As defined by The International Committee for Monitoring Assisted Reproductive Technologies (ICMART), infertility is a disease characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner
It’s common for couples to experience issues with infertility. Many of these couples have no symptoms. They don’t have any reason to suspect they may have infertility until they start trying to conceive.
For this reason, it’s recommended that couples who’ve been trying to get pregnant for over a year without success seek the advice of a doctor. For women over age 35, that timeline is reduced to six months. Infertility issues increase with age.
Signs and Symptoms of Infertility
Signs and symptoms of infertility are often related to other underlying conditions. For example, 10 to 15 percent of untreated chlamydia cases will lead to pelvic inflammatory disease (PID). PID leads to a blockage of the fallopian tubes, which prevents fertilization.
There are numerous conditions that can contribute to infertility in men and women. The signs and symptoms of each can vary greatly. If you’re concerned, it’s important to consult with your doctor.
Common signs and symptoms of infertility in Women
1. Irregular periods
The average woman’s cycle is 28 days long. But anything within a few days of that can be considered normal, as long as those cycles are consistent. For example, a woman who has a 33-day cycle one month, a 31-day cycle the next, and a 35-day cycle after that, is probably having “normal” periods. But a woman whose cycles vary so greatly that she can’t even begin to estimate when her period might arrive is experiencing irregular periods. This can be related to hormone issues, or to polycystic ovarian syndrome (PCOS). Both of these can contribute to infertility.
2. Painful or heavy periods
Most women experience cramps with their periods. But painful periods that interfere with your daily life may be a symptom of endometriosis.
3. No periods
It’s not uncommon for women to have an off month here and there. Factors like stress or heavy workouts can cause your period to temporarily disappear. But if you haven’t had a period in months, it’s time to get your fertility checked.
4. Symptoms of hormone fluctuations
Signs of hormone fluctuations in women could indicate potential issues with fertility. Talk to your doctor if you experience the following:
- skin issues
- reduced sex drive
- facial hair growth
- thinning hair
- weight gain
5. Pain during sex
Some women have experienced painful sex their entire lives, so they’ve convinced themselves it’s normal. But it’s not. It could be related to hormone issues, to endometriosis, or to other underlying conditions that could also be contributing to infertility.
Common Signs and symptoms of Infertility in Men
1. Changes in sexual desire
A man’s fertility is also linked with his hormone health. Changes in virility, often governed by hormones, could indicate issues with fertility.
2. Testicle pain or swelling
There are several different conditions that could lead to pain or swelling in the testicles, many of which could contribute to infertility.
3. Problems maintaining erection
A man’s ability to maintain an erection is often linked to his hormone levels. Reduced hormones may result, which could potentially translate into trouble conceiving.
4. Issues with ejaculation
Similarly, an inability to ejaculate is a sign that it might be time to visit a doctor.
5. Small, firm testicles
The testes house a man’s sperm, so testicle health is paramount to male fertility. Small or firm testicles could indicate potential issues that should be explored by a medical practitioner
Fertility interventions may be initiated in less than 1 year based on medical, sexual and reproductive history, age, physical findings and diagnostic testing.
Risk factors of infertility in women
The following are factors which can affect your ability to ovulate, conceive, or carry a pregnancy to term:
- excessive, or very low, body fat can affect ovulation and fertility
- chronic diseases, such as diabetes, hyper or hypothyroidism, lupus, arthritis, hypertension, or asthma—tell your doctor about prescription medicines that you are currently taking
- abnormal pap smears which have resulted in treatment such as cryosurgery or cone biopsy
- your mother took DES when she was pregnant with you — tell your doctor so an x-ray can be done to assess the size and shape of your uterus
- hormonal imbalance—periods exceeding six days, cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles, very heavy periods, excessive facial hair, or acne on face, chest, abdomen
- multiple miscarriages—two or more early pregnancy losses
- environmental factors—cigarette smoking or alcohol consumption, exposure to workplace hazards or toxins
Even if your fertility does not seem at risk now, remember that fertility declines with age. A woman in her late 30’s is about 30% less fertile than she was in her early 20’s. See your doctor if you are over 30 and have been trying to conceive for six months or more.
Sexually Transmitted Diseases(STDs)
Twelve million cases of newly diagnosed STDs occur in the USA annually, with one quarter of those acquired by teenagers. Some STDs can be asymptomatic. They are transmitted more easily to women, and can lead to pelvic inflammatory disease (PID) in women, and epididymitis in men. Complications are more common in women, including subsequent scarring, miscarriage, adhesions, blocked tubes, and ectopic pregnancy. Ultimately, infertility can be a consequence of STDs.
To decrease this risk:
- consider that people in mutually monogamous relationships with an uninfected partner have the lowest risk of getting an STD
- use latex condoms for contraception
- detect and treat infections early. Both partners should be treated simultaneously if one has an infection
Fallopian tube disease accounts for about 20% of infertility cases treated. If you are having trouble conceiving, or are worried about your future fertility, be sure to tell your doctor if you have had:
- STDs, such as gonorrhea, syphilis, or chlamydia, pelvic pain, unusual vaginal discharge, bleeding or fever, pelvic surgery for ruptured appendix, ectopic pregnancy, or ovarian cyst
- an IUD for contraception
- two or more abortions
Remember, use of a condom can be effective in preventing the spread of STDs. If you have an infection, your partner must be treated also. A specialist can assess the health of your uterus and tubes with an x-ray known as a hysterosalpingogram (HSG).
Endometriosis is a disease in which uterine tissue is found outside of the uterus; on the ovaries, fallopian tube, and often on the bladder and bowel. It can occur in menstruating women of all ages, including teens. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and preservation of fertility.
Be sure to report these symptoms to your doctor:
- painful menstrual cramps that may be worsening with time
extremely heavy menstrual flow
- diarrhea or painful bowel movements, especially around your period
- painful sexual intercourse
Endometriosis runs in families, so it is important to tell your doctor if your mother or sisters had symptoms or were diagnosed with the disease. It may be symptom-less, however, and diagnosis may only be confirmed with an outpatient surgery known as laparoscopy.
Risk factors of infertility in men
- exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity, and x-rays
- cigarette or marijuana smoke, heavy alcohol consumption
- prescription drugs for ulcers or psoriasis
- DES exposure in utero
- exposure of the genitals to elevated temperatures — hot baths, whirlpools, steam rooms
Medical risk factors
- hernia repair
- undescended testicles
- history of prostatitis or genital infection
- mumps after puberty