Are you also frustrated with your dream of having a baby? Let's talk about infertility.

You and your husband have probably been dreaming of having a baby for a long time. But sometimes, no matter how hard you try, it can be a little late to make that dream come true. It's normal to feel sad and worried when that happens. But you're not alone. We call this condition ``Infertility``. Today, we'll talk about this in detail, very simply.

What is Infertility? Let's understand it simply!

Simply put, infertility is the inability to conceive a child due to a condition in your reproductive system. This can affect anyone, and there can be many reasons for it. Conceiving a child is not as easy as you think. It requires a few steps to be followed.

Think of it this way:

• First, your brain needs to produce reproductive hormones . These hormones control the function of the ovaries.
• Next, an egg must mature in one of your ovaries .
• That mature egg needs to be released from the ovary . We call this ovulation.
• Then, you need to retrieve this egg from your fallopian tube .
• Meanwhile, the sperm must travel through the vagina and through the uterus into the fallopian tube .
• There, the sperm must unite with the egg (fertilize) to form an embryo .
• Eventually, this embryo must travel down the fallopian tube and implant itself in the wall of the uterus .

If one thing doesn't go right in this process, pregnancy won't occur.

In general, if you are under 35 years of age and have not conceived after a year (12 months) of regular, unprotected sex , a doctor may suspect infertility. If you are 35 years of age or older and have tried for six months without success, it is a good idea to seek medical advice.

Infertility is a much more common condition than you might think. But the good news is that there are treatments available today that can help many people who are hoping to start or expand their family.

What are the types of infertility?

Infertility can be divided into several main types:

• Primary infertility: If you have never conceived a child before, and have been trying for a year (6 months if you are over 35) and have not had a child, it falls into this category.
• Secondary infertility: This is when you have already had one child successfully and then are unable to conceive again.
• Unexplained infertility: Sometimes, despite all the necessary testing, a specific reason for the inability to conceive cannot be found.

How common is infertility?

This condition affects both men and women. It's actually more common than you might think. For example, in the United States, one in five women between the ages of 15 and 49 suffer from primary infertility. And one in 20 women suffer from secondary infertility. Worldwide, about 48 million couples live with infertility. So you can see, this is a problem that affects a lot of people.

What are the symptoms of infertility?

The main symptom is failure to conceive after six months or a year of regular, unprotected sex . There may be no other symptoms. However, some women or men may experience physical symptoms such as:

• Pelvic or abdominal pain .
• Irregular vaginal bleeding, irregular menstruation, or complete loss of menstruation .
• Penile disorders or issues with ejaculation in men .

What are the causes of infertility?

There can be many reasons for infertility. Sometimes, it's hard to find a simple answer to why you can't have a baby. Only a doctor can determine the exact cause and determine the best treatment for you.

Whatever the reasons, studies have shown that:

• 33% of infertility causes come from women.
• 33% of infertility causes come from men.
• The remaining 33% of infertility cases are due to problems on both sides or unexplained causes.

In some couples, infertility may be caused by more than one cause.

Common risk factors for infertility

Some causes affect only one person, while others can affect both. Here are some common risk factors that can contribute to infertility:

• Age : Especially for women in their late 30s or 40s. Age starts to affect men's fertility around the age of 50.
• Eating disorders : Conditions like `(Anorexia nervosa)` and `(bulimia)`.
• Excessive alcohol consumption .
• Exposure to environmental toxins : Things like chemicals, lead, pesticides.
• Exercising too much .
• Receiving radiation therapy or chemotherapy .
• Sexually transmitted infections (STIs) .
• Smoking and use of tobacco products : This habit accounts for between 13% and 15% of infertility.
• Drug use .
• Excessive obesity or being too thin .
• Abnormalities in the hormone-producing centers of the brain (hypothalamus or pituitary gland) .
• Chronic illnesses .

Causes of infertility in women

The main cause of infertility in women is ovulation disorders . Ovulation is the process by which an egg is released from your ovary to be fertilized by a sperm.

These factors can contribute to female infertility:

• Endometriosis : The growth of tissue that lines the inside of the uterus (endometrium) outside the uterus.
• Structural abnormalities of the vagina, uterus, or fallopian tubes .
• Immune system diseases : Conditions such as `(Celiac disease)` or `(Lupus)`.
• Kidney disease .
• Pelvic Inflammatory Disease (PID)
• Disorders of the hypothalamus and pituitary gland .
• Polycystic Ovary Syndrome (PCOS) .
• Primary ovarian insufficiency or poor egg quality .
• Sickle cell anemia .
• Uterine fibroids or uterine polyps .
• Thyroid diseases .
• Blockage of the fallopian tubes due to previous surgery (infertility surgery - `(tubal ligation)` or `(salpingectomy)`) .
• Genetic or chromosomal abnormalities .
• Sexual function problems .
• Absence of ovaries due to surgery or birth .
• Menstruation very rarely or not at all .

Causes of male infertility

The most common cause of male infertility is problems with sperm shape, motility, or low sperm count .

Other reasons may include:

• Enlargement of the veins surrounding the testicles (in the sac that holds the testicles) `(varicocele)` .
• Genetic diseases : such as `(Cystic fibrosis)`.
• Chromosomal abnormalities : such as `(Klinefelter syndrome)`.
• Exposure of the testicles to excessive heat due to wearing tight clothing, frequent use of hot tubs and saunas, and keeping laptops or heating pads on or near the testicles .
• Injuries to the testicles or scrotum .
• Low testosterone levels (hypogonadism) .
• Abuse of anabolic steroids .
• Sexual function problems : such as erectile dysfunction, anejaculation, premature ejaculation, or retrograde ejaculation.
• Undescended testicles .
• Having previously received radiation or chemotherapy for cancer .
• Absence of testicles due to surgery or birth .
• Previous surgical procedure to block the spermatic cord (vasectomy) .

How to diagnose infertility in women?

First, your doctor will ask you for a complete medical history and details about your sex life.

A woman's fertility depends on healthy ovulation. That means your brain sends hormonal signals to the ovary, which releases an egg, travels down the fallopian tube, and reaches the wall of the uterus. Fertility tests look for problems with these processes.

These tests can help identify problems or confirm that there is no such problem:

• Pelvic exam : The doctor performs this exam to check for structural problems or symptoms.
• Blood tests : Hormone levels can be checked to see if there is a hormonal imbalance and whether ovulation is occurring properly.
• Transvaginal ultrasound : The doctor inserts an ultrasound device into the vagina to check for problems with the reproductive system.
• Hysteroscopy : The doctor inserts a thin, lighted tube (hysteroscope) into the vagina and examines the uterus.
• Saline sonohysterogram (SIS) : The doctor fills your uterus with saline (sterilized salt water) and performs an ultrasound examination through your vagina.
• Sonohysterosalpingogram (HSG) : During the (SIS) test, the doctor fills the fallopian tubes with saline and air bubbles to check for blockages.
• X-ray hysterosalpingogram (HSG) : An X-ray image is taken of a dye injected through the fallopian tubes to check for blockages.
• Laparoscopy : The doctor makes a small incision in the abdomen and inserts a laparoscope (a thin tube with a camera) through it. This helps diagnose problems like endometriosis, uterine fibroids, and scar tissue.

How to diagnose male infertility?

Male infertility is usually diagnosed by looking at whether they are ejaculating healthy sperm. Many fertility tests look for problems with sperm.

These tests may help:

• Semen analysis : This checks for low sperm count and poor sperm motility. Some men may need to have a needle biopsy to take sperm from the testicles for testing.
• Blood tests : These can check thyroid and other hormone levels. Genetic blood tests look for chromosomal abnormalities.
• Scrotal ultrasound : An ultrasound of the scrotum can detect varicoceles or other testicular problems.

How is infertility treated?

Treatment for infertility depends largely on the cause and your expectations. Your age, how long you've been trying to have a baby, and your personal preferences will all play a role in deciding which treatment to use. Sometimes only one partner needs treatment, while other times both partners need treatment.

In many cases, women and couples with infertility have a high chance of having a baby. They can get help with things like medication, surgery, or assisted reproductive technology (ART). In many cases, making lifestyle changes or adjusting the frequency and timing of sexual intercourse can increase the chances of having a baby. Sometimes, more than one of these methods is used in combination.

Infertility treatment for women

Treatments for women include:

• Lifestyle changes : Losing or gaining weight, stopping smoking or drug use, and controlling other health conditions can increase your chances of having a baby.
• Medications : Fertility drugs stimulate the ovaries to release more eggs, which increases the chances of having a baby.
• Surgery : Surgery can be performed to open blocked fallopian tubes, remove polyps, fibroids, or scar tissue.

Doctors can also suggest ways to increase your chances of conceiving a child. For example:

• You can get an idea of ​​when you are ovulating by measuring your basal body temperature, using a fertility tracking app, and recording your cervical mucus.
• Using a home ovulation kit, available at a pharmacy or online, can help predict when ovulation will occur.

Infertility treatment for men

Treatments for men include:

• Medications : Medications can be given to increase testosterone or other hormone levels. There are also medications for erectile dysfunction that help keep the penis erect during sex.
• Surgery : Some men need surgery to open blockages in the tubes that carry sperm or to repair structural problems. Surgery for a varicocele can improve sperm health and increase the chances of conceiving a child.

What are the commonly used fertility treatments?

Some couples need extra help to have a baby through assisted reproductive technology (ART). ART is any fertility treatment in which a doctor manipulates sperm or eggs. To increase your chances of having a baby, you can take medication to stimulate ovulation before trying one of these methods.

• In vitro fertilization (IVF) : This involves taking eggs from your ovaries and combining them with sperm in a laboratory. The sperm then fertilizes the eggs. A doctor then transfers one to three of these fertilized eggs (embryos) into your uterus.
• Intracytoplasmic sperm injection (ICSI) : This procedure can be done during IVF. An embryologist injects a single sperm directly into an egg. One to three embryos are then transferred into the uterus.
• Intrauterine insemination (IUI): A doctor uses a long, thin tube to insert sperm directly into your uterus. IUI is sometimes called artificial insemination.
• Assisted hatching : A process that opens the outer layer of an embryo, making it easier for it to implant in the uterine wall.
• Third-party ART : Some couples use donor eggs, donor sperm, or donor embryos. Some couples need a gestational carrier or surrogate to carry the baby.

What are the possible complications of treatment?

Infertility treatments can cause complications such as:

• Increased risk of multiple births (twins, triplets, or more) : Multiple egg production and transfer of more than one embryo increases the risk of multiple pregnancies. Complications such as miscarriage, premature birth, low birth weight, neonatal death, and long-term health problems are common among women carrying multiples.
• Ovarian hyperstimulation syndrome (OHSS) : A condition in which the ovaries become painfully swollen due to fertility drugs. This can be serious and requires immediate medical attention.
• Ectopic pregnancy: There is a high risk of ectopic pregnancy during IVF treatment.
• Failed cycles : Failure to achieve pregnancy after completing a cycle of treatment.

Can infertility be cured?

Yes, but it depends on the cause. In between 85% and 90% of cases , a woman can conceive a child by treating infertility with lifestyle changes, medication, ART, or surgery.

Remember: Infertility is not the end of the world. With today's advanced medical science, many people have been able to find solutions to this problem.

What can I do to prevent infertility?

To protect your fertility, especially when trying to conceive, you can take these steps:

• Eat a well-balanced diet and maintain a healthy weight that suits you.
• Don't smoke, don't abuse drugs, and don't drink alcohol .
• Get treatment for sexually transmitted infections (STIs) .
• Limit exposure to environmental toxins .
• Stay physically active, but don't overdo it .
• Don't postpone having children until you are older .
• Consider fertility preservation procedures (egg or sperm freezing) .

What should I expect if I have infertility?

About 9 out of 10 couples who undergo fertility treatment will have children. The success rate varies depending on the cause of infertility, the couple's age, and other factors.

Infertility can be mentally, physically, financially, and psychologically overwhelming. Remember to take care of yourself and your partner throughout this process, and be patient . Infertility is not easy. So surround yourself with people who support you, or join an online support group. Sometimes, it can be very helpful to share your feelings with someone who understands what you are going through.

Is insurance coverage available for infertility treatment?

Health insurance policies vary, so you should always check with your insurance company. This may vary in Sri Lanka. However, for example, in countries like the United States, many insurance companies provide coverage for medically necessary procedures such as surgery to treat endometriosis and uterine fibroids. Some policies may cover fertility procedures such as ``IUI'', but may not cover ``In vitro fertilization'' or ``IVF''.

In some states in the US, there are laws that require employers to provide infertility coverage as part of their employees' health insurance policies. As of June 2022, the National Infertility Association (Resolve) states:

• Twenty states have passed insurance coverage laws for fertility; 14 of those laws include IVF coverage; and 12 states have fertility preservation laws for medically induced infertility (iatrogenic infertility).

While this information may not apply to Sri Lanka, it is important to be aware that such facilities are available in some parts of the world. Be sure to check if your insurance policy covers these things.

When should you seek help for infertility?

Women under the age of 35 who have been trying for a year and have not conceived should see a doctor. If you are between the ages of 35 and 39, you should seek help as soon as possible after six months of trying. If you are 40 or older, you should seek medical advice after less than six months of trying. Your chances of conceiving decrease with age . For example, a 25-year-old woman has a 25% to 30% chance of conceiving each menstrual cycle. By the time you are 40, that chance drops to less than 5% each cycle.

Regardless of gender, if you have a risk factor or medical condition that could affect your fertility, you should seek help immediately. If you know or suspect you have premature ovarian failure, severe endometriosis, or uterine/fallopian tube disease, get medical tests done right away.

Family doctors and gynecologists may recommend seeing a fertility specialist, urologist, or reproductive endocrinologist to diagnose and treat infertility.

What questions should I ask my doctor?

You can ask the doctor questions like these:

• Do I need to see a fertility specialist?
• Should I get tested to see if my partner and I both have fertility problems?
• Depending on our age, how soon should we get fertility tests?
• What is the best treatment for us?
• What is the success rate of the treatments?
• What are the side effects or risks of the treatments?
• Should I be aware of symptoms of complications?

A few more small questions...

Can Chlamydia cause infertility?

Chlamydia is a common sexually transmitted infection. If left untreated, chlamydia can cause pelvic inflammatory disease (PID). PID is an infection that can permanently damage your fallopian tubes, uterus, or ovaries. So, yes, chlamydia is a risk factor for infertility.

Can birth control methods cause infertility?

No. Studies have shown that using birth control does not harm your future fertility.

Is Endometriosis a cause of infertility?

Yes, endometriosis is a risk factor for infertility. Between 30% and 50% of women with endometriosis experience infertility.

Finally, take this into account (Take-Home Message)

The experience of infertility is challenging. It can be a huge burden for someone who dreams of starting or expanding a family. It can affect your relationships and mental health. In addition, infertility treatments can be expensive and financially stressful.

If you're still having trouble conceiving despite all your efforts, it might be time to see a doctor. They can determine if there's an underlying cause and talk to you about treatment options that might be right for you.

The most important thing is to not give up hope. Most couples eventually have children. Some turn to assisted reproductive technology, others adopt children. You too will find the path that works for you.

We wish you strength and courage on this journey!

` Infertility, fertility, pregnancy, reproductive health, IVF, IUI, women's health