The Ultimate Guide to Infertility: Causes, Diagnosis, and Effective Management
Infertility is a deeply personal and often distressing journey for many people. Defined as the inability to conceive after 12 months of regular, unprotected intercourse, infertility affects approximately 1 in 6 people of reproductive age worldwide (1).
It’s a condition that can cause emotional, physical, and financial strain, leaving many women feeling isolated or uncertain about the next steps. In this post, we will explore the common causes of infertility in women, how it is diagnosed, and the treatment options that can help increase the chances of conception. Whether you’ve just started trying to conceive or have been navigating this challenging road for some time, this information can guide and empower you to make informed decisions about your reproductive health.
Causes of Infertility
There are many reasons why a woman may have fertility issues:
Age-related: As women age, their fertility naturally declines due to a decrease in the quantity and quality of eggs. Women over 35 may experience increased difficulty conceiving due to a reduction in egg quantity, hormonal changes, and other reproductive health factors.
Ovulatory disorders: Some disorders such as PCOS can lead to irregular or lack of ovulation (release of eggs from the ovary)
Endometriosis: Endometriosis occurs when tissue similar to the tissue that normally lines the inside of the uterus grows outside of it. This can lead to inflammation, scarring, and adhesions, which can impair fertility by affecting the ovaries, fallopian tubes, and uterus.
Damaged/blocked fallopian tubes: The fallopian tubes are essential for transporting the egg from the ovary to the uterus. Any blockage or damage to these tubes can prevent fertilisation. Common causes include endometriosis, pelvic inflammatory disorder, previous surgery or ectopic pregnancy.
Uterine or cervical issues: Problems with the uterus or cervix e.g. uterine fibroids, polyps or adhesions, can make it difficult for a fertilised egg to implant or stay in the uterus.
Endocrine disruptors: These are chemicals found in plastic, pesticides, herbicides, industrial chemicals and household products that mimic, block, or alter the function of hormones including reproductive hormones thus affecting fertility.
Unexplained: In some cases, after all tests and evaluations, no clear cause of infertility can be found. This is known as "unexplained infertility" and can be one of the most frustrating diagnoses for couples trying to conceive.
Diagnosis of Infertility
If initial evaluations after a thorough review of your medical history and a physical examination, suggest potential infertility, various diagnostic tests can help identify the underlying cause.
Ovulation testing: Ovulation can be assessed in a variety of ways:
Blood tests: To measure hormones like luteinizing hormone (LH), progesterone, and thyroid hormones, which help regulate ovulation.
Basal Body Temperature (BBT): Some women track their BBT over the course of their menstrual cycle to identify ovulation patterns. A rise in temperature after ovulation indicates that ovulation has occurred.
Ovulation Predictor Kits: Ovulation tests can help track your cycle by testing your urine for LH surges that occur just before ovulation.
Ultrasound: There are 2 types of ultrasound that might be indicated:
Pelvic Ultrasound: This can help detect structural issues, such as ovarian cysts, fibroids, or polyps, which could impact fertility.
Transvaginal Ultrasound: This test is often used to assess the ovaries and uterus more closely to check for any abnormalities or conditions like PCOS or fibroids.
Hysterosalpingography (HSG): This procedure involves injecting a special dye into the uterus and fallopian tubes and taking X-rays to check for blockages or structural problems, such as tubal obstructions, that could prevent conception. It also provides a clearer view of the shape and structure of the uterus.
Laparoscopy: A laparoscopy is a minimally invasive surgery used to examine the ovaries, fallopian tubes, and uterus. It is often used to diagnose conditions like endometriosis or pelvic adhesions that may not show up on other tests.
Hormone testing: Blood tests are done to assess levels of hormones such as FSH (Follicle-Stimulating Hormone), AMH (Anti-Müllerian Hormone), and estradiol, which provide insight into ovarian reserve (the number and quality of a woman’s eggs) and hormonal balance.
While most diagnostic tests focus on women, infertility can also affect men. Male infertility is caused by either low sperm production and/or abnormal sperm function. Common tests include:
Semen Analysis: This is the most common test for diagnosing male infertility. It evaluates the quantity, quality, motility (movement), and shape of sperm. A low sperm count, poor motility, or abnormal sperm shape can impair the ability to fertilise an egg.
Hormone Testing: Blood tests are often done to evaluate hormone levels, such as testosterone and prolactin, to check for imbalances that may affect sperm production.
Genetic Testing: In some cases, a genetic test may be recommended to identify potential genetic causes such as a Y-chromosome microdeletion, which can impact sperm production.
Testicular Biopsy: If a semen analysis shows no sperm or a very low sperm count, a testicular biopsy may be performed to determine whether sperm production is occurring within the testes. This can help determine if sperm extraction is possible for fertility treatment like IVF (in vitro fertilisation).
Treatment Options for Infertility
Diet & lifestyle modification
Before turning to medical interventions, couples are often advised to make certain diet and lifestyle changes that can improve fertility.
Diet
Maintain a Healthy Weight: Being either overweight or underweight can affect hormone production and ovulation and may have a negative impact on fertility. Achieving a healthy weight for you and optimising body composition may help restore fertility.
Balanced Diet: A nutrient-rich diet made up of wholegrains, fruit and vegetables, lean animal and plant protein and healthy fats can improve fertility in both men and women.
Key Nutrients For Men And Women: Some key nutrients can play a role in supporting fertility such as folate, zinc, iron, omega 3 and vitamin D. Including foods rich in these nutrients or taking supplements where indicated can have a positive impact on fertility.
Reduce Alcohol and Caffeine Intake: High alcohol consumption and excessive caffeine may negatively affect fertility.
Lifestyle Modification
Exercise: Exercising regularly but not going overboard is crucial for fertility. Women who take part in high-intensity exercise too often can harm their fertility as it may cause them to temporarily lose their periods. On the flip side of this, not exercising at all can also have a negative impact on your fertility and overall well-being.
Quit Smoking: Smoking can decrease fertility and damage reproductive organs in both men and women.
Stress Management: Chronic stress can impact fertility, so relaxation techniques like meditation, yoga, or regular exercise may help improve fertility by balancing hormones.
Environmental exposures: Reducing exposure to pesticides, heavy metals and other chemicals in our everyday lives can also support fertility (2).
Medication for ovulation induction
If a woman has ovulatory disorders (like PCOS or hypothalamic dysfunction), medications can stimulate ovulation, increasing the chances of pregnancy. Common medications include:
Clomiphene Citrate (Clomid): One of the most commonly prescribed medications for women with ovulation issues, it works by stimulating the ovaries to release eggs.
Letrozole (Femara): This is often used for women with PCOS who are not responding to Clomid. It works by reducing estrogen levels, which in turn stimulates the ovaries to produce more eggs.
Gonadotropins: These are injectable hormones that directly stimulate the ovaries to produce eggs. They are often used when other treatments (like Clomid) have been unsuccessful or for women undergoing assisted reproductive technologies like IVF.
Metformin: For women with PCOS, Metformin (a medication commonly used to manage diabetes) may be prescribed to improve insulin resistance, regulate menstrual cycles, and promote ovulation.
Assisted conception
Assisted conception refers to medical procedures and technologies that help individuals or couples conceive a child when they are unable to do so naturally. These methods are typically used when infertility issues prevent pregnancy. There are a range of methods available including:
In vitro fertilisation (IVF)
This is one of the most effective infertility treatments. It is commonly used for women with blocked fallopian tubes, severe male infertility, or endometriosis, as well as for couples with unexplained infertility or those who have been unsuccessful with other treatments.
IVF involves the following steps:
Ovarian Stimulation: The woman undergoes hormonal treatment to stimulate the ovaries to produce multiple eggs.
Egg Retrieval: Once the eggs are mature, they are retrieved from the ovaries using a needle.
Fertilisation: The eggs are fertilized in the lab with sperm. In some cases, ICSI (intracytoplasmic sperm injection) is used to inject a single sperm directly into an egg.
Embryo Transfer: Once fertilization occurs, the embryos are cultured for several days, and one or more healthy embryos are selected for transfer into the woman’s uterus.
Intrauterine insemination (IUI)
IUI is a common treatment for couples with mild male factor infertility, unexplained infertility, or ovulation problems.
During IUI, sperm is washed and concentrated in the laboratory, and then directly inserted into the uterus during the woman’s ovulation window. This bypasses any issues with sperm mobility or cervical mucus, increasing the chances of fertilisation.
Intracytoplasmic sperm injection (ICSI)
ICSI is a specialized form of IVF where a single sperm is injected directly into an egg to assist fertilization. It is typically used for male infertility issues, such as low sperm count, poor sperm motility, or sperm that can’t penetrate the egg. It can also be used in cases where IVF with traditional insemination hasn’t worked.
Egg donor and sperm donor
When one partner has a significant fertility issue e.g. low egg quality or male infertility, using an egg or sperm donor may be an option.
Egg Donation: A woman who has low-quality eggs or ovarian failure can receive eggs from a donor. The donor's eggs are fertilised with the male partner’s sperm via IVF, and the resulting embryos are transferred to the woman’s uterus.
Sperm Donation: If male infertility is a concern, sperm from a donor may be used in IUI or IVF.
Gestational surrogacy
Gestational surrogacy is often used in cases where a woman cannot carry a pregnancy due to health issues (such as uterine abnormalities, previous hysterectomy, or severe recurrent miscarriage) or when IVF with the woman’s own eggs is not an option. The surrogate undergoes IVF with either the intended mother’s egg or an egg donor. After fertilisation, the embryo is implanted in the surrogate’s uterus, where she carries the pregnancy to term.
Surgery
Some infertility issues can be treated with surgery, especially when there are structural problems with the reproductive organs. Common surgical treatments include:
Laparoscopy: Used to diagnose and treat conditions like endometriosis, fibroids, or blocked fallopian tubes.
Hysteroscopic Surgery: This procedure may be used to remove fibroids, polyps, or adhesions (scar tissue) in the uterus that may be preventing implantation.
Tubal Surgery: In cases where the fallopian tubes are blocked, surgery may be performed to open or repair the tubes.
Alternative therapies
In some cases, couples turn to complementary or alternative therapies, such as acupuncture or herbal treatments, to improve fertility. While there is limited scientific evidence to support their effectiveness, some individuals find these therapies helpful in reducing stress and improving overall well-being.
Mental & Emotional Impact of Infertility
Infertility can be an emotional rollercoaster, often taking a significant toll on mental health. The journey is filled with uncertainty and disappointment, leading many to experience anxiety, depression, and a deep sense of isolation. The constant worry about the future and the emotional strain of trying for a child can create an overwhelming sense of hopelessness for some.
There are several strategies that can support you and your partner during this challenging time:
Open Communication
One of the most important tools in managing the emotional challenges of infertility is maintaining open communication with your partner, family, and friends. Sharing your feelings and concerns can provide a sense of relief, helping to alleviate the loneliness that often accompanies infertility. Discussing the emotional impact of infertility with loved ones creates a support system that can help you navigate the highs and lows of the experience together. It’s essential to communicate openly about your needs, fears, and any difficult emotions that arise, ensuring that everyone involved understands the journey you're going through.
Coping Strategies
As the emotional toll can be heavy, finding coping strategies that work for you is crucial. Therapy can be a powerful tool, especially when working with a counsellor or therapist who specialises in infertility. These professionals are equipped to help you process complex feelings and navigate the mental health challenges that come with fertility struggles. Support groups also provide an invaluable space for connecting with others who understand the emotional weight of infertility. Hearing others’ experiences and sharing your own can reduce feelings of isolation, offering solidarity and emotional validation.In addition to professional support, mindfulness and self-care practices can be effective ways to manage stress and anxiety. Taking time for yourself to relax, reflect, and focus on your emotional well-being can restore a sense of balance during a time that often feels out of control. Simple practices like deep breathing, journaling, or even just taking walks in nature can help manage overwhelming emotions.
Self-Compassion, Patience, and Resilience
During this challenging journey, it's important to be kind to yourself. Infertility is not a reflection of your worth or your ability to love and care for a child. Practising self-compassion—acknowledging your feelings without judgment—is key to protecting your emotional health. Patience is also necessary, as it’s easy to become frustrated with the process. Building resilience in the face of setbacks allows you to endure the emotional ups and downs, helping you find strength even when things feel difficult.Exploring Options Beyond Traditional Treatments
While traditional treatments like IVF or medication are common options for those struggling with infertility, it’s essential to remember that there are other paths to building a family. Adoption, surrogacy, and choosing a child-free life are all valid options that can bring fulfillment and joy in their own unique ways. Exploring these possibilities—either as an alternative or complement to traditional treatments—can open new avenues for growth, offering peace of mind when traditional methods feel out of reach.Navigating infertility can be challenging, but with the right support, resources, and knowledge, you can make informed decisions about your journey. Whether you're just beginning to explore treatment options or seeking emotional guidance, remember that you're not alone. Be sure to check out our other blog posts on fertility for more in-depth insights and nutrition advice to help you on your path to parenthood.