At Dandi, we talk so much about the infertility community and how important it is to feel supported on your journey to growing your family. But what exactly is infertility? Here, we’ll dive into the official  definition of infertility, as well as initial testing for both female and male partners, diagnosis of this very common disease, and what happens from there. Let’s go…

What is infertility?

The American Society of Reproductive Medicine (ASRM) defines infertility as a “disease, condition, or status” characterized by the inability to achieve a successful pregnancy based on medical history, sexual or reproductive history, age, physical findings, diagnostic findings, or any combination of these factors.” 

This includes the potential need for donor sperm or egg (also known as third-party reproduction) to achieve a successful pregnancy as an individual or couple. 

1 in 6 are affected by infertility.

Anyone can see a physician for basic fertility testing, but it’s strongly recommended that women under 35 with regular menstrual cycles who have tried to conceive for one year get evaluated; if you’re older than 35, get a workup after six months of trying to conceive. Infertility is common, affecting as many as 1 in 6 individuals in their lifetime.

What are the causes of infertility?

One of the easiest ways to think about how to evaluate infertility is to think about the various parts of human anatomy that are required to successfully make a baby, and then to understand what happens when that organ doesn’t function properly. 

Ovary or Egg Issues

Quick refresher: the brain is involved in stimulating a woman’s ovaries to mature and release an egg every month.

But if this isn’t happening normally—in cases such as polycystic ovary syndrome [PCOS], insufficient body weight, over-exercise, etc—then anovulatory (lack of ovulation) infertility can occur.

The brain is acting on the ovary. If there aren’t enough eggs in the ovaries (menopause), or if the eggs are not genetically normal (typically due to advancing female age), then the ovary and its eggs can be the primary issue. 

Tubal Issues

The egg that’s released then has to be collected by the fallopian tube and transported by the tube toward the uterus. If the fallopian tubes are blocked, whether through prior inflammation or infection, then this results in what we call tubal factory infertility.

Cervical or Uterine Issues

Lastly, the cervix and uterus are the means by which sperm travel up into the fallopian tube, and are the place where the embryo needs to implant and develop. The endometrium (lining of the uterus) must be receptive to the embryo, but many things can interfere with this process such as uterine fibroids, infection, inflammation, and polyps.

Male Factor Infertility

For the male patient, the brain serves a similar function in stimulating normal testicular sperm production. Rarely, the brain doesn’ send normal signals for spermatogenesis (sperm creation) to occur. But various issues in sperm production can lead to low sperm concentration, motility (swimming ability), or morphology (shape). 

Sperm also needs to be able to travel successfully through the male genetical tract and be released normally upon ejaculation. Any sort of obstruction to this process can result in male factor infertility (MFI). 

How is infertility diagnosed? 

In an initial fertility workup, both female and male brains are checked via bloodwork to check levels of reproductive hormones that originate in the brain. There’s also some additional testing involved for both female and male partners.

Infertility Testing

Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are the main drivers of egg development from the female brain.

When these values are high, it can indicate a weaker egg supply, known as diminished ovarian reserve or DOR.

When values are low, we may consider other issues related to diet, exercise, and stress levels.

As part of an initial fertility workup for women, a doctor may perform the following:

  • A transvaginal ultrasound to visualize the ovaries and approximate egg quantity and/or evaluate any potential issues with the uterine lining
  • A saline sonogram, where sterile water is placed into the uterus to evaluate the uterus
  • A hysterosalpingogram (HSG), where a radio-opaque dye is placed into the cervix and an X-ray is performed. If dye comes out of both ends of the tubes, this means your tubes are clear and not blocked
  • A blood test to determine your Anti-Mullerian hormone (AMH), a hormone secreted by the follicles that tells us the overall amount of eggs in the ovary

A male fertility workup includes semen analysis, where a sperm sample is produced via masturbation. The male partner’s sperm will be checked for several parameters, which all contribute to our understanding of male reproductive potential. 

Semen Analysis checks for:

  • Volume
  • Sperm concentration (amount)
  • Motility (swimming ability)
  • Morphology (shape) 

What happens at an initial fertility consult?

After an initial workup, you’ll typically meet with your reproductive endocrinologist (fertility doctor) to craft a customized treatment plan based on the testing results and your family-building goals.

Luckily, nowadays almost all of the diagnoses can be treated in some form, but donor gametes, egg or sperm, will be required if you’re in premature menopause or if egg or sperm quality is severely diminished. 

Some cases can be solved simply through lifestyle modification, oral medication, or insemination (washing sperm and placing it directly through the cervix into the uterus, also called IUI), but the big gun of fertility treatment is IVF (in vitro fertilization), an invasive process that involves daily injections to recruit eggs to grow, a surgical procedure to extract those eggs, and then transfer of an embryo whose growth was fostered in the lab environment. 

These treatments typically involve daily injections for several weeks—and it’s where Dandi is posed to make a difference in patient’s comfort, confidence, and compliance with those nightly injections. 

Questions? Talk to a Registered Fertility Nurse.

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