What is infertility?

Up to one in seven couples will deal with infertility when trying to conceive, either having trouble conceiving or delivering a healthy baby. There are many different causes of infertility for both men and women, but some infertility is simply unexplained. If you are dealing with infertility and want to know more about its causes, this guide is for you.

The causes of infertility in women

There are many causes of female infertility. Here are some of the most common infertility causes in women and other AFAB (assigned female at birth) people.

Scarring from surgery – Residual scarring from pelvic surgeries can damage your fallopian tubes and/or damage your cervix.

Sexually Transmitted Infections (STIs) – Chlamydia and Gonorrhoea are some of the most causes of infertility in women.

Cervical mucus problems – Cervical mucus helps sperm travel through the fallopian tubes and reach the egg. However, hostile cervical mucus can result in little or no lubrication to help sperm reach their target or can cause acidity that destroys the sperm.

Fibroids – While plenty of women with fibroids get pregnant quickly and deliver healthy babies, fibroids can and do cause problems for others. They can change the shape of the uterine cavit6y and cause problems with conception and pregnancy loss.

Endometriosis – Endometriosis, in which uterine tissue grows in other parts of the body, can cause scarring, adhesions, and changes in the shape of the uterus. It can also cause hormonal imbalances that can damage egg production and prevent embryo implantation.

Pelvic inflammatory disease (PID) – Women can develop PID when bacteria (often caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)) travels into the reproductive organs.

Medicines and drugs – Many different medicines and drugs can negatively impact your fertility, including:

Chemotherapy – Chemo can lead to ovarian failure.

Non-steroidal anti-inflammatory drugs (NSAIDs) –when taken long term, high doses of Ibuprofen and aspirin can lead to infertility.

Spironolactone – This medicine, which helps with fluid retention, can hamper fertility. However, the effects are usually reversed around 2 months after you stop taking the meds.

Neuroleptic medicines – Antipsychotic medicines can cause missed periods and infertility.

Illegal drugs – Cocaine, cannabis, and other illegal drugs can cause irregular ovulation.

How is female infertility diagnosed?

If you have any of the issues listed above and have been struggling to conceive, your GP or specialist will prescribe one or more of the following investigations.

Pelvic exam – The first phase of your fertility investigations is usually a pelvic exam to assess your cervix and test for STIs, such as chlamydia.

Blood tests – Blood tests will check for hormone levels, including FSH (Follicle Stimulating Hormone), Prolactin, AMH (Anti-Mullerian Hormone), oestradiol, progesterone, and thyroid hormones. Some of these tests must be done on specific days of your cycle.

Transvaginal ultrasound – Ultrasounds and transvaginal ultrasounds, in which a wand is inserted into the vagina, are common investigations. They assess the structures of your uterus, ovaries, and fallopian tubes. These scans look for abnormalities and blockages, giving your doctor a better understanding of your uterine thickness and number of follicles.

Hysteroscopy – A hysteroscopy is an invasive procedure in which a camera is passed through your cervix into your uterus. Traditionally, hysteroscopies were always done under general anaesthetic. However, they are now often done as outpatient procedures with no pain management. Some women tolerate the pain, but up to 1 in 4 describe it as excruciating. Remember – if you need a hysteroscopy, you have a right to adequate pain relief. You can also request general anaesthetic.

Saline sonohysterogram (SIS) – An SIS is a specific ultrasound that injects sterile fluid into your uterus and monitors the lining and cavity shape.

Hysterosalpingogram (HSG) – With an HSG, fluid is injected into your uterus via a thin catheter through your cervix, and an X-ray looks at the fluid moving through your fallopian tubes.

Laparoscopy – A laparoscopy is a keyhole surgery in which a thin camera is passed through a small incision. It examines your uterus, ovaries, and fallopian tubes. The doctor may also inject dye into your fallopian tubes to make blockages easier to spot.

Male infertility

causes of infertility and how it's diagnosed

Causes of male infertility

Male factor infertility (MFI) is responsible for up to half of all infertile couples. Here are some of the most common causes of infertility in men and AMAB (assigned male at birth) people.

Semen and Sperm – The most common cause of MFI is sperm problems, including poor morphology (shape), motility (ability to swim to the egg) and overall count. In many cases, the causes for abnormal sperm are unexplained, but keeping your testicles cool has been shown to improve sperm quality.
Testicles – Damaged testicles can negatively impact your sperm count and quality. This can occur due to testicular cancer or surgery, a testicular infection, congenital defects, or undescended testicles.
Ejaculation disorders – Some men have psychological or physical problems that can make ejaculation difficult or impossible.
Hypogonadism – Hypogonadism refers to an extremely low level of testosterone, which is necessary for making healthy sperm. Drugs, a tumour, or Klinefelter syndrome (which causes an extra female chromosome) can all cause hypogonadism.
Varicocele – Varicocele refers to enlarged veins in the scrotum, which can negatively affect sperm quality and cause testicles to shrink.
Sterilisation – Some men undergo a vasectomy if they do not want any more children (or no children at all), and then they change their minds later. While this procedure can be reversed, it is not often successful.
Medicines and drugs – Many different medicines and drugs can have a negative impact on male fertility, including:
- Sulfasalazine – This anti-inflammatory medicine treats rheumatoid arthritis and Crohn’s disease. It temporarily decreases sperm count.
- Anabolic steroids – Often used illegally, anabolic steroids reduce sperm count and motility.
- Chemotherapy – Chemotherapy can severely impact sperm count and quality.
- Herbal remedies – Men trying to conceive should stay away from certain herbal remedies, including Tripterygium wilfordii.
- Illegal drugs – Street drugs, including cannabis and cocaine, lower semen quality.

How is male infertility diagnosed?

Male infertility is often diagnosed with the following methods.

Semen analysis – Your doctor will prescribe a semen analysis test, which looks for abnormalities with your motility, morphology, and overall count.
Blood tests – Clinicians will test your blood to ensure you have adequate levels of testosterone and follicle-stimulating hormone (FSH).
Scrotal ultrasound – A scrotal ultrasound helps assess the structure of your testes. It looks for abnormalities, including varicoceles, duct blockages, and epididymal abnormalities.
Ejaculation analysis – An ejaculation analysis looks at the functional sperm delivery, looking for problems with the penis and reproductive tract to identify anything preventing normal ejaculation.

Unexplained infertility

Around 1 in 4 cases of infertility is unexplained.

In these cases, doctors and specialists can find no cause in either partner.

Risk factors for infertility

Everyone is different; a risk factor for one person may be completely innocuous for another. However, these are some of the most common risk factors for both male and female infertility.

Maternal age – Sadly, maternal age is still one of the biggest risk factors for infertility. Egg quality decreases dramatically as a woman reaches 35, making it harder to conceive and carry a healthy pregnancy.
Weight – While people of all shapes and sizes can get pregnant and deliver healthy babies, high and low weight is correlated with infertility. Having a BMI above 30 or below 20 is considered a major risk factor.
Sexually Transmitted Infections – Chlamydia and Gonorrhoea are both leading causes of infertility in women.
Alcohol – Even a few drinks per week can have a serious impact on your fertility. If you are trying to conceive, it’s time for both parties to switch to non-alcoholic choices.
Sleep – Get regular quality sleep, and avoid screens for a few hours before bed each night. It’s also smart to turn down the night shifts, as graveyard shift workers tend to experience hormonal disruption.
Environmental pollutants – If at all possible, limit your exposure to solvents and environmental pollutants. That new flat next to the motorway could have some severe repercussions for your fertility! Stay away from dry cleaning, household cleansers (stick to vinegar instead), and pesticides.
Stress – We all know that stress is, well, stressful, but it can do a real number on your chances of conception. Stress negatively impacts your hormones, and some doctors posit that it can signal to your body that it’s the wrong time to have a baby. After all, our ancestors would be stressed in times of famine or war, which are not ideal times to get pregnant.

Infertility and Natural Treatments

If you’ve been googling about infertility causes and treatments, you’ve probably experienced a barrage of ads on social media. They all offer you solutions and natural remedies for infertility, including at-home IUI kits, essential oils, and supplements.

Always remember that there is a lot of money to be made in the infertility industry. As a result, many of these products are designed solely to part you with your money. Unscrupulous companies sell ‘snake oil’ and prey on the hopes and dreams of people who want nothing more than to have a baby. Common sense comes first – if it seems too good to be true, it probably is.

While there is no one ‘magic cure’ for infertility, there are some natural remedies that can help with relaxation and nutrition. I’m sure you’re sick of hearing ‘just relax,’ but there is some evidence to show that relaxation can reduce cortisol levels and balance hormones. Even if they don’t help with your fertility, some of these methods will make you feel better and improve your mental state. We could all use a little of that when dealing with infertility.

Acupuncture – The science is very mixed on acupuncture, in which a practitioner inserts fine needles into your body’s natural energy channels. While some peer-reviewed studies show it is effective, others debunk its efficacy. If acupuncture feels good and relaxes you, go for it. If not, opt for a relaxing massage instead.

Yoga and Meditation – Yoga is good for your mind, body, and soul. Again, you’ll hear anecdotal evidence that yoga is a ‘wonder cure’ for infertility, but the truth is much less sensational. If they relax you and make you feel good, then yoga and meditation are the right things for your body, but they are not ‘cures’ for infertility.

Hypnotherapy and Mindfulness – Similar to meditation listed above, hypnotherapy and mindfulness can help you reduce your stress levels and get in a better headspace.

Essential oils – No matter what an MLM rep says to you, there is zero evidence that essential oils can help fertility. While some studies show they may help balance hormones in lab animals, this has not been shown effective for fertility. In fact, some studies show that the chemicals in strong scents and essential oils can have a negative impact on fertility (yes, even ‘all natural’ products are made of chemicals).

Vitamins and Supplements – Here is a natural remedy that has robust scientific evidence! Specific vitamins and supplements can help improve your overall health, balance your hormones, and help you get pregnant. The most important vitamins are Vitamin D and folic acid, but many others can help. Invest in both male and female fertility supplements, and ensure you are both eating a healthy diet packed with fruit and vegetables.

Determining the causes of infertility can help your journey

Whether you identify the cause (or causes) of your infertility or end up with a diagnosis of ‘unexplained,’ the results of these tests will help inform the rest of your journey.

The most important things you can do are to find a doctor you can trust and focus on your mental health. It’s a tough road, and finding a good support system will make all the difference.