Infertility Treatment in Women and Men

If you and your partner are having difficulty conceiving, you are not alone. Millions of people globally experience this challenge. Infertility is the medical term for the inability to conceive after a year of regular, unprotected sex for most couples.

Infertility can be due to health issues affecting either partner, or a combination of factors that hinder pregnancy. There, however, are many safe and effective treatments available that can increase your chances of conception. Dr Monga’s in Delhi has a team of doctors who are well versed and highly experienced in treating patients suffering from infertility.

What is Infertility?

Infertility occurs when a couple is unable to conceive (get pregnant) despite having regular unprotected sex.

Approximately 1 in 7 couples may experience difficulties in conceiving.

More than 8 out of 10 couples, with the woman under 40, will conceive naturally within a year if they engage in regular unprotected sex (every 2 to 3 days).

For couples who have been trying to conceive for over 3 years without success, the chance of getting pregnant naturally within the following year is 1 in 4, or less.

Types of Infertility

There are two types of infertility:

• Primary infertility: Difficulty conceiving for someone who has never conceived a child before.
• Secondary infertility: Difficulty conceiving again for someone who has had one or more pregnancies in the past.

Causes of infertility in women

Infertility is often caused by issues with ovulation, which is the monthly release of an egg from the ovaries.

Some problems prevent an egg from being released at all, while others interfere with egg release in some cycles but not others.

Ovulation problems can result from:

Polycystic ovary syndrome (PCOS)

• Thyroid problems: Both an overactive thyroid gland and an underactive thyroid gland can affect ovulation.
• Premature ovarian failure: When the ovaries stop functioning before the age of 40.

Scarring from surgery

Pelvic surgery can damage and scar the fallopian tubes, which connect the ovaries to the womb.

Cervical surgery can sometimes cause scarring or shorten the cervix (the neck of the womb).

Cervical mucus problems 

During ovulation, the mucus in your cervix becomes thinner, allowing sperm to swim through it more easily. If there is an issue with the mucus, it can hinder conception by making it more difficult for sperm to reach the egg.

Fibroids

Non-cancerous growths known as fibroids, located in or around the womb, can impact fertility. In certain instances, they might hinder the attachment of a fertilised egg in the womb, or obstruct a fallopian tube.

Endometriosis

Endometriosis is a condition in which tissue resembling the lining of the uterus (the endometrium) grows outside the womb. This abnormal growth can harm the ovaries or fallopian tubes, potentially leading to fertility issues.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection affecting the upper female genital tract, including the uterus, fallopian tubes, and ovaries. 

Often resulting from a sexually transmitted infection (STI), PID can cause damage and scarring to the fallopian tubes, which can prevent an egg from travelling to the uterus.

Sterilisation

Some women opt for sterilisation if they do not wish to have more children. This procedure involves blocking the fallopian tubes to prevent an egg from reaching the uterus. 

Sterilisation is rarely reversible, and even if the procedure is reversed, it does not guarantee the ability to conceive.

Medicines and drugs 

The side effects of certain medicines and drugs can impact fertility. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): Long-term use or high doses of NSAIDs, such as ibuprofen or aspirin, can make conception more difficult.
• Chemotherapy: Chemotherapy medications can sometimes cause ovarian failure, impairing the ovaries’ ability to function properly.
• Neuroleptic medicines: Antipsychotic drugs, often used to treat psychosis, can occasionally result in missed periods or infertility.
• Spironolactone: This medication, used to treat fluid retention (edema), may temporarily affect fertility, which usually recovers about two months after stopping the drug.
• Illegal drugs: Substances such as marijuana and cocaine can affect fertility and make ovulation more challenging.

Causes of infertility in men

There can be numerous reasons behind infertility in men.

Semen and sperm

A frequent cause of infertility in men is poor-quality semen, the fluid containing sperm that is released during ejaculation.

Reasons for abnormal semen may include:

• Insufficient sperm count: You might have a very low number of sperm or none at all.
• Sperm motility issues: Sperm that do not move effectively will struggle to reach the egg.
• Abnormal sperm shape: Sometimes sperm are irregularly shaped, making it difficult for them to move and fertilise an egg. This condition is also known as teratozoospermia or teratospermia.

Many instances of abnormal semen remain unexplained. Although there is a connection between higher scrotal temperatures and decreased semen quality, it is unclear whether wearing loose-fitting underwear enhances fertility.

Testicles

The testicles are responsible for producing and storing sperm. Damage to them can significantly impact semen quality.

This damage can result from:

• An infection in the testicles
• Testicular cancer
• Surgery on the testicles
• A congenital defect affecting the testicles
• Undescended testicles, where one or both testicles have not moved down into the scrotum
• Physical injury to the testicles

Sterilisation

Some men opt for a vasectomy if they do not wish to have children or more children. This procedure involves cutting and sealing the vas deferens, the tubes that transport sperm from the testicles, so that the semen no longer contains sperm.

While a vasectomy can be reversed, the success rate of reversals is generally low.

Ejaculation disorders

Some men encounter ejaculation difficulties that hinder their ability to release semen during sexual activity.

Hypogonadism

Hypogonadism refers to a notably low level of testosterone, the male sex hormone crucial for sperm production. This condition may stem from factors such as a tumour, illicit drug use, or Klinefelter syndrome, a rare genetic condition characterised by an excess female chromosome.

Medicines and drugs

Certain medications can potentially lead to infertility issues. These include:

• Sulfasalazine: This anti-inflammatory medication, used to treat conditions like Crohn’s disease and rheumatoid arthritis, may decrease sperm count temporarily. Sperm count, however, typically returns to normal once the medication is discontinued.
• Anabolic steroids: Often abused illegally for muscle building and athletic enhancement, long-term use of anabolic steroids can affect sperm count and motility.
• Chemotherapy: Some chemotherapy medications can severely impact sperm production.
• Herbal remedies: Certain herbal remedies, such as extracts from the Chinese herb Tripterygium wilfordii, may affect sperm production or reduce testicular size.
• Illegal drugs: Substances like marijuana and cocaine can also influence semen quality.

Unexplained infertility

In the UK, approximately 25% of infertility cases are attributed to unexplained infertility, where no identifiable cause can be found in either partner.

If the cause of fertility issues remains elusive, it is important to discuss the next steps with your doctor.

According to guidelines from the National Institute for Health and Care Excellence (NICE), women with unexplained infertility who have been actively trying to conceive through regular unprotected sex for two years without success should be offered IVF treatment.

Risk factors

Various factors can influence fertility:

• Age: Fertility decreases as individuals age.
• Weight: Being overweight or obese (BMI of 30 or higher) can reduce fertility. In women, both being overweight and severely underweight can affect ovulation.
• Sexually transmitted infections (STIs): Certain STIs, such as chlamydia, can impact fertility.
• Smoking: Both active and passive smoking can reduce the chances of conceiving and affect semen quality.
• Alcohol: Excessive alcohol consumption can impair sperm quality. It is advisable to abstain from alcohol during pregnancy, and adults should adhere to recommended limits (no more than 14 units per week, spread evenly over three days or more).
• Environmental factors: Exposure to certain pesticides, solvents, and metals can affect fertility, especially in men.
• Stress: Stress can affect relationships and libido (sex drive). In severe cases, it may impact ovulation and sperm production.

Physical examination

If you are a female, your doctor might:

• Assess your body mass index (BMI) to determine if you have a healthy weight.
• Conduct a pelvic examination to inspect for signs of infection, lumps, or tenderness, which could indicate conditions like fibroids, ovarian tumours, endometriosis, or pelvic inflammatory disease (PID).

If you are a male, your doctor may:

• Examine your testicles for any lumps or irregularities.
• Assess the shape, structure, and any apparent abnormalities of your penis.

Following the physical examination, either your course of treatment is decided or you are referred for further evaluation.

Fertility tests for women

To diagnose the cause of infertility in women, various tests may be conducted, including:

Blood tests

Samples of your blood can be analysed to measure hormone levels. For instance, levels of progesterone can indicate whether ovulation is occurring. 

The timing of these tests depends on the regularity of your menstrual cycles. If your periods are irregular, you may undergo tests to measure gonadotropins, hormones that stimulate egg production in the ovaries.

Chlamydia test

Chlamydia, a sexually transmitted infection (STI), can impact fertility. To diagnose chlamydia, a swab, similar to a small, soft, rounded cotton bud, is used to collect cells from your cervix for testing. 

Alternatively, a urine test may be carried out. If chlamydia is detected, antibiotics will be prescribed as treatment.

Ultrasound scan

An ultrasound scan can effectively assess the health of your ovaries, womb (uterus), and fallopian tubes. Conditions like endometriosis and fibroids, which can affect the womb, may hinder pregnancy, and an ultrasound can help identify such issues.

Furthermore, the scan can detect signs of potential blockages in the fallopian tubes, which may obstruct the passage of eggs from the ovaries to the womb. If a blockage is suspected based on the ultrasound results, your doctor may refer you to a specialist for further evaluation, such as a laparoscopy.

During a transvaginal ultrasound scan, a probe is gently inserted into the vagina to examine the health of the womb and ovaries and to detect any blockages in the fallopian tubes.

In some cases, a hysterosalpingo-contrast-ultrasonography may be performed to assess the fallopian tubes. This procedure involves injecting a small amount of fluid into the womb through a tube inserted into the cervix. Ultrasound is then used to track the flow of the fluid through the fallopian tubes, checking for any blockages or abnormalities.

If this test indicates a potential blockage, your doctor may recommend further investigations, such as a laparoscopy, to confirm the diagnosis.

X-ray

A hysterosalpingogram is a diagnostic procedure that involves taking X-ray images of the womb and fallopian tubes following the injection of a special dye.

This procedure helps identify any blockages in the fallopian tubes that may be obstructing the passage of eggs from the ovaries to the womb.

Laparoscopy

Laparoscopy, also known as keyhole surgery, involves making a small incision in your lower abdomen to insert a thin tube equipped with a camera at the end, called a laparoscope. This allows for a detailed examination of your womb, fallopian tubes, and ovaries.

During the procedure, dye may be injected into your fallopian tubes through the cervix to highlight any potential blockages.

Laparoscopy is typically reserved for cases where there is a likelihood of an underlying issue, such as a history of pelvic inflammatory disease (PID) or if imaging tests indicate possible blockages in one or both fallopian tubes.

Fertility tests for men

Tests conducted to determine the cause of infertility in men include:

Semen analysis

This test evaluates various parameters of sperm, including sperm count, motility (movement), and morphology (shape), to identify any abnormalities that may contribute to infertility.

Chlamydia test

A urine sample will be collected and tested for chlamydia, as this infection can impact fertility.

If chlamydia is detected, your doctor will prescribe antibiotics as treatment.

Regarding fertility problems, the treatment options available to you will depend on the underlying cause of the issue and the experience and expertise of your doctor.

Infertility Treatment

If you and your partner have been attempting to conceive without success and are considering seeking treatment, the recommended course of action can be influenced by several factors, including:

• The identified cause of infertility, if known.
• Duration of time spent trying to conceive.
• Age of both partners.
• Overall health status of both partners.
• Personal preferences of you and your partner, following thorough consultation about available treatment options.

Infertility Treatment in Men

Male infertility can be addressed through various treatment modalities, tailored to the underlying cause:

• Surgery: Surgical interventions can correct obstructions hindering the presence of sperm in the ejaculate. Additionally, conditions like varicocele can be addressed through surgery. In cases where sperm are not present in the ejaculate, surgical procedures can retrieve sperm directly from the testicles for use in assisted reproductive technology (ART) treatments.
• Medication: Medications are used to address hormonal imbalances and other conditions affecting male fertility, such as erectile dysfunction (ED) or infections impacting sperm count.
• Assisted Reproductive Technology (ART): This encompasses treatments where eggs and sperm are managed outside the body. ART options include in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Sperm for ART procedures can be obtained from ejaculate, extracted from the testicles, or sourced from a donor.
• Ayurvedic Approach: Ayurvedic treatment for infertility is mainly aimed at understanding the underlying causes behind the condition and then preparing a treatment method, which may include medications, lifestyle changes and counselling, to effectively treat you and produce the desired results without the chances of any side-effects.

Infertility Treatment in Women

Treatment for female infertility encompasses a range of options, including surgery, medication, and reproductive assistance like ART. Often, a combination of treatments may be necessary to address female infertility effectively.

While surgery was once a common approach, advancements in fertility treatments have made it less common. Surgery, however, can still be beneficial in cases where it can:

• Correct abnormalities in the shape of the uterus
• Unblock fallopian tubes
• Remove fibroids

Reproductive assistance methods include intrauterine insemination (IUI) and ART. In IUI, millions of sperm are inserted directly into the woman’s uterus around the time of ovulation.

IVF, a type of ART, involves retrieving eggs, fertilising them with sperm in a laboratory, and then transferring the resulting embryo into the uterus.

Medications used for female infertility typically work as natural hormones in the body to stimulate or regulate ovulation.

Furthermore, Ayurvedic treatment for infertility in women is known to produce great results without causing any side-effects.

Infertility and natural treatments

Natural treatments for infertility may include practices like acupuncture and yoga.

• Acupuncture for infertility

Acupuncture entails the insertion of small, thin needles into specific points on the body, thought to stimulate the flow of energy within the body. While there is no conclusive evidence supporting acupuncture as a standalone treatment for infertility, recent reviews of clinical trials suggest that it may offer some benefits for certain conditions.

For instance, a review of studies found limited evidence indicating that acupuncture could potentially enhance ovulation and menstruation in women with polycystic ovary syndrome (PCOS). However, more research is needed to fully understand the effectiveness of acupuncture in treating infertility.

• Yoga for infertility

Yoga involves a combination of postures and breathing exercises aimed at promoting relaxation and reducing stress levels.

While research on the effectiveness of yoga specifically as a treatment for infertility is limited, it is believed that practising yoga may help alleviate the stress often associated with fertility treatments. By promoting relaxation and reducing stress, yoga may indirectly support overall well-being and potentially improve fertility outcomes for some individuals.

• Vitamins for infertility

Several vitamins and minerals play a role in promoting fertility and overall reproductive health. Some key nutrients to consider include:

• Folate: Essential for healthy foetal development and reducing the risk of birth defects.
• Zinc: Important for sperm production and overall reproductive health in both men and women.
• Vitamin C: Acts as an antioxidant, protecting sperm from oxidative damage, and may improve hormone levels in women.
• Vitamin E: Another antioxidant that may enhance sperm quality and protect against oxidative stress.
• Iron: Crucial for maintaining healthy blood levels and supporting overall reproductive health.

In addition to these vitamins and minerals, other supplements like probiotics can contribute to healthy digestion and overall wellness, indirectly supporting fertility. 

You should never start taking any vitamin or mineral without consulting with your doctor as it may affect you negatively in certain situations.

• Tea for infertility

While commercially available fertility teas are popular, their effectiveness in improving fertility is not well-established due to limited research.

Investigations into the effects of fertility tea formulations on fertility outcomes are sparse. However, some studies suggest that certain antioxidant compounds found in green tea may have potential benefits for fertility. For example, these compounds may improve sperm count and motility in men.

It is important to approach fertility teas with caution and consult with a healthcare professional before incorporating them into your routine, especially if you are undergoing fertility treatments or have underlying health conditions.

• Essential oils for infertility

Essential oils, extracted from plants, are commonly sourced from roots, seeds, or leaves. They are often used in aromatherapy to induce relaxation and alleviate stress through methods like massage, bathing, or diffusing.

While aromatherapy with essential oils is known for its potential stress-reducing effects, additional research is required to fully understand their impact on fertility.

Fertility diet

Dietary recommendations aimed at boosting fertility primarily target issues related to ovulation problems in women. These recommendations may not be effective for infertility caused by physical conditions such as fallopian tube blockages or uterine fibroids.

Some dietary suggestions for enhancing fertility include:

• Prioritising fibre-rich foods like vegetables and whole grains over refined carbohydrates high in sugar.
• Avoiding trans fats commonly found in fried and processed foods.
• Substituting some animal protein with vegetarian protein sources.
• Opting for high-fat dairy products like whole milk instead of low-fat alternatives.

Following these dietary guidelines, along with maintaining a nutrient-rich diet, can also contribute to improving sperm health in men.

Incorporating dietary changes alongside lifestyle modifications such as increased physical activity can promote fertility.

Fertility cycle

Women experience peak fertility around ovulation, the time when the ovaries release a mature egg, typically occurring once a month. During ovulation, the egg travels through the fallopian tubes, where it can be fertilised by sperm.

Although ovulation itself lasts only about one day each cycle, a woman’s fertile window extends beyond this timeframe. Sperm can survive within the female reproductive tract for up to five days, increasing the likelihood of fertilisation. As a result, a woman is typically fertile for about five to six days per menstrual cycle.

Since ovulation timing varies from month to month, it is crucial to recognize signs indicating ovulation. These may include physical symptoms like abdominal cramping and a slight increase in body temperature. Identifying these signs can help couples optimise their chances of conception by timing intercourse during the woman’s fertile window.

Infertility facts and statistics

According to the Centers for Disease Control and Prevention (CDC), approximately 12.1 percent of women aged 15 to 44 in the United States encounter challenges with conceiving and carrying a pregnancy to term. Among married women within this age range, nearly 7 percent experience infertility.

Furthermore, data from the CDC reveals that about 7.3 million women aged 15 to 44 in the U.S. have utilised infertility services, accounting for approximately 12 percent of women in this demographic.

The National Institutes of Health (NIH) estimates that the fertility of a woman in her 30s is approximately half that of a woman in her early 20s.

The Office on Women’s Health reports that around 20 percent of women in the U.S. are becoming first-time mothers after the age of 35, highlighting age as a significant contributing factor to infertility.

Approximately 9 percent of men encounter fertility issues, although male fertility typically declines at a slower rate compared to female fertility with increasing age.

Infertility can stem from various factors, with approximately 1 in 4 couples unable to identify a specific cause.

However, more than 8 in 10 couples, particularly where the woman is under 40, are expected to conceive naturally within a year of engaging in regular unprotected intercourse (once every 2-3 days).

When to get medical help

It is common for some couples to conceive quickly, while others may take longer. If you have not conceived after a year of trying, it is advisable to consult a doctor.

For women aged 36 and older, as well as those with known fertility concerns, seeking medical advice earlier is recommended. A doctor can assess you for common causes of fertility issues and suggest appropriate treatments.

It is important to seek medical attention sooner if you fall into these categories or have other reasons to be concerned about fertility, such as a history of cancer treatment or potential exposure to sexually transmitted infections (STIs).

Given that fertility tests may require time, and female fertility declines with age, early consultation is ideal. During the initial assessment, the doctor can identify potential causes of fertility problems and provide guidance on next steps.

It is beneficial for both partners to visit the doctor, as fertility issues can affect either or both individuals. The process of trying to conceive can be emotionally challenging, so supporting each other is crucial. Managing stress is particularly important, as it can impact fertility.

Questions your doctor may ask

The doctor will ask you about your medical and sexual history:

• What is your history of previous pregnancies and children?
• How long have you been trying to conceive?
• What is your frequency of sex and do you face any difficulties during intercourse?
• When did you stop taking contraception?
• What is your medical history and symptoms?
• What medicines are you taking?
• What is your lifestyle?

Takeaway

Infertility in men and women is a widespread condition which is getting more common with each passing year. The causes behind it vary from hormonal imbalances and physical obstructions to lifestyle factors and unexplained issues. There are multiple treatment methods available in medical science today, but they may be very expensive despite not being sure-shot.

Ayurvedic treatment for infertility, on the other hand, is very effective and way cheaper than other modes of treatments. At Dr Monga’s in Delhi, the team of doctors use a combination of allopathy and ayurveda to treat their patients effectively. If you are also suffering from the symptoms of infertility, book an appointment today with Dr Monga’s in Delhi and embark on your healing journey.