement
Small testes
Hair loss
Loss of muscle tone
Oily skin or acne
Unnatural weight gain or weight loss
Anxiety and depression
Urinary problems
Gallbladder problems such as pain under ribs, indigestion, light colored stool
Erectile Dysfunction and Ejaculation Problems
These can be symptoms of underlying problems such as high blood pressure, diabetes and infertility.
Physical problems
Undescended testis or dislocated urethral opening can be regarded as symptoms of infertility in men.
Infections
It is recommended to seek immediate medical help if there are frequent infections in the reproductive system. Infections can be caused by sexually transmitted diseases, weak immune system, injuries or post surgery complications. Following physical conditions resulting from an infection can be symptoms of infertility.
Blisters or sores in genital area
Swollen testes or pain in genital area
Changes in semen color
Burning sensation while urinating, discolored urine
Itching or discomfort in genital area
Discharge or unusual smell from penis
High temperature
Most common causes of infertility in men are explained in this article. An exact cause is not known in some cases (known as unexplained infertility).
Sperm Disorders
There are four types of sperm disorders: low sperm count known as Oligospermia, complete absence of sperm cells referred to as Azoospermia, poor sperm motility known as Asthenospermia (inability of the sperm to move fast enough or to move in a straight line) and abnormal sperm morphology referred to as Teratospermia (abnormally shaped sperm). All these conditions interfere with a sperm’s ability to reach and fertilize an egg and are regarded as major causes of infertility in men.
Sperm disorders are results of: birth defects, hormone deficiency in the pituitary gland or hypothalamus, aging, exposure to harmful substances, radiations or high temperature, chemotherapy, sexually transmitted diseases and other lifestyle factors such as smoking, alcohol abuse, use of marijuana or cocaine, excessive exercise, bike riding, stress etc.
Structural Disorders
Most common structural disorders that can cause infertility in men are:
Blocks in Vas Deferens or Ejaculatory Duct: Sperm are transported from testes to penis through vas deferens (a pair of tubes, one from each testicle) and ejaculatory duct. A genetic defect such as cystic fibrosis (click for more information), scarring from tuberculosis or sexually transmitted diseases can cause blockages in vas deferens or ejaculatory duct. This can result in low sperm count or complete absence of sperm cells is semen.
Varicocele: is enlargement of varicose veins around testes. This raises temperature in testes, thereby causing reduced sperm count and abnormal sperm morphology.
Torsion: is characterized by a tissue abnormality which allows testes to twist inside the scrotum, damaging blood vessels and causing swelling. This can lead to sperm disorders.
Cryptorchidism: refers to a condition usually seen in new born babies when one or both testicles fail to descend from abdomen into the scrotum. Cryptorchidism can cause low sperm count and/or poor sperm quality. There are medical treatments available for cryptorchidism.
Hypospadias: is a birth defect in which the urethral opening is not at the tip of the penis. This condition can interfere with transportation of sperm from testes to penis. Hypospadias can be surgically corrected.
Genetic Disorders
Genetic disorders such as the ones listed below can lead to infertility:
Klinefelter Syndrome: Men with Klinefelter Syndrome have two X chromosomes and one Y chromosome (instead of one X and one Y). This can lead to destruction of testicular structures, causing infertility. Klinefelter syndrome can be diagnosed by chromosome analysis and treatments are available if detected in early stages. Click symptoms of Klinefelter syndrome for more information.
Polycystic Kidney Disease: is characterized by growth of cysts in kidneys and other organs. If these cysts start to develop in the reproductive tract, it can lead to infertility.
Kartagener Syndrome: is a rare disorder that can harmfully affect sperm motility (ability of the sperm to move fast enough or to move in a straight line).
Erectile Dysfunction
Erectile dysfunction, also known as impotence is the inability to develop or maintain an erection of the penis. This condition prevents successful ejaculation in men, leading to infertility. Causes of erectile dysfunction include: anxiety, stress, guilt, diabetes, alcohol abuse, obesity, high blood pressure, heart and vascular disease, hormonal problems, injuries to pelvic area or spinal cord and some prescription drugs such as diuretics, antihypertensives, antipsychotics, antidepressants etc.
Premature Ejaculation
A condition in which ejaculation happens before a man fully inserts his penis to partner’s vagina. This can cause infertility, since sperm are not able to move through vagina towards fallopian tube to reach the egg and fertilize it.
Retrograde Ejaculation
In this condition, muscles of the bladder dysfunction and sperm are forced to flow backward into the urinary bladder instead of moving forward to the penis. This could result in low ejaculate volume, low sperm count, low sperm quality and cloudy urine after ejaculation. Retrograde ejaculation can be caused by surgeries to bladder, prostate, urethra or spinal cord, diabetes, aging, use of blood pressure medications, tranquilizers and certain antipsychotic drugs.
Autoimmune Problems
Human body may develop antibodies that mistakenly target and fight sperm cells treating them as foreign bodies. This happens most commonly after a vasectomy (click for more information), injury to testes or infection.
Other causes of infertility in men
Other causes include: tight underwear, malnutrition and anaemia, obesity, injuries to testes, anabolic steroid use, hot baths, imbalances in hormones produced by the pituitary gland or thyroid gland, infections in the reproductive tract, aging, exposure to harmful substances, exposure to radiations or high temperature, chemotherapy, sexually transmitted diseases, lifestyle factors such as smoking, alcohol abuse, use of marijuana or cocaine, excessive exercise, bike riding, stress and diseases such as mumps, tuberculosis, gonorrhea etc.