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.
Infertility is common, affecting as many as 1 in 6 individuals in their lifetime. 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.
What are the causes of infertility?
One of the easiest ways to think about how to evaluate infertility is to consider the various parts of human anatomy that are required to successfully make a baby and 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.
In cases such as polycystic ovary syndrome (PCOS), insufficient body weight, or over-exercise, for example, anovulatory infertility can occur, which means that a woman is not releasing an egg.
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 eggs can be the primary issue causing infertility.
Tubal Factor Infertility
The egg that’s released during ovulation has to be released into the fallopian tube and transported through 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.
This causes infertility because the sperm cannot reach the egg due to the fallopian tube being blocked and the egg cannot be transported our of the fallopian tub into the uterus where an embryo would need to implant to achieve pregnancy.
Cervical or Uterine Factor Infertility
The cervix needs to allow sperm to enter the uterus to reach the fallopian tube to fertilize an egg. And the uterus is 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 a male partner, the brain serves a similar function in stimulating normal testicular sperm production.
Various issues in sperm production can lead to low sperm concentration, sperm motility (swimming ability), and/or sperm 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 hormones are checked via bloodwork to check levels of reproductive hormones that are regulated by the brain.
There’s also some additional testing involved for both female and male partners.
Female Infertility Testing
For females, follicle stimulating hormone (FSH) and luteinizing hormone (LH) are the main drivers of egg development.
When FSH or LH are high, it can indicate a low egg supply, known as diminished ovarian reserve or DOR.
When FSH or LH 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:
- A transvaginal ultrasound to visualize the ovaries, approximate egg quantity, and/or evaluate the uterine lining
- A saline sonogram in which sterile water is used to visualize the uterus
- A hysterosalpingogram (HSG), where a radio-opaque dye is used to see via X-ray whether there are blockages of the fallopian tubes. If dye comes out of both ends of the tubes, this means your tubes are clear and not blocked
- A blood test measuring Anti-Mullerian hormone (AMH), a hormone secreted by the follicles that tells us the overall amount of eggs a woman has, referred to ovarian reserve
Male Infertility Testing
A male fertility workup primarily involves a 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 of sperm per mL)
- Motility (swimming ability of sperm)
- Morphology (shape of sperm)
If sperm count is low, this can affect fertility. If motility is low, then it may be difficult for the sperm to successfully reach an egg during ovulation. If the morphology is poor meaning that the sperm head, neck, and/or tail are not normal, this can affect success rates as well.
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. However, donor gametes, egg or sperm, may be needed for patients with premature menopause or very poor egg or sperm quality.
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 procedure to extract the 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 dedicated to making difference in your comfort and confidence with those nightly injections.
If you're starting the fertility journey and need support, book 1:1 with one of our fertility nurses who can answer questions, guide you through the process, and help you through your fertility injections seamlessly. We're here to be your fertility resource!
You can check out what to expect during a fertility consult with our Dandi nursing team to learn more.
