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Infertility is the inability to become pregnant after one year of trying, or 6 months if you’re a female 35 years of age or older. It is a common condition in 9% of men and 11% of women. The causes of infertility have a wide range from age to hormone deficiency. Although infertility rates appear to be rising, there have been many advancements in assisted reproductive treatments to overcome fertility problems. Let’s take a look at the causes of infertility as well as the medications and procedures available to treat it.
What is infertility?
Infertility is the inability to become pregnant or maintain a pregnancy. Individuals who have been trying to conceive or having unprotected sex for a consecutive year without fertilization may have concerns of being infertile; for women aged 35 or older, that timeframe decreases to 6 months.
Types of infertility
There are two categories of infertility:
- Primary infertility: Individuals or couples who cannot conceive after 12 months of trying to become pregnant, or 6 months in women aged 35 years or older
- Secondary infertility: Individual or couples who have already had at least one pregnancy, but are subsequently unable to become pregnant again.
Causes of infertility
Both women and men can experience infertility. Causes of infertility vary greatly from low egg reserve or sperm count, underlying health conditions, exposure to heat or chemicals, and even excessive alcohol consumption. Although self diagnosis is common with infertility, a healthcare professional can perform a physical examination and order tests to determine a diagnosis of infertility. Although a clear answer is not always detected, fertility can be evaluated a variety of ways through blood tests that assess hormone levels, semen analysis, and ultrasounds to determine the ovarian reserve.
Causes of infertility in women
While age definitely plays a role in female infertility, there are numerous reasons why a woman may not be able to conceive. The most common causes of female infertility include ovulation problems, damage to fallopian tubes or uterus, or problems with the cervix. Age can also contribute as women’s fertility naturally declines with age.
Ovulation problems may manifest as a result one or more of the following:
- Hormonal imbalances, including genetic disorders like congenital adrenal hyperplasia and chronic kidney disease
- Thyroid gland disorders
- Premature menopause
- Obesity
- Low body weight (including eating disorders and lack of nutrition)
- Stress
- Exposure to radiation or chemotherapy
- Exposure to pesticides
- Excessive use of alcohol, tobacco, marijuana, cocaine, or other drugs
Damage to the fallopian tubes or uterus can cause fertility due to one or more of the following:
- Pelvic inflammatory disease
- Uterine fibroids
- Endometriosis
- Side effects of medication
Causes of infertility in men
Men can also experience infertility. The most common causes of male infertility are categorized as problems with abnormal sperm production or function, problems with delivery of sperm, exposure to certain environmental factors, or direct damage related to cancer treatment.
Causes of abnormal sperm production or function include:
- Undescended testicle(s)
- Varicocele (Varicose vein in scrotum)
- Testicular failure
- Accessory gland failure
- Hormonal imbalances, such as is seen in hypogonadism
- Medical conditions, like diabetes
- Genetic conditions, like Klinefelter syndrome
- Certain bacterial or viral infections
- Stress or anxiety
Problems with the delivery of sperm can occur secondary to the following:
- Premature ejaculation
- Cystic fibrosis
- Structural abnormalities, like testicular blockage or hypospadias
- Injury to reproductive organs
- Retrograde ejaculation (semen is released into bladder instead of exiting the penis)
Overexposure to environmental factors, including:
- Exposure to pesticides
- Excessive use of alcohol, tobacco, marijuana, cocaine, or other drugs
- Side effect from certain medications, like antibiotics and antidepressants
- Use of anabolic steroids
- Frequent use of hot tub or sauna
- Tight underwear
RELATED: How a dad’s health impacts his baby’s
How is infertility diagnosed?
Before you can get treated for infertility you must be tested and diagnosed by a healthcare professional. A physical exam and overview of your medical history can help the doctor determine if you need to undergo fertility treatment.
Couples may be referred to a fertility specialist, also known as a reproductive endocrinologist. Some men may also be recommended to see a urologist for further testing if needed. Men and women will likely need to have some labs done.
Men may undergo:
- Sperm analysis: A microscopic examination of a semen sample is used to analyze sperm concentration, motility, morphology, volume, pH levels, liquefaction time, and fructose levels.
- Testicular biopsy: A small portion of the testicle is removed and analyzed to identify possible blockages, detect testicular cancer, or to retrieve sperm for IVF.
- Genetic testing: A blood test to identify genetic diseases that could cause infertility
Women may undergo:
- Hysterosalpingogram: An X-ray of the cervix to examine the health of the uterus and female reproductive organs.
- Pelviscopy: A small video camera is used to view the organs within the pelvic cavity for any abnormalities that may be contributing to infertility.
- Hysteroscopy: A fiber optic telescope inserted through the vagina used to examine the uterus.
A woman may also be asked to document her menstrual cycle, frequency of intercourse, her basal body temperature, and assess her vaginal mucus as part of diagnosing infertility.
Infertility treatment options
A variety of holistic and medical options are available for increasing chances of conception. Hormone treatments, surgery, and assisted reproductive technology (ART) are among the methods used to treat infertility.
Lifestyle changes
“Smoking, alcohol, or drugs can drastically reduce fertility in men and women,” according to Lina Velikova, MD, a medical writer for Supplements 101. Lifestyle changes for both men and women, such as refraining from drinking alcohol and maintaining a healthy body weight can also affect one’s fertility. Be sure to inform your doctor of all necessary information that could affect your infertility; identifying the cause of infertility may take months.
Hormone therapy
Hormone injections can be used in men or women. Infertility caused by dwindling testosterone can be boosted with hormone injections. Testosterone replacement therapy (TRT) is used to increase healthy sperm production. Hormone therapy may involve using follicle stimulating hormone (FSH) and luteinizing hormone (LH) to increase sexual reproduction health.
Reproductive medicine
Medications are available for both men and women to increase fertility. If a man is experiencing erectile dysfunction, medication can help the male reproductive organ function properly. A doctor may also prescribe medication to increase sperm production. Clomiphene citrate is an estrogen-blocking drug that could also help male fertility. Meanwhile, women can be prescribed fertility medication or hormones that can induce or regulate ovulation.
Talk to your healthcare provider about potential medications that could be helpful in increasing fertility. Medications could lead to conception without having to have surgery.
Surgery
A variety of surgeries could help in correcting infertility. Surgery to remove scar tissue from endometriosis, fibroids, polyps, or adhesions may be helpful in restoring a woman’s reproductive system. Blocked fallopian tubes can be reopened through laparoscopic surgery. If the surgeon cannot remove the blockage, the fallopian tube may be severed and reconnected to remove the damaged portion.
A man may need to have surgery as well. For example, an epididymis (a transport system that stores and moves sperm) can be blocked. A surgical procedure can unblock this vital tubal passageway to allow sperm to be ejaculated properly.
Another example is a varicose vein in the scrotum that can increase the temperature of the reproductive organs, causing infertility. This condition is called varicocele. A surgical procedure can be helpful in restoring the affected vein causing infertility.
In vitro fertilization
In vitro fertilization (IVF) is the process of extracting eggs from the female’s body to be fertilized with sperm (either from the male partner or donor sperm) in a laboratory. Fertilized eggs are reinserted into the woman’s uterus. Success rates of IVF are highly dependent on several factors, but as a generalization can vary from 40% to 60%. Donor eggs can also be used to enhance success.
Assisted reproductive technology such as IVF and artificial insemination can lead to multiple births. More than one egg can be fertilized during the process leading to twins, triplets, quadruplets, or more.
Intrauterine insemenation
Intrauterine insemination (IUI) involves inserting sperm into the uterus using a catheter. This method guarantees that the sperm is reaching the uterus increasing the opportunity for fertilization.
Fertility drugs
Estrogen modulators
Estrogen modulators, or selective estrogen receptor modulators (SERMs), act as estrogen in the receptors of breast tissue. SERMs can act either as agonists or antagonists, meaning they can activate estrogen’s effect in other cells or block its effect on other cells.
SERMs such as clomiphene citrate and tamoxifen can be used to treat male infertility and were shown to increase serum luteinizing hormone, follicle-stimulating hormone as well as sperm concentration and count.
These SERMs also help to activate ovulation in women by imitating the effect of estrogen on the pituitary gland. Clomiphene citrate, also known as Clomid or Serophene are used to treat women with polycystic ovarian syndrome (PCOS).
Common side effects of SERMs include but are not limited to:
- Fatigue
- Hot flashes
- Night sweats
- Vaginal discharge
- Mood swings
Anti-diabetic medication
Anti-diabetic medications manage blood glucose levels for those with diabetes but can also aid in infertility.
Metformin—also known as Glucophage, Riomet, or Glumetza—is a medication used to treat Type 2 diabetes, but it can also treat infertility in women due to polycystic ovary syndrome (PCOS). PCOS leads to a hormonal imbalance that causes the egg to not be fully developed or be released from the ovaries and Metformin helps to improve the rate of ovulation by regulating reproductive hormones. For those with diabetes, it can also help to sustain a healthy blood sugar level while pregnant.
Side effects of metformin include:
- Heartburn
- Stomach pain
- Nausea or vomiting
- Bloating
- Gas
Hormones
Hormonal medications work by triggering the body’s natural processes to prepare for pregnancy.
- Progesterone: Often prescribed for ART procedures such as IVF. Progesterone helps to prepare the uterus for pregnancy by thickening the uterine lining to maintain implantation of a fertilized egg and creating an ideal environment for the fetus. Crinone, Prometrium, Utrogestan, and Cyclogest.
- Estradiol: Estradiol is a form of the estrogen hormone that helps in the maturation and release of an egg, as well asthickening of the uterine lining to support implantation. Estradiol medications include Vivelle-Dot, Yuvafem, and Delestrogen.
- Gonadotropins: An injectable hormone that contains follicle stimulating hormone (FSH) and/or luteinizing hormone (LH) which helps to produce and release eggs from the ovaries. Gonadotropin medications include Follistim, Menopur, Bravelle, and Gonal-F.
Sex hormone suppression
Sex hormone suppression medications suppress the body’s production of hormones produced by a sex organ.
Leuprolide acetate: Commonly known as Lupron, this is an injectable medication commonly used in IVF cycles to reduce the production of estrogen and progesterone by the ovaries to allow for a more predictable response to gonadotropins.
Side effects of Lupron include:
- Hot flushes
- Headaches
- Nausea
- Mood changes
- Decrease in breast size
- Vaginal dryness
What is the best medication for infertility?
| Best medications for infertility | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Lupron (leuprolide acetate) | Gonadotropin-releasing hormone (GnRH) agonist | Injection | 0.25-1 mg subcutaneous injection daily for ~14 days | Headache, hot flashes, decreased libido |
| Ovidrel (choriogonadotropin alfa) | Human chorionic gonadotropin (hCG) | Injection | 250 mcg/0.5 mL subcutaneous injection once | Nausea, vomiting, abdominal pain |
| Ganirelix | Gonadotropin-releasing hormone (GnRH) agonist | Injection | 250 mcg/0.5 mL subcutaneous injection daily (until directed to administer hCG) | Headache, stomach pain, nausea |
| Cetrotide (cetrorelix) | Gonadotropin-releasing hormone (GnRH) agonist | Injection | 0.25 mg subcutaneous injection once daily (until directed to administer hCG) | Nausea, headache and redness or itching around injection site |
| Doxycycline | Tetracycline antibiotic | Oral | 100 mg capsule twice a day for 4 days, beginning the day of egg retrieval | Diarrhea, headache, vomiting |
| Endometrin (progesterone) | Progesterone | Vaginal insert | 100 mg capsules intravaginally 2-3 times daily for 10-12 weeks by a physician | Bloating, stomach pain, nausea |
| Estrace (estradiol) | Estradiol | Oral | 1-2 mg tablet by mouth twice a day for 14 days | Nausea, vomiting, bloating |
| Clomiphene citrate | Selective estrogen receptor modulators (SERMs) | Oral | 50 mg by mouth once a day for 5 days | Stomach pain, bloating, hot flashes |
| Glumetza (metformin) | Giguanide | Oral | 500 mg orally once daily | Nausea, vomiting, stomach pain |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of infertility medication?
Side effects of infertility medication will depend on the drugs being prescribed. This is not a complete list of side effects and you should always speak with your healthcare provider to discuss possible side effects or drug interactions. Common side effects among fertility drugs include:
- Stomach pain
- Bloating
- Headache
- Hot flashes
- Nausea
- Vomiting
Some medications can have serious side effects that are a sign of a life threatening condition. For example, Ganirelix and Ovidrel can lead to ovarian hyperstimulation syndrome (OHSS). Mild to moderate OHSS can occur, and usually goes away after about a week. Severe OHSS symptoms warrant immediate medical attention and include:
- Severe pelvic pain
- Swelling of hands or legs
- Stomach pain
- Bloating
- Shortness of breath
- Diarrhea, nausea, or vomiting
Complications with infertility treatment
While infertility treatment has proven to be effective for millions of families, there are risks involved. A recent study indicates that women who undergo IVF treatment for infertility have an increased risk of severe complications during pregnancy.
- 30.8 per 1,000 women vs. 22.2 per 1,000 women experienced a severe complication.
Any pregnancy has potential risks, but severe complications associated with pregnancy following IVF include but are not limited to:
- Sepsis (serious infection)
- Hemorrhage (excessive bleeding)
- Eclampsia (seizure from high blood pressure)
- Injuries resulting in the need to be admitted to Intensive Care Unit (ICU)
- Death (rare but possible)
The benefits of fertility treatment outweigh the risks for the millions of people who choose this option to have a family. In addition to risks, there are significant costs associated with some infertility treats that need to be considered.
What is the best home remedy to boost fertility?
There are natural ways to increase the chances of getting pregnant. Modifications to diet along with regular exercise are options to remedy infertility, which include:
- Eating antioxidant rich foods such as fruits, vegetables, nuts and whole grains has been associated with higher rates of fertilization.
- A low-carbohydrate diet can improve PCOS symptoms as high insulin levels and metabolic issues are connected to PCOS. This means controlling intake on grains, starch, rice and sugar.
- Eating a big breakfast instead of consuming the majority of calories at dinner has been found to reduce insulin levels and testosterone levels for women with PCOS.
- Avoiding trans fats such as baked goods, fried foods, and refrigerated dough is associated with a greater chance of developing infertility.
- Diversifying protein sources among animal and vegetable protein sources can lead to increased fertility.
- Regular exercise and maintaining a healthy weight are not only good for overall health but factor into the possibility to conceive.
- Limiting alcohol intake has been found to have a positive effect on reproductive health in women and men. Heavy drinking has been associated with a longer period before getting pregnant.
Frequently asked questions about infertility
How is infertility treated?
Once diagnosed, infertility can be treated through medications (such as Clomid, Estrace, or Ganirelix), hormone therapy, and/or procedures such as in-vitro fertilization (IVF), or surgery.
What is the best fertility drug to get pregnant?
Clomid, Follistim AQ, and Glumetza are popular fertility drugs. Medication also differs between men and women. Those experiencing infertility should speak to a healthcare provider to find which medication is the best fit.
How long does it take for fertility pills to work?
For those taking Clomiphene, ovulation usually begins after about seven days after the last dose. If this doesn’t happen a doctor may increase the dose. The length of time for an infertility medication to lead to successful conception varies depending on the medication and individual.
What are the side effects of taking fertility drugs?
Side effects of infertility medication will depend on the drugs being prescribed, however common side effects include stomach pain, bloating, headache, hot flashes, nausea, and vomiting. This is not a complete list of side effects and you should always speak with your healthcare provider to discuss possible side effects for prescribed medication or drug interactions.
What fertility pills make twins?
Clomiphene and gonadotropins have been found to increase chances of the conception of twins. Studies have found that gonadotropin leads to multiple or twin pregnancies about 30% of the time.
Related resources for infertility
- How common is infertility?, National Institutes of Health (NIH)
- Selective estrogen receptor modulators (SERMs), Breastcancer.org
- Selective estrogen receptor modulators may be effective for male infertility, Renal & Urology News
- Progesterone and pregnancy: A vital connection, The National Infertility Association
- Estradiol, Hormone Health Network
- Gonadotropins, Pacific Fertility Center
- Lupron (Leuprolide), Fertility Center of Oregon
- Boost your fertility with antioxidant supplements, American Pregnancy Association
- Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome, NIH
- Trans fats may raise risk of infertility, Harvard Medical School
- Protein intake and ovulatory infertility, American Journal of Obstetrics and Gynecology
- Coffee, tea and caffeine consumption and risk of primary infertility in women: a Danish cohort study, Wiley’s Obstetrics and Gynaecology
- Alcohol, Fertility Coalition
- High frequency of iatrogenic monozygotic twins with administration of clomiphene citrate and a change in chorionicity, ScienceDirect
- Multiple pregnancy and birth: Twins, triplets, and high order multiples, ReproductiveFacts.org