KNOWLEDGE BASE

What is Infertility?
Infertility is defined as the inability to conceive after having unprotected intercourse for a period of one year.

Causes of Infertility
The causes of infertility can be divided into three main categories, female factors, male factors and unexplained infertility.

Female Factors
There are several factors that can affect a woman’s ability to conceive. These include:

Blocked fallopian tubes:
When a woman has a blockage in her fallopian tubes, it is very difficult for an egg to reach the uterus so that fertilization can occur. IVF is often recommended in this instance as eggs are retrieved directly from the ovary and do not have to travel along the fallopian tubes.

One of the causes of tubal blockage is previous tubal ligation.

Endometriosis:
Endometriosis is a condition that occurs when uterine tissue grows outside the uterus. It can impact the functioning of the ovaries, uterus, and fallopian tubes.

Ovulation Disorders:
Ovulation disorders are a common cause of infertility in women. Ovulation can be irregular or absent resulting in missed or sporadic menstrual periods and creating difficulty in conceiving. One of the most common ovulation disorders in women of reproductive age is Polycystic Ovarian Syndrome (PCOS).

Previous tubal ligation: (under blocked fallopian tube)
If a woman has previously had a tubal ligation to prevent pregnancy, it means her fallopian tubes have either been cut or permanently blocked. To be able to conceive after this procedure there are only two options, a tubal reversal or IVF.

Decline of in the number of viable eggs Women are born with a finite number of eggs (oocytes) in their ovaries. As women age, both the number of eggs and the quality of their eggs decline. Women’s ability to achieve a pregnancy declines gradually, but significantly after the age of 32 and more rapidly after the age of 37 according to the American College of Obstetrics and Gynaecology. For further information see ovarian reserve.

Other Medical Issues  Infertility can also be caused by abnormalities of the uterus or a previous history of pelvic infection.  Similarly, sexually transmitted disease, such as chlamydia, can lead to infertility.

Lifestyle factors There are also lifestyle factors which can have an impact on female fertility including excessive alcohol use, using illicit drugs, smoking, poor diet, athletic training, being overweight or underweight and of course stress. Diet and lifestyle plays an important role in a couple’s fertility. Maintaining a healthy lifestyle with regular exercise, weight management, and a proper diet is important. We at Oasis Fertility believe in adopting a comprehensive approach to fertility management and will refer you to lifestyle and/or weight management counselor as needed.

Male Factors
Male factor infertility accounts for approximately 40% of all cases of infertility. Throughout the Western world, male sperm counts have been declining for the last 70 years. This decline in male fertility is worrisome, and may be due to environmental causes, including exposure to environmental toxins, pesticides and insecticides now in common use.

The causes of male infertility are:

Hormone Imbalances
This can be the result of congenital or acquired conditions. Damage to the testes can be the result of infections such as mumps, or from trauma, surgeries, chemotherapy or radiation.

Undescended Testicles
In some men, one or both testicles fail to descend from near the stomach to the scrotum. There is growing evidence that the earlier this defect is corrected surgically during infancy, the less likelihood of causing fertility problems later in life.

Ejaculatory & Erectile Disorders
The inability to attain and maintain an erection, premature ejaculation, or a congenital abnormality of the penis may interfere with sexual function and male fertility. These will be discussed with you during your consultation.

Environmental & Lifestyle Factors
Exposure to certain environmental toxins, especially insecticides and pesticides “may” effect male fertility and are thought to be the reason for the decline in male fertility that we have observed over the past half a century.  

Certain lifestyle factors can impact male fertility. Using drugs (such as anabolic steroids) can shrink the testes and reduce sperm count. Marijuana and cocaine are also known to reduce the number and the quality of sperm. Drinking alcohol in excess can lower testosterone levels and decrease sperm production. Obesity can result in hormone changes that impact fertility.  

Other conditions can also adversely affect male fertility such as previous or current infections (ie: gonorrhea or chlamydia), retrograde ejaculation, or varicocele.

Diagnosis
The first step in determining if infertility is related to male factor, is to have a Sperm Functional Assessment (SFA). This assessment is performed by preparing the sperm in a special way and examining it under the microscope to assess the count and function of the sperm. We are also able to determine how many of the sperm in the specimen are abnormal. Please note that it is normal for up to 40% of sperm to appear abnormal. According to WHO standards, normal sperm count is over 15 million sperm per ml, with over 32% motility, and over 50% normal forms.

An SFA is one of the best indicators to determine if there something wrong with the sperm. Depending on what is found, further tests may be recommended.

Unexplained Infertility
At Oasis Fertility Centre both partners will undergo comprehensive testing to identify the causes of infertility. However, despite our best efforts we are unable to identify the cause of infertility in approximately 15% of cases which is considered to be unexplained infertility.

Although this is a frustrating diagnosis, it does not mean that all is well. In most cases there are subtle abnormalities that have not shown up by routine testing. This may be to do with the function of the eggs and the sperm.

When to seek treatment for infertility
Generally, you should seek treatment for infertility if you are less than 35 years old and have been trying to achieve a pregnancy through unprotected intercourse for one year. The common misconception is that patients feel that trying for a pregnancy means doing temperature charting in the morning, as well as checking for ovulation. This is a misconception as it depends on fecundity.

Fecundity is defined as the natural capability to produce offspring, or the probability conceiving.

This means that if you are under the age of 35, you have approximately a 15% to 20% chance of getting pregnant per cycle. You should seek treatment sooner if you are over the age of 35 or have other factors that may decrease your probability off getting pregnant. These factors would include irregular periods, a condition such as polycystic ovarian syndrome or other medical issues such as abnormalities of the uterus or a previous history of pelvic infection. Similarly, if you’ve had chlamydia infection in the past, it is prudent to seek referral to the reproductive endocrinologist and infertility specialist sooner, as the cause may be blocked fallopian tubes. The Road to Fertility requires a series of investigations that will help your physician determine the best treatment option for you.