When referring to such an important, yet difficult topic, we should take things slow and from the beginning. What is "Infertility"? How is it caused? Can we do something about it? These are some of the most important questions that we aim to answer in this article, trying not to overload you in the process with statistical facts.
Disclaimer: Midwifery is a very inclusive and safe space for everyone, where your identity and your needs are valid and important to us. Thus, the terms used in this article aim towards making everyone feel comfortable and included.
Uterus owner (person with a uterus, uterus having person) <--> person with female genitalia
Parent <--> father (dad), mother (mom)
Birthing person <--> mother (mom), father (dad)
Pregnant (pregnant person) <--> mother (mom), father (dad)
Breastfeeding (Breast) <--> Chestfeeding (Chest)
[if you feel that you are not included at any point, please contact us and help us change that]
© NIKOLETA CHATZIPANAGIOTIDOU, SOME RIGHTS RESERVED 01/04/2021
What is "infertility"?
According to CDC, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex, but usually 1 year is the "mark" for placing the diagnosis of infertility.
How does pregnancy actually occur?
In order for someone to get pregnant, there are a few steps that the sperm has to do for it to reach the egg and fertilise it.
A woman's body must release an egg from one of the ovaries (ovulation) into that fallopian tube.
The sperm has to go in the vagina and then, through the cervical canal, it has to go in the uterus.
From the uterus, the sperm has to go through the fallopian tubes, on the right side where the egg is, and find the egg.
After finding the egg, it has to try and fertilize the egg.
Assuming that the fertilisation has happened, the, now fertilized, egg has to go in the uterus and attach to the inside of the uterus (implantation).
A problem in any of those stages can lead to infertility or it can make it hard to get pregnant. On top of that, the egg lives for approximately 24 hours (to be more accurate...due to the modern way of living, its life is about 20 hours) after it's been released from the ovary and the sperm lives for approximately 7 days after ejaculation (again, for the same reasons...its life is about 5 days). That means that if the fertilization doesn't happen in that 20-hour window, there won't be a pregnancy for that circle of ovulation.
How common is infertility? Is it a usual phenomenon?
Globally, infertility affects 15% of couples of reproductive age. A report from the 2006–2010 National Survey of Family Growth estimated that 6% of married females aged 15–44 years in the United States are infertile, and 12% have impaired fecundity, defined as the inability to conceive and carry a baby to term. According to WHO, in 2020, between 48 million couples and 186 million individuals live with infertility globally.
Is it just "a woman's" problem?
No, definitely not! Infertility is a problem that can be caused by the male and the female body. According to Office on Women’s Health, 1/3 of the infertility cases are a result of male infertility, 1/3 is of female infertility and the other 1/3 is a combination of the two or of unknown causes. So, we have no right to "accuse" the women if a couple is diagnosed with infertility as they did back in the years. We have no right to accuse anyone! There are many factors causing this problem and only very few of them are directly linked with people's decisions.
What are the causes?
There are many causes for infertility and sadly not all of them are known to specialists yet. 1 in 4 cases of infertility, according to NHS in 2020, was of an unknown cause. In those cases, it is called "unknown infertility" and it means that no problems were detected to either of the partners.
When it comes to the causes referring to the female genitalia, these include (NHS, 2020):
polycystic ovary syndrome (PCOS)
thyroid problems ( overactive & underactive thyroid gland can prevent ovulation)
premature ovarian failure ( when the ovaries stop working correctly before the age of 40 and there is no ovulation)
scarring from surgery ( scars from pelvic surgeries or from surgeries on the cervix can close up the fallopian tubes or shorten the cervix)
cervical mucus problems ( normally the mucus in the cervix becomes thinner when it's time for ovulation in order for the sperm to have an easier passage to the egg, but if mucus stays thick, sperm will be trapped there and it will not be able to fertilize the egg)
fibroids ( depending on their placement and size, fibroids can affect the attachment of the fertilized egg or, in worst cases, they can block the fallopian tubes)
endometriosis ( the existence of uterine lining outside the womb (the uterus) in places like the tubes or the ovaries can seriously affect fertility)
pelvic inflammatory disease (PID) ( PID is a serious infection in the upper female genital tract and it can cause scarring on the tubes and damage them so much that it is not possible for the egg to pass through them)
sterilisation (a medical procedure where the fallopian tubes are cut and tied in order to prevent pregnancy)
medication
drugs
Infertility can also happen because of problems with the male genitalia:
semen and sperm (quality and quantity; if there is low sperm count, the sperm is not active or it is abnormal, it cannot fertilize an egg in most cases.)
testicles ( testicles store the semen, the sperm, so if they have a problem the quality of the semen will be lower. Some of those problems can be an infection, cancer, a surgery and others.)
sterilisation ( a vasectomy can be done if the male does not want any children and it is a reversible surgery. However, according to NHS, it is not always successful to reverse this surgery.)
ejaculation disorders
hypogonadism ( in this disorder the testosterone levels are very low in the male and that affects the creation of semen. Some causes of that is a tumor, Klinefelter syndrome or illegal drugs.)
medicine
drugs
What are the risk factors for infertility?
Many of us have heard plenty of people telling us "don't stand too close to the microwave, you are putting your fertility at risk" or "we have to cover your pelvic and pubic area when you are getting a scan to protect your genital organs". But why are they saying those things? What are the risk factors and how do these things actually affect us? Let's take a look at them one by one.
Risk factors for Uterus Owners
increasing age (especially >35): the female fertility is wearing down as she gets older, making it more difficult to get pregnant and carry a healthy pregnancy.
smoking cigarettes: almost 13% of infertility is caused by smoking. Some of the outcomes of smoking include earlier menopause by 1-4 years & a higher risk for stillbirths and preterm pregnancies. The American College of Obstetricians and Gynecologists also agrees that nicotine can lead to hypertension, diabetes, obesity, neurobehavioral defects, infertility, and even respiratory failure.
heavy use of alcohol: this interrupts the normal ovulation cycle and also disturbs the hormonal levels of testosterone, estradiol and luteinizing hormone.
being overweight, obese, or significantly underweight: This disrupts the normal cycle and can even cause early menopause.
having certain sexually transmitted infections (STIs): those can damage the reproductive system permanently, making it extremely difficult to get pregnant.
Chronic diseases such as diabetes, lupus, arthritis, hypertension, and asthma
Risk factors for Penis Owners
History of prostatitis, genital infection, or sexually transmitted infections
Regular contact with radiation, radioactivity, welding & toxins ( such as lead )
Cigarette or marijuana smoke
Heavy alcohol drinking
Exposure of the genitals to high temperatures: Ideally, sperm production occurs at around 93.2ºF (34ºC). This is 5.4ºF (3ºC) below normal body temperature of 98.6ºF (37ºC ). When the temperature gets too hot, the quality of sperm can be harmed. In particular, sperm count and sperm motility (the ability of sperm to swim and reach an egg to fertilize) can decline.
Hernia repair ( only small chances for it to cause infertility): A hernia occurs when part of an internal organ or body part protrudes into an area where it should not. A hernia repair is a surgical procedure to fix a hernia. This procedure is also known as herniorrhaphy.
Undescended testicles
Mumps after puberty: This inflammatory condition (orchitis) generally affects just one testicle but can affect both testicles in about 1 in 6 men. This is the reason why mumps causes male infertility.
A genetic or congenital problem
What can people do to help themselves, before they reach out to a specialist?
Not all cases of infertility can be prevented, but there are some precautions that people can take in order to improve their chances to conceive. Lifestyle and daily habits have a big impact on the way the body functions and if we do not take care of it, it cannot work to the best of its ability. So, some helpful suggestions include:
1) Maintain a healthy weight
2) Stop smoking
3) Try to minimize the alcohol intake
4) Reduce stress
5) Limit caffeine
What treatments are available for infertility?
*All the information listed below are for informational reasons ONLY. Do not take any medicine or undergo any procedures without consulting a doctor.*
If diagnosed with infertility, your doctor will provide you with the suitable options for you and your needs regarding your journey to parenthood. These options fall into 3 main categories; medicines, surgical procedures and assisted conception.
Medicine
According to NHS, common fertility medicines include:
clomifene – encourages the monthly release of an egg (ovulation) in women who do not ovulate regularly or cannot ovulate at all
tamoxifen – an alternative to clomifene that may be offered if you have ovulation problems
metformin – is particularly beneficial for women who have polycystic ovary syndrome (PCOS)
gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men
gonadotrophin-releasing hormone and dopamine agonists – other types of medicine prescribed to encourage ovulation in women
Some of these can have side effects like nausea, vomiting, headaches and hot flushes.
Side note: Medicine that stimulates the ovaries is not recommended for women with unexplained infertility because it has not been found to increase their chances of getting pregnant.
Surgical procedures
1) Fallopian tube surgery
2) Laparoscopic surgery for endometriosis, fibroids and PCOS
3) Correcting an epididymal blockage and surgery to retrieve sperm
Assisted conception
Intrauterine insemination (IUI)
IUI is a type of artificial insemination, in order to treat infertility. The visit for intrauterine insemination takes about 15 to 20 minutes and is usually done in a doctor's office or clinic. The IUI procedure itself takes just a minute or two and requires no medications or pain relievers. Your doctor or a specially trained nurse performs the procedure in which a vial containing a sample of healthy sperm to the end of a long, thin, flexible tube (catheter) is entered into the uterus of the patient, pushing the sperm inside and then the catheter is removed. The hoped-for outcome of intrauterine insemination is for the sperm to swim into the fallopian tube and fertilize a waiting egg, resulting in a normal pregnancy.
2. In vitro fertilisation (IVF)
IVF (In Vitro Fertilisation) is a procedure, used to overcome a range of fertility issues, by which an egg and sperm are joined together outside the body, in a specialised laboratory. The fertilised egg (embryo) is allowed to grow in a protected environment for some days before being transferred into the woman's uterus increasing the chance that a pregnancy will occur.
Usually, the embryos grow in the laboratory until Day 5, known as the Blastocyst stage, because there is strong evidence that these embryos are more likely to implant into the uterus. Fertilised embryos are transferred to the woman’s uterus in a simple procedure called an embryo transfer (a very similar technique to a pap smear). If more than two embryos develop, we can freeze those that are surplus for use in subsequent cycles. If there is any concern about sperm quality, the process of fertilisation is carried out by Intracytoplasmic Sperm Injection (ICSI). This is where one sperm is inserted into each egg.
3. Egg and sperm donation
If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually done using IVF.
Conclusion
Infertility is an issue that is common and it has many causes, some still unknown to us. It is a difficult time for a person when diagnosed with infertility and it can cause a lot of stress and fear, amongst other negative emotions. However, we have to know that we can take some measures that can help prevent, to some degree, infertility (if the cause has to do with the person's choices in life). Apart from that, there are many treatments available, with very high success rates, for helping people who wish to get pregnant.
Always do your research beforehand and get many opinions on this subject from various specialists until you come across someone that you feel comfortable and safe with.
We really hope this article informed you and helped you with understanding this difficult topic. We strongly encourage you to contact us in whatever way suits you and discuss the article, suggest ideas for upcoming content, tell us your strong and emotional stories or for any other reason you would like.
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The “Being a Midwife” team
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