Dr. Lester De Silva asked:


Background

Definition of unexplained infertility: Infertility cases in which the standard infertility testing has not found a cause for the failure to conceive.

The definition of what “standard testing” consists of is not agreed upon by all experts. Unexplained infertility is also referred to as idiopathic infertility. Medical studies have reported that 0-26% of infertile couples have unexplained infertility. The most commonly reported figures are between 10-20% of infertile couples. However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to – leaving more couples in the unexplained category. The current rate of unexplained infertility is probably about 50% for couples with a female partner under age 35 and about 80% by age 40 (see discussion below about female age issues).

In reality, there are probably hundreds of “causes” of infertility. What this means is that there are a lot of things that have to happen perfectly in order to conceive and have a baby. As a simplified example:

The hormones that stimulate egg development must be made in the brain and pituitary and be released properly The egg must be of sufficient quality and be chromosomally normal The egg must develop to maturity The brain must release a sufficient surge of the LH hormone to stimulate final maturation of the egg The follicle must rupture and release the follicular fluid and the egg The tube must “pick up” the egg The ***** must survive their brief visit in the vagina, enter the cervical mucous, swim to the fallopian tube and “find” the egg The ***** must be able to get through the cumulus cells around the egg and bind the shell (zona pellucida) of the egg The ***** must undergo a biochemical reaction and release their DNA package (23 chromosomes) into the egg The fertilized egg must be able to divide   The early embryo must continue to divide and develop normally After 3 days, the tube should have transported the embryo into the uterus The embryo must continue to develop into a blastocyst The blastocyst must hatch from its shell The endometrial lining of the uterus must be properly developed and receptive  The hatched blastocyst must attach to the endometrial lining and “implant” Many more miracles in early embryonic and fetal development must then follow…

 A weak link anywhere in chain can this cause failure to conceive

The above list is very oversimplified, but the point is made. There are literally hundreds of molecular and biochemical events that have to function properly in order to have a pregnancy develop. The standard tests for infertility barely scratch the surface and are really only looking for very obvious factors, such as blocked tubes, abnormal ***** counts, ovulation regularity, etc. These tests do not address the molecular issues at all. That is still for the future…2

The subtle causes of sub fertility that have been proposed as underlying unexplained infertility are as follows3

Ovarian and endocrine factors

 Abnormal follicle growth

Luteinized unruptured follicles and ovarian cysts

Hyper secretion of LH

Hypersecretion of prolactin in the presence of ovulation

Reduced growth hormone secretion /sensitivity

Cytological abnormalities in oocytes

Genetic abnormalities in oocytes

Antibodies to zona pellucida

  Peritoneal factors

 Altered macrophage and immune activity

Mild endometriosis

Antichlaydial Ab

  Tubal factors

 Abnormal peristalsis or cilliac activity

Altered macrophage and immune activity

  Endometrial factors

 Abnormal secretion of endometrial proteins

Abnormal intergrin/adhesion molecules

Abnormal t cell and natural killer cell activity

Secretion of embryo toxic factors

Abnormalities in uterine perfusion

 Cervical factors

 Altered cervical mucous

Increased immunogenicity

General immune factors

Altered cell mediated immunity

  Male factors

 Reduction in motility, acrosome reaction, oocyte  binding ,and zona penetration

Ultrasructural abnormalities of head morphology

  Embryological factors

 Poor quality embryos

Reduced progression to blastocyst

Abnormal chromosomal complement-increased miscarriage rate

Unexplained infertility and female age

Women are born with certain number of eggs and when they attain menarche they start releasing these eggs cyclically. As the woman ages they run out of there eggs and quality of eggs will become poorer too. Therefore the likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over – and greatly increased in women over 38. Since we do not have a “standard category” called egg factor infertility, these couples sometimes get lumped in to the “unexplained” infertility category. Most women over 40 who try to get pregnant will have difficulty, and fertility over age 44 is rare – even in women who are ovulating regularly every month. The point is that the older the female partner, the more likely that there is an egg related issue causing the fertility problem. Unfortunately, there is currently no specific test for “egg quality”.2

Unexplained infertility and Mild endometriosis

It is not quite clear whether mild endometriosis causes infertility and treating mild endometriosis improve the fertility rates. Some recent studies has shown surgical treatment for mild endometriosis increases the fertility. Some experts would also consider infertility associated with mild endometriosis to be in the “unexplained” category. This is because a cause and effect relationship has not been definitely established between mild endometriosis and fertility problems.

Chance for getting pregnant on own – without fertility treatment – for couples with unexplained infertility

The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. After 5 years of infertility, a couple with unexplained infertility has less than a 10% chance for success on their own.

One study showed that for couples with unexplained infertility and over 3 years of trying on their own, the cumulative pregnancy rate after 24 months of attempting conception without any treatment was 28%. This number was found to be reduced by 10% for each year that the female is over 31.4

Treatment options for unexplained infertility

Ovarian stimulation and/or intrauterine insemination (IUI)

Intrauterine insemination vs. timed *********** – no medications involved

Studies have been shown that chances of pregnancy is increased with intrauterine insemination  compared to timed ***********.

Clomid and timed intercourse

Glazener et al .treated 100women,43% of whom were porous ,with either clomid 100mg from days 2-6 and placebo in a randomized cross over study. Overall there was a 50% increase in pregnancy rates after 3 cycles of treatment. Benefit was seen in after 3 years of infertility and more so in parous women.The same study showed that there were no conception in women over 35 years.5 This suggest that these women are not suitable candidates for clomid treatment and should be treated vigorously with assisted conception methods.

Clomid plus IUI

Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that.

Deaton et al carried out a randomized study between timed *********** or clomid with IUI, and showed that monthly fecundity was 9.5% in clomid plus IUI group compared to control group- a significant difference.6  In the same study it has been showed that there was no difference in number of follicles between conception and non conception cycles, suggesting that the insemination component have a more important influence than the Clomid does on outcome- but success rates are higher when both are used together.

Collating all studies together a recent systematic review, Hughes et al. reported that treatment with clomid is superior to no treatment or placebo (95% CI 1.5-4.65).7

Injectable gonadotropins plus intercourse

This is less extensively studied. However a study by Mascarenhas et al demonstrated that super ovulation with gonadotrophins significantly increased the pregnancy rates in unexplained infertility.8

Injectable gonadotropins (shots of FSH hormone) plus IUI

Several studies showed improved pregnancy success rates with injectable FSH plus IUI treatment as compared to no treatment. A meta-analysis by Hughes9 indicated that FSH plus IUI increases the pregnancy rate by 2.3 times than compared to FSH plus timed ***********.

It is most likely that super ovulation and IUI  both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.

Assisted reproductive technologies

IVF

In vitro fertilization (IVF) has high success in young women with normal ovarian reserve (normal FSH levels) and unexplained infertility. Most couples with unexplained infertility with a female partner under age of 35 could try about 3 artificial inseminations and if fail to pregnant  it is sensible to have IVF. On the other hand women over 35 years should have been offered IVF as a first line treatment.

GIFT

Gamate intrafallopian transfer goes one step further than superovulation/IUI as it involves the collection of oocytes and ***** into fallopian tubes. The main disadvantage compared to IUI is the need of laparoscopy and more complicated ovarian stimulation regimes. Compared with GIFT the main advantages of IVF are, that being able to study the fertilization, gives the opportunity to transfer best quality embryos to the uterus, and it also gives couple with surplus fertilized oocytes which can be cryo preserved for future use.

A large multi-center randomized study performed by European Society of Human Reproductive and Emryology to compare five treatments for unexplained fertility .The study concluded that there was no significant difference in outcome between them.(super ovulation 15% per cycle, super ovulation 27%,superovulation/IUI 27%,GIFT28%,IVF26%.10

 In summary, strategic management of unexplained infertility should focus on the efficacy of the method ,cost effectiveness and invasiveness of the procedures involved. Evidence suggest that there would be little or no benefit if treatment start in  a woman less than 35 years. Therefore it is worth considering superovulation and/or IUI for 3 cycles after 3 years of infertility, and if not successful go for IVF. However for older women (over 35) to consider IVF straight away.

References

1. Hull MGR, Glazener CMA, Kelly NJ et al.(1985), Population study of causes,

2. Unexplained Infertility

http ;//www.advancedfertility.com/unexplain.ntm( accessed 11/03/2008).

3. Adam, H.B. & Howard, S.J, (2003), Infertility In Practice, Churchill Livingstone, London.

4. Collings JA ( 1989), Natural course of unexplained infertility, Proceedings of the Serono symposium on unexplained infertility : basic and clinical aspects. Serono Aries Publishers, Rome.

5. Glazener CMA, Coulson C, Lambert PA et al, ( 1990), Clomiphene treatement for women with unexplained infertility : placebo-controlled study of hormonal responses and conception rates. Gynecol Endocrinol 4: 75-83

6. Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ & Brumsted JR, (1990), A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 54 : 1083- 1088.

7. Hughes E, Collins J, & Vandekerchhove P (2002),Clomiphene citrate for unexplaine subfertility in women. Cochrane Database of systematic Reviews, Issue 1, 2002.

8. Mascarenhas L, Khastgir G, Davies WAR & Lee S, ( 1994),Superovulation and timed intercourse: can it provide a reasonable alternative  for those unable to afford assisted conception ? Hum Reprod  9: 67 -70

9. Hughes EG (1997), The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility : a meta-analysis. Hum Reprod 12 : 1865-1872

10. Crosignani PG, Walters DE & Soliani A, (1991), ESHERE multicentre trail on the treatment of unexplained infertility : a preliminary report. Hum Reprod 6: 953-958.



Alice

Low Jeremy asked:


Reproduction is one of the more important mechanisms, that we humans are equipped of. In the absence of this, some of us may consider the valuable loss of life. This is probably why once a couple does not conceive within a 1-year period of unprotected sexual intercourse, they become anxious that they may be subject to infertility.

In fact, the symptom of not conceiving in 1 year alone is one good basis for diagnosing infertility. There is not much that the medical community hasn’t unraveled yet when it comes to infertility. This article will focus on the causes of infertility for both men and women.

Causes of Female Infertility

Endometriosis- this is a condition characterized by the growth of the endometrial tissue outside the uterus. This tissue is the substance women discharge during menstruation.

Ovulation problem- a condition that arises from abnormality in the release of hormones that drive the release of mature eggs from the ovaries.

Poor egg quality- the weakness or damage in the egg cells usually characterizes poor egg quality. Age is primarily the root cause since as women mature, their eggs mature with them. This condition eventually leads to menopause.

Polycystic ovary syndrome- formation of small cysts in the ovaries may be the result of irregular ovulation or hormonal imbalances.

Female tube blockages- once the passage of the eggs towards the uterus or the ***** towards the ovaries is blocked, conception would be impossible since the meeting of the two cells won’t facilitate. Causes of this condition may be pelvic inflammatory disease and several forms of sexually transmitted disease.

Causes of Male Infertility

Male tube blockages- this may occur either at the epididymis or the vas deferens, both of which are ***** passages. However, varicoceles located at the ********* account for the leading cause of this condition.

Sperm problems- this could be anything from the absence of ***** cells to low ***** count along with poor ***** quality and ***** deformation.

Sperm allergy- this may the product of the immune system’s reaction towards any phenomenon that attracts brain signals sending the reaction of the system. Men usually experience this after having vasectomy.

Combination of Female and Male Factors- This occurs when both couples present conditions that may be identified as causes of infertility.

Unexplained Infertility- This probably is the catch-all of causes when physicians don’t find any results after conducting intensive study of the case.

Signs To Watch Out For:

The most definite and obvious sign of infertility is the weakness of a person or a couple to conceive a child within a period of a year of unprotected sexual ***********.

Though that may be quite simple, the struggles that this sign entails create dramatic changes in a couple’s life. In most cases, people have no knowledge that they are actually patients of infertility. The main reason- the lack of immediate symptoms.

Infertility by nature is a condition that does not deal with the physical-external make-up of the person affected by it. There are no external measures and symptoms that we may conduct and observe when examining if a person is infertile. In fact, before any diagnosis is made pertaining to infertility one has to undergo a series of extensive examinations, physical tests and other techniques which themselves are very taxing.

In case that the couple was able to conceive yet have undergone multiple miscarriages, they probably may fall under the category of infertility. However, it would still be safe if they consult a physician first for further analysis of their case.

If you are experiencing the absence of menstrual bleeding yet the results of pregnancy test tells you that you are not pregnant, then you might be a patient of infertility. If this condition prevails for some months it is likely that something in your reproductive system is impaired.

Once you experience pain somewhere in your pelvic area, it would be best that you disclose this with a physician. Abnormal pain may be caused by conditions like endometriosis and internal infections.

Watch out for basal temperatures. These are good indications that your system may be having some troubles. Abnormal rise or fall of basal body temperature is linked with hormonal imbalances that concern mostly the hormones needed for ovulation.

Say if your basal body temperature is low while undergoing the first part of your cycle that may indicate too high estrogen release in your body. Meanwhile, high basal body temperature at this stage could possibly indicate low progesterone.

Anovulation may be indicated through the absence of upward shifting of the basal body temperature. On the other end of the scale, male infertility seems to posses no clear signs except the obvious- erectile dysfunction.

This condition is characterized by the inability to create erection, which may be contributed largely by the abnormalities in the blood vessels, specifically those found in the *****. Diseases and conditions like stroke, abuse of alcohol, and major problems in the circulatory system may also cause Erectile Dysfunction.



Gertrude

Cindy Heller asked:


To learn that one can’t conceive can be both overwhelming and depressing. The feeling of worthlessness and inferiority do affect people once they are aware they can’t conceive but certain causes of infertility can be reversed by treatment. With proper infertility treatments, you could get pregnant but even with causes that is irreversible, there is still hope as adoption can make up for the your inability to have children.

You could be hearing from someone you know who have problem with infertility and gradually many will take the position of someone who is knowledgeable about the subject but the truth is that many of their information are inaccurate. Infertility can be both embarrassing and hurtful and your frustration can be made worst by feeling that no one is able to understand what you are going through. It is essential to seek the facts so that you will know what to do.

Infertility will always be on a couples mind if they have been attempting to conceive for more than a year without success. Millions of American share the same problem and it is essential that you deal with it positively as negative feelings can cloud the issues. Reasons are aplenty when it comes to the issue of infertility and getting the facts right is vital to deal with the issue of infertility.

The statistics in United States for couples who are infertile is one in eight and seeking the help of a infertility expert is vital if you are keen to conceive. Just by getting rid of stress and anxiety will not automatically mean that you will be able to conceive as the causes of infertility are many and varied. The many underlying causes mean that you need to seek treatment as soon as possible.

The issue of infertility can cause a female to blame herself and most female worst fear is to be told that they are not able to produce children. The causes of female infertility can be many and varied and they include genetics, smoking, poor diet, complete lack of exercise, imbalances in their hormones, etc.

Lifestyle causes such as smoking, poor diet and lack of exercise can be corrected but in the case of genetics, it will be impossible. There is no need to fear and think that you are the main cause of infertility as male contribute to it as well. Tests with the infertility physician will determine the cause.

The causes of male infertility are due to low ***** count, irregular sperm, diseases, genetics, etc. Lifestyle characteristics such as smoking, drug use, poor diet, etc contribute to it as well. The male is as likely to cause infertility so it is essential that they get tested. If the male is the cause, a ***** sample is required and even blood and urine test are necessary to see if the cause is internal.

The cause for infertility can be different or men and women but they are mainly due to lifestyles. By changing your lifestyles, you can increase the possibility of conceiving. If there is blockages in the male reproductive organ, then surgical procedures can cure it. Toxins from the environment can contribute to it poor ***** quality too. As for female, problem with ovulation and menstruation can be the biggest cause, therefore it is essential for all organs to be functioning in order to couples to conceive.

There are many treatment options and you don’t just have to consider adoption, relaxation and assuming different positions while engaging in ***. Although adoption is not a cure, it can bring joy to couples by the wonderful addition to their home. Adopting relaxation techniques could help but it contributes not much to conception. How you perform in bed is your own and no one else business.

These are usually offered by well meaning people but there are proper infertility treatment options. By going for a full medical examination, the right treatment can be applied on your way to possible conception. Others, hormone pills or complex procedure like in vitro fertilization may be necessary.

Infertility experts can provide most of the answers and it is essential that you make the right treatment decision as every person is different but with the correct treatment, you are most likely to conceive.

Infertility is usually not permanent and for most couples, solutions are many and the route to treatments will end in healthy children. Adoption can be the means to expand the family unit and others might prefer to remain childless but whatever lifestyles you adopt, remain positive as infertility will not stick with you.



Diane

Bertil Hjert asked:


Nothing is more beautiful and satisfying then giving birth to a new life. A woman considers this as the best moment of her life. However, unfortunately, every woman cannot fulfill her dreams to give birth to the bundle of joy. Some suffer from infertility problems.

Medical science refers infertility to the lack of capacity of a person; male or female to conceive or let conceive a child via the process of sexual ***********.

When it comes to women, this condition is very severe and usually occurs in almost one out of six women. According to a research conducted, it is clear that female infertility is responsible for only about 40% of all cases of infertility. The most common causes of female fertility are endometriosis, blocked fallopian tubes and ovulation problems.

Fortunately, there are several infertility treatment options available these days. One of the most common among these options includes solutions from non-drug treatments.

Acupuncture can work wonders to treat infertility problems. However, most people have under estimated the power of this miraculous treatment option available for infertility.

Acupuncture can be effectively used in cases of infertility treatment where the actual cause of the problem is functional and not structural. Functional infertility can be referred to as a condition where the main problem lies with hormones or emotions of a person. Structural infertility on the other hand, is a condition of a blocked fallopian tube.

The main job of an acupuncturist is to observe the causes of infertility and then act accordingly.

Several studies have proved that acupuncture as an infertility treatment is extremely effective when used in combination with several infertility procedures including ‘in vitro’ fertilization.

When the acupuncture needles are inserted inside the female body there is a stimulation of some specific vital gender oriented chemicals existing in the body. This also accompanies with a feeling of good mental health as well as confidence that works towards making acupuncture more helpful.

Usually, the acupuncturist analyzes the reasons behind the increase in the success rate when the restoration of the flow of blood towards the reproductive organs proceeds. This finally results in the hormonal level normalization inside the body.

This facilitates ovulation and enhances the overall chances of conception. The best part is that there are no risks involved in going for acupunctures as a treatment for infertility.

Acupunctures treatments can also be carried out in combination with a wide variety of herbal medication specially prescribed for treating infertility. This increases the chances of treating the disease more effectively and successfully.

You can even go for a healthy diet and lifestyle change options in conjunction with acupuncture in order to treat infertility problems successfully. This increases the chances of achieving better results.

Acupuncture is also known to reduce the chances of miscarriages and trouble in pregnancies.

Remember that acupuncture is only effective in cases where the treatment is carried out by an experienced acupuncturist.

Make a thorough research prior to deciding on going for acupuncture as a treatment for infertility.



Georgia

Smit Mathur asked:


Infertility specialists and fertility management Australia are involved day and night in research and development to discover infertility drugs, which can cure infertility problems of couples. The problem or the cause of infertility can be divided into- 

• Male infertility

• Female infertility 

There are hundreds of reasons behind male and female infertility and their treatment depends upon the type of the problem. Few of the common causes of infertility among men are- 

• Smoking

• Alcohol

• Drugs

• Genetic disorders

• Environmental factors

• Less ***** formation

• Age, etc. 

However reasons behind female infertility are much more complex in nature. Some common female infertility problems are 

• Blockage in fallopian tube

• Uterine fibroid

• Urine infection

• Poor diet and nutrition

• Genetic problem 

The number of causes of infertility are countless and excessive research and tests are done on the patients by the doctors to know the exact reason due to which they are not getting pregnant. Sometimes even after a series of medical tests for infertility, doctors fail to discover or understand the exact reason of their patient’s infertility problem. This condition is medically termed as unexplained infertility problem. This situation is very stressful for the patient and sometimes causes depression in them. In female the cases of unexplained infertility increase with their age say after 35 years of age and above. It has been seen that women who delays their pregnancy treatment for a long period have a low chance of getting pregnant. 

There are a number of treatment procedures available for couples facing infertility problems. Some of the most important ones are 

• IVF treatment and IVF diagnosis

• Natural fertility treatment

• Traditional Chinese medicine

• Surrogate mothers

• Pregnancy treatment

• Infertility acupressure

• Chinese infertility medicine 

Among all these treatments IVF treatment is the most costly and advanced one. Couples who are not able to have a baby through other possible treatments go for IVF treatment and IVF preparation. And we can consider it as the final option of infertility treatment. 

Chinese infertility medicine and herbs have proved beneficial for infertility treatments and their success ratio is approximately70%. Infertility acupuncture treatments are also proving benefit to the patient as it helps them in getting relaxed during the treatment procedure and thus increase their chances of conceiving. You can choose a reputed acupuncture, clinic which specializes in acupuncture pregnancy and infertility acupressure. 

Australia is also a good destination for couples seeking good treatment. Infertility management Australia provides latest technologies and medication for infertility treatment.



Jill

peterhutch asked:


What is Infertility ?

Infertility is defined as the failure to become pregnant after one year of unprotected ***********. There are two types of infertility; Primary infertility, which is infertility without any previous pregnancy; and secondary infertility, when there has been a previous pregnancy.

A couple can say that they have an infertility problem after they try to conceive for an year without a result. Lots of women panic if they can conceive after only three month of trying. If the infertility problem can’t be resolved with treatment then it is also called sterility. A woman who can get pregnant but has repeated miscarriages is also considered infertile.

It is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual *********** (using no birth control methods).

Infertility affects about 6.1 million people in the United States, about 10% of men and women of reproductive age.

Infertility affects men and women equally.

What are the main causes of infertility?

The most common causes of male infertility include azoospermia (no ***** cells are produced) and oligospermia (few ***** cells are produced). Sometimes, ***** cells are malformed or they die before they can reach the egg. In rare cases, male infertility is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common cause of female infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS) and endometriosis. Repeated miscarriages may be caused by congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids.

There are many potential causes of both male and female infertility. Approximately 15% of couples are infertile. Of this 15%, male infertility counts for approximately 20% of the cases. Female infertility accounts for up to 70% of these cases, largely due to the very complex processes involved in the female reproductive system.

Most women are unaware that they may be infertile until they begin trying to get pregnant. Some signals of potential difficulties can be irregular menstrual periods or other conditions that cause pain during *********** or menstruation.

Age is the single most important factor affecting a woman’s fertility. As she matures, the chance for pregnancy decreases and the odds for miscarriage increase. At 25, a woman has a 25% of becoming pregnant during unprotected sexual intercourse

Infertility can be caused by poor sexual or lifestyle habits that are easily remedied. For example, the couple may be using a sexual lubricant that interferes with the survival of the man’s *****. Or, they may not be having *** often enough. Other easily treated illnesses or lifestyle habits that may contribute to infertility are:

Heavy use of alcohol, tobacco or drugs.

Starvation diets or anorexia in the woman.

Tight underwear or pants in the man, which raises the crotch temperature and reduces ***** count.

Weight: Women who are substantially heavier or lighter than their ideal body weight are more likely to be anovulatory, and consequently infertile, than women who are within their normal body weight range. It has been shown that in obese patients, weight loss of even 10% can significantly improve pregnancy outcomes.

Tobacco smoking. Men who smoke may have a lower ***** count than do those who don’t smoke.



Ron

Adam Khan asked:


An in-depth report on the causes, diagnosis, treatment, and prevention of male infertility.

Age

The effect of aging on male fertility is not totally clear. However, growing evidence suggests that it may be a factor (although not to the extent that it is in women). This evidence indicates that age-related ***** changes in men are not abrupt, but are a gradual process. Aging can adversely affect ***** counts and ***** motility (the sperm’s ability to swim quickly and move in a straight line). A 2006 study also suggested that the genetic quality of ***** declines as a man ages. The researchers found that poor ***** motility was associated with DNA fragmentation. This led to some older men having an increased risk of passing on gene mutations that cause dwarfism and possibly other genetic diseases.

Temporary and Lifestyle Causes of Low ***** Count

Nearly any major physical or mental stress can temporarily reduce ***** count. Some common conditions that lower ***** count, temporarily in nearly all cases, include:

Emotional Stress. Stress may interfere with the hormone GnRH and reduce ***** counts.

Sexual Issues. In less than 1% of cases, impotence, premature ejaculation, or psychological or relationship problems contribute to male infertility, although these conditions are usually very treatable. Lubricants used with condoms, including spermicides, oils, and Vaseline, can affect fertility. Astroglide, Replens, or mineral oil may not be as harmful to *****. However, oil-based lubricants can damage latex condoms and should be avoided.

Testicular Overheating. Overheating, such as from high fevers, saunas, and hot tubs, may temporarily lower ***** count. Persistent exposure to high temperatures during work may impair fertility. Several studies have found no negative effects on fertility from wearing tight trousers, briefs, or athletic supports, even every day.

Substance Abuse. Cocaine or heavy marijuana use appears to temporarily reduce the number and quality of ***** by as much as 50%. ***** actually have receptors for certain compounds in marijuana that may impair the sperm’s ability to swim and also inhibit their ability to penetrate the egg. Alcohol does not appear to affect fertility, unless it is so abused that it causes liver damage.

Smoking. Smoking impairs ***** motility, reduces ***** lifespan, and may cause genetic changes that affect the offspring. One 2002 trial found that men or women who smoke have lower success rates with assisted reproductive technologies. An earlier study reported that men who smoke also have lower *** drives and less frequent ***.

Malnutrition and Nutrient Deficiencies. Deficiencies in certain nutrients, such as vitamin E, vitamin C, selenium, zinc, and folate, may be particular risk factors for infertility

Obesity. Obesity may be a risk factor for male infertility. A 2006 epidemiological study found that a 20-pound increase in a man’s weight increased the chance for infertility by about 10 percent.

Bicycling. Exercise Bikes or Bicycling has been linked to impotence in men and also may affect fertility. Pressure from the bike seat may damage blood vessels and nerves that are responsible for *********. Mountain biking, which involves riding on off-road terrain, exposes the perineum (the region between the ******* and the anus) to more extreme shocks and vibrations and increases the risk for injuries to the *******. One study found that men who mountain bike are far more likely to have scrotal abnormalities, including calcium deposits, cysts, and twisted veins. Men who cycle can reduce such risks by:



Taking frequent rests while biking

Wearing padded bike shorts

Using a padded or specially contoured bike seat that is raised high enough and sits at the proper angle



Genetic Factors

Problems in the genes that regulate male fertility and in the genetic material of ***** itself are important contributors to infertility problems in men. In fact, even in men with no known fertility problems, 19% of the ***** are genetically defective. Certain inherited medical conditions also contribute to male infertility. Defective genes themselves can be inherited, produced by environmental assaults (such radiation exposure), or both. Of some concern is the possibility that these mutations will be passed to offspring in men who undergo fertilization techniques that retrieve ***** and directly fertilize the egg. (Under natural conditions, genetically abnormal ***** would be very unlikely to reach and fertilize the egg.)

Defective Genetic Material. ***** carry half the genetic material necessary to make a human being. Infertile men have been reported to have a relatively high percentage of ***** with broken or damaged DNA (the molecular chain that makes up a gene).

Genetic Factors Specifically Affecting ***** Production or Quality. Abnormalities in genes that specifically regulate ***** production and quality are major factors in male infertility. Some research suggests that about 10% of cases of male infertility may be due to problems, most likely genetic, in the acrosome. The acrosome is the enzyme-filled membrane cap on the ***** — its warhead — that is critical for piercing the egg. In one study, pregnancy was impaired if 7% or more of ***** had abnormalities in the acrosome.

Inherited Disorders that Affect Fertility. Certain inherited disorders can impair fertility. Examples include:



Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm). In fact, men whose infertility is caused by an inborn missing vas deferens have a 60% chance that they carry the gene for cystic fibrosis (even if they don’t have the disease itself).

Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the seminiferous tubules in the ********* during puberty, although most other male physical attributes are unimpaired.

Kartagener syndrome, a rare disorder that is associated with a reversed position of the major organs, also includes immotile cilia (hair-like cells in lungs and sinuses that have a structure similar to the tails of sperm). ***** motility may also be impaired by this condition.

Polycystic kidney disease, a relatively common genetic disorder that causes large cysts to form on the kidneys and other organs during adulthood, may cause infertility as the first symptom if cysts develop in the reproductive tract.



Environmental Assaults

Exposure to toxins, chemicals, or infections may reduce ***** count either by direct effects on testicular function or by altering hormone systems, although the extent of the impact and specific environmental assaults involved are often controversial. Some experts believe it is contributing to a general worldwide decline in male fertility.

Free Radicals (Oxidants). The primary suspects in the link between environmental assaults and infertility are free radicals, also called oxidants. These are unstable molecules, usually containing oxygen, that are released as a by-product of many natural chemical processes in the body. Infections, chemicals, and other environmental assaults can produce high levels of these particles. High levels may even affect the genetic material in cells. ***** are particularly vulnerable to the damaging effects of this oxidation process. There have been reports that significant levels of oxidants occur in the ***** of about 25% of infertile men.

Exposure to Estrogen-Like and Hormone-Disrupting Chemicals. European studies have increasingly reported a worsening in male reproductive health and an increase in testicular and prostate cancers. Many investigators strongly suspect environmental causes, particularly excessive chemicals that disrupt hormones, as a major cause for both these events. Estrogen-like chemicals found in pesticides and other chemicals are of particular concern. Overexposure to estrogen in male animals reduces the number of Sertoli cells (the cells necessary for the initial development of sperm). Some hormone-disrupting chemicals under investigation include:

Treatment of prostate cancer varies depending on the stage of the cancer and may include surgical removal, radiation, chemotherapy, hormonal manipulation or a combination of these treatments.



Bisphenol A is a widely used chemical found in plastic food containers and bottles that has provoked concern. It has potent estrogen-like effects in low dose. Use of the chemical in female rats has produced prostate abnormalities in their male offspring.

Phthalates, chemicals used to soften plastics, are under particular scrutiny for their ability to disrupt hormones. Specific phylates of special concern include dibutyl phthalate (DBP), which is found in many products, including cosmetics and clay products sold to children (Fimo, Sculpey). Animals exposed to phylates have significantly impaired ***** count and abnormalities in their reproductive structures, such as the testes. In addition, there is some concern that exposure in pregnant women may affect the offspring,

Organochlorines are compounds that combine chlorine and organic substances — usually petrochemicals. Many have estrogen-like effects, including those previously used to make plastics (PCBs) and pesticides (DDT and p,p-DDE). Some, such as dioxins and furans, are byproducts of many chemical processes. Fortunately, most of these chemicals have been banned, but they were heavily used in manufacturing before 1970 and are still widespread in the environment. Studies report that when men had a history of moderate or high on-the-job exposure to pesticides containing organochlorines, their fertility rates were lower than men without such exposures. Studies have found a strong correlation between high levels of polychlorinated biphenyls (PCBs) or p,p-DDE with reduced ***** quality and quantity. In one of the studies, even men with healthy ***** with high organochlorine levels had a lower ***** count than those with lower levels of these compounds.



Most evidence on the hormone of chemical estrogens has occurred in animals and birds. Tests of single chemicals containing estrogen have reported little danger for people. Some studies suggest, however, that exposure to more than one of these chemicals may be very harmful. At this time, there is no strong evidence supporting a serious harmful effect in people who have normal exposure to these chemicals. Major efforts are underway to determine the extent of any possible harm from these chemicals.

Hydrocarbons and Other Industrial Chemicals. In a 2000 study, workers in a rubber factory who were chronically exposed to hydrocarbons (ethylbenzene, benzene, toluene, and xylene) had lower than average ***** counts and ***** qualities. (In a 2001 study, men who smoked and worked in petrochemical plants had particularly poor ***** quality.) Still, not all major studies have confirmed the effects of these chemicals, and evidence showing any significant effect on fertility is weak.

Exposure to Heavy Metals. Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect ***** quality. Trace amounts of these metals in ***** seem to inhibit the function of enzymes contained in the acrosome, the membrane that covers the head of the *****.

Radiation Treatments. X-rays and other forms of radiation affect any rapidly dividing cell, so cells that produce ***** are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to 2 years to resume normal ***** production and, in severe circumstances, may never recover.

Low ***** Levels

Men with fertility problems because of low ***** levels when they ejaculate may have a structural abnormality in the tubes transporting the *****. (A normal amount of ***** is 2.5 – 5 mL, or about 1/2 – 1 teaspoon.)

Varicocele

A varicocele is an abnormally enlarged and twisted (varicose) vein in the spermatic cord that connects to the ********. Varicoceles are found in 15 – 20% of all men and in 25 – 40% of infertile men, although it is not clear how or even if they affect fertility. They tend to occur more commonly (85%) on the left side. Some theories supporting their possible effect on infertility include:



Varicoceles may partially obstruct the passages through which ***** pass.

Varicoceles may elevate temperature in the testes.

Varicoceles may produce higher levels of nitric oxide, a substance that has beneficial effects on blood flow and other functions but which might, in excess, injure *****.

Varicoceles may block oxygen supply to the *****.

Varicoceles have been associated with abnormalities in cellular material in the *****. One study suggested that some men may have genetic defects that cause both varicoceles and impaired sperm, rather than the varicocele itself causing infertility.



Some reports indicate that only varicoceles that are large enough to be felt (or palpable ) may impact fertility. On the other hand, however, an 8-year study of men with and without varicoceles found no differences in ***** quality or in the ability to conceive. Furthermore, the few well-conducted studies on repair of varicoceles suggest that the procedure does not improve pregnancy rates. Their effect on fertility remains unclear.

Testosterone Deficiencies and Hypogonadism.

Hypogonadism is the general name for a severe deficiency in gonadotropin-releasing hormone (GnRH), the primary hormone that signals the process leading to the release of testosterone and other important reproductive hormones. Low levels of testosterone from any cause may result in defective ***** production.

Hypogonadism is uncommon and is most often present at the time of birth, usually the result of rare genetic diseases affecting the pituitary gland that may include selective deficiencies of the hormones FSH and LH, Kallman syndrome, or panhypopituitarism, in which the pituitary gland fails to make almost all hormones. It can also develop later in life from brain or pituitary gland tumors or as a result of radiation treatments. Defects in the gene on the X chromosome that regulates receptors that bind to androgens (male hormone) may also prove to be very important causes of male infertility.

Autoantibodies

Autoimmunity is a condition in which antibodies of the immune system attack specific cells in the body, mistaking them for foreign microinvaders. In the case of male infertility, these so-called autoantibodies (”self” antibodies) target the *****. Antibodies bind to specific parts of the sperm, such as the head or tail and, depending on the site of attachment, cause various problems:



Sperm may stick together (agglutinate)

They may fail to interact with cervical mucous

They may be unable to penetrate the egg



Some experts believe that in most cases the presence of these antibodies will not prevent conception unless a large percentage of ***** are affected.

Vasectomy and Anti-Sperm Antibodies. Vasectomy, the primary sterility procedure in men, is the most common cause of ***** autoantibodies (also called anti-sperm antibodies). Experts believe their typical development is as follows:



Vasectomy works by severing the vas deferens, the tube that carries ***** from the ********* to the urethra (which leads out of the penis).

After vasectomy, ***** continue to be produced but, instead of being confined to the reproductive passages, they leak out into the body.

Here, the immune system may perceive them as foreign invaders and develop antibodies to attack them.



Such antibodies often persist, even if a man restores ***** flow by a successful reversal procedure (vasovasostomy). The persistence of anti-sperm antibodies may result in infertility.

Other Causes of Autoantibodies. Antibodies to ***** can also appear in men without previous vasectomies and have been reported to be present in 10% of all men with fertility problems. They may be linked to ******* infections or injury, although the cause is usually not known.

Retrograde Ejaculation

Retrograde ejaculation occurs when the muscles of the urethra do not pump properly during ****** and ***** are forced backward into the bladder instead of forward out of the urethra. ***** quality is often impaired.

Retrograde ejaculation can be the consequence of several conditions:



Surgery to the lower part of the bladder or prostate (the most common cause of retrograde ejaculation)

Diabetes

Multiple sclerosis

Back surgery

Spinal cord injury



Medications such as tranquilizers, certain antipsychotics, or hypertension medications also may cause temporary retrograde ejaculation.

Testicular Dysgenesis Syndrome and Other Physical or Structural Abnormalities

Any structural abnormalities that affect the testes, tubes, or other reproductive structures can have a profound effect on fertility.

Testicular Dysgenesis Syndrome. Testicular dysgenesis syndrome is a recently observed occurrence of three conditions — impaired ***** production and quality, testicular cancer, and ******* tract abnormalities. Environmental factors that increase damage from oxidants are believed to be responsible.

The ******* abnormalities identified with this syndrome are undescended testes and hypospadias, each of which is associated with infertility:



Undescended Testes (Cryptorchidism). In some cases, there is a failure of the testes to descend from the abdomen into the ******* during fetal life. Cryptorchidism is associated with mild to severe impairment of ***** production. In one survey, 38% of men who as youngsters had two undescended ********* and 10% of men with one undescended ******** were infertile, compared with 5% of men who had normal testes. Even one undescended ******** may impair fertility. In cryptorchidism, the testes are exposed to the higher internal body heat, but this may not totally explain the damage in ***** production that can occur. (Men who suffer from this condition should be aware that even if the ******** is surgically moved to the scrotum, their risk of testicular cancer is significantly increased, warranting careful self-exams and regular follow-up with a doctor.)

Hypospadias. This is a birth defect in which the urinary opening is on the underside of the penis, can prevent ***** from reaching the cervix if not surgically corrected. 



Blockage in the Tubes that Transport *****. Some men are born with a blockage in the epididymis or ejaculatory ducts or other problems that later affect fertility. One center reported that 2% of men seeking treatment had no vas deferens.

Anorchia. In the very rare condition known as anorchia, a man is born without any testes.

Syringomyelia . This is a disease of the spinal cord that results in no ejaculate at all (aspermia).

Cancer and Its Treatments

Birth rates among cancer survivors are only 40 – 85% of normal rates. Certain cancers, particularly testicular cancer, impair ***** production, often severely. Cancer treatments such as chemotherapy and radiation can damage ***** quality and quantity, causing infertility. The closer radiation treatments are to reproductive organs, the higher the risk for infertility. Fortunately, while men may fail to produce ***** for as long as 5 years after radiation therapy, many men eventually recover their ***** production ability. Chemotherapy with drugs that harm reproductive function tends to affect fertility more severely in men than in women. New drug regimens are helping to improve fertility rates.

Adolescents and adult men undergoing cancer treatments who may want to father children should consider banking and freezing their ***** for later use in assisted reproductive therapies. This technique is called ***** cryopreservation. ***** cryopreservation is recommended by the American Society of Clinical Oncology as the method with the highest likelihood of success for male cancer survivors. However, these banking methods are not appropriate for pre-adolescent boys being treated for childhood cancers such as leukemia. Researchers are investigating ways that stem cell transplantation may someday help these children regain their fertility while avoiding leukemia relapse.

Infections

There is some controversy over the effect of infections on infertility. Simply detecting the presence of an infection in infertile men does not necessarily mean that it has any relationship to the infertility itself. Some experts believe that the immune response to some infections may release inflammatory factors and oxidants, chemically unstable particles that can damage *****. The exact impact of this process on ***** is unclear, however. Infections may alter the liquidity of ***** and ***** motility, although these are likely to be temporary effects. Among the infections most implicated in infertility are:

Sexually Transmitted Diseases. Repeated Chlamydia trachomatis or gonorrhea infections are most often associated with male infertility. Such infections can cause scarring and block ***** passage. Human papillomaviruses, the cause of ******* warts, may also impair ***** function.

Mycoplasma. Mycoplasma is an infectious organism that appears to fasten itself to ***** cells and render them less motile.

Mumps. When mumps develops after puberty, it damages the ********* in 25% of men afflicted with the disease. (Interferon, an anti-viral drug, may help prevent infertility in adult males with active mumps, but the drug is highly toxic and caution is essential.)

Glandular Infections in the Urinary Tract or ********. Glandular infections that may affect fertility include prostatitis (in the prostate gland), orchitis (in the testicle), semino-vesculitis (in the glands that produce semen), or urethritis (in the urethra), perhaps by altering ***** motility. Even after successful antibiotic treatment, infections in the testes may leave scar tissue that blocks the epididymis.

Other Conditions Associated with Infertility

Medical Conditions. Other medical conditions that can affect male fertility include any severe injury or major surgery, diabetes, HIV, thyroid disease, Cushing syndrome, heart attack, liver or kidney failure, and chronic anemia.

Medications

The effects of medications on ***** quality and count have not been rigorously studied, and many medicines are commonly prescribed without knowing whether they impair fertility. Anabolic steroids (which are often abused by weight lifters and other athletes) deserve special notice because they are known to severely impair ***** production. Among the other drugs that can affect male fertility are cimetidine (Tagamet), sulfasalazine (Azulfidine), salazopyrine, colchicine, methadone, methotrexate (Folex), phenytoin (Dilantin), corticosteroids, spironolactone (Aldactone), thioridazine (Mellaril), and calcium channel blockers.



Lori

spoiled asked:


Just looking at the different things people might think can casue infertility and wether or not they know if it’s treatable. And if you read an answer that you know isn’t correct PLEASE let us know and give us some sources to rely on in case WE PANIC! I don’t want a bunch of people freaking out or thinkin they’ll never have babies!

Jessica

Darrell Miller asked:


Infertility is typically defined as a failure to conceive after a year or more of regular intimate activity during the time of ovulation. This term can also refer to the inability to carry a pregnancy to term. About 6.1 million American couples are impaired when it comes to their ability to have children, with 2.1 million of these couples being infertile. The exact cause of the problem can be extremely difficult to pinpoint, as ovulation, fertilization, and the passage to the fertilized ovum through the fallopian tube and to the uterus are extremely complex processes. In order for pregnancy to occur, many events must work together perfectly.

In 40 percent of infertile couples, problems that affect the male partner are either partially or wholly the cause of infertility. Infertility in men is usually the result of a low ***** count or an anatomical abnormality. There are a variety of factors that can result in a low ***** count. Among these factors are alcohol consumption, endocrine disorders, exposure to toxins, radiation or excessive heat, recent acute illness or prolonged fever, testicular injury, and rarely, mumps-induced wasting of the *********. An abnormal enlargement of veins that drain the testicles, referred to as varicoceles, can cause infertility in men. This is because the veins of the testes are no longer able to moderate the temperature of the ********* correctly, which can negatively affect *****.

The most common causes of infertility in women include an ovulatory failure or defect, blocked fallopian tubes, endometriosis, and uterine fibroids. Additionally, some women are able to develop antibodies to their partners’ sperm, which causes the woman to almost be allergic to them. Chlamydia, a transmitted disease which affects 4 million Americans each year, also causes many cases of infertility. There are also psychological issues, such as stress or fear of parenthood, which can also contribute to infertility.

However, in most cases, stress is usually the result of infertility, not the cause of it. ***** abnormalities account for about 41 percent of infertility cases. The following reasons are the most common to explain why couples cannot conceive: the woman has endometriosis; the man has abnormal sperm, a low ***** count, or erectile dysfunction; the woman’s fallopian tubes are blocked; ovulation takes place rarely or irregularly; the couple is unable to have complete intimate relations; the cervical mucous attacks and kills the sperm; the woman does not manufacture enough progesterone to carry a baby to term; the woman is over thirty-four; and/or one or both members of the couple eats a poor diet and experiences too much stress.

The following nutrients are extremely beneficial in helping one or both partners deal with infertility: selenium, vitamin C with bioflavonoids, vitamin E, zinc, DMG, octacosanol, phosphatidyl choline, essential fatty acids, l-arginine, manganese, proteolytic enzymes, pycnogenol, raw orchic glandular, raw ovarian glandular, 7-keto DHEA, vitamin A, and vitamin B complex. Also, the following herbs have been shown to be beneficial in dealing with infertility: astragalus, damiana, ginseng, sarsaparilla, saw palmetto, yohimbe, dong quai, false unicorn root, gotu kola, licorice root, wild yam root, green oat, and yin-yang-huo. It should also be noted that heavy use of Echinacea, ginkgo biloba, and St. John’s wort may cause infertility in men, and should be avoided.

Infertility can be a complicated and mentally depressing due to lack of pregnancy by both men and women. Depression can lead to more stress and needs managed by a health care provider. Always consult your doctor when you think you are infertile. Natural vitamins like the ones listed above are available at your local or internet health food store. Look for name brands vitamins to ensure you receive quality supplements.

*Statements contained herein have not been evaluated by the Food and Drug Administration. Vitamins and herbs are not intended to diagnose, treat and cure or prevent disease. Always consult with your professional health care provider before changing any medication or adding Vitamins to medications.



Alex

Dr. Eric Daiter asked:


Infertility in men is about as common as infertility in women. Infertility is described as the inability to conceive after about one year of sexual *********** without the use of contraceptives. If age is a factor, then you may want to consult a doctor or infertility specialist after about six months of trying, as fertility decreases with age. Some causes for infertility can be harder to treat the longer they are left without intervention, so don’t hesitate to seek advice early if you suspect that infertility may be a factor for you.

Many things can cause infertility in men. Illness, disease, injury, obstruction in the tubes of the testes, diet, weight and activity levels are only some of the causes of male infertility. Common causes of infertility are low ***** count, dysfunctional or immobile sperm, and impaired ***** delivery. Men can be born with some of these conditions, or they can develop them later in life.

When determining the cause of infertility in a couple, the man and woman should be examined. The procedures for examining male infertility are generally simple and non-invasive. Your doctor will check for ***** production, irregularities in the testes, and hormonal imbalances among other possible causes. A ***** analysis will tell if the ejaculate has adequate seminal fluid to allow for ***** movement. The ***** will be checked for number of sperm, the shape and structure of the sperm, mobility, seminal fluid and total volume or amount of ejaculate.

If there is no ***** present in the seminal fluid, then it is termed azoospermia. This can be caused by a malformation in the testes or a possible obstruction in one of the ducts necessary to deliver the ***** effectively into the ejaculate. If ***** is present in the fluid, then it will be tested for abnormalities. If a significant number of ***** are abnormal, then they can be a cause for infertility. Your infertility specialist may wish to perform a sperm-mucus interaction test. This test will determine if the ***** are able to live within and move through cervical mucus and thus, through the female reproductive system.

Your doctor may also wish to conduct a ***** *********** assay. This will determine your sperm’s ability to latch on and penetrate an egg’s outer layer. Infection, disease and illness will be looked for. These things can affect your testosterone and ***** production.

About half of all male infertility cases can be treated through assisted reproduction. Your infertility specialist will determine which treatments will be best for you depending on your situation. If there is a neurological reason that ejaculate can not be obtained, such as spinal cord injury, then you may be a candidate for electroejaculation. This process stimulates the body to excrete *****. If an obstruction, injury or deformity is present, then a surgeon can sometimes retrieve ***** surgically from the ***** duct. Sometimes this procedure can be conducted with a needle and surgery isn’t required. ***** washing refers to the method that mixes ***** with a washing medium, and concentrates the healthiest ***** into an inert buffered fluid that can be used for intrauterine insemination, increasing your chances of conception.

Talk with your doctor and infertility specialist about possible causes and treatments of male infertility. Remember that about half of all infertile men can be treated and conception can be possible for you.



Rose