Common Infertility Treatments for Men and Women

Fertility is an essential aspect of reproductive health. After all, it is necessary for human reproduction and the continuation of the species—but there are many different terms under the larger umbrella of fertility. Understanding it can be like learning a new language.

Fertility is the natural ability of an individual to conceive and produce offspring. In males, fertility involves producing and releasing healthy sperm capable of fertilizing an egg. In females, fertility involves the production of viable eggs and the ability of the uterus to support the growth and development of a fertilized egg.

Various factors, including age, genetics, lifestyle choices, underlying medical conditions and environmental factors, influence fertility.

On the other hand, subfertility is a condition in which an individual or couple has reduced fertility or a decreased ability to conceive, despite engaging in regular unprotected sexual intercourse. It simply means that you may be less fertile than others, or that it may take longer to achieve a successful pregnancy.

Subfertility is sometimes used interchangeably with infertility, but the terms are different—infertility typically refers to a complete inability to conceive or carry a pregnancy to term. The Centers for Disease Control and Prevention (CDC) defines infertility as "not being able to get pregnant (conceive) after one year (or longer) of unprotected sex."

Who does infertility affect?

Infertility can affect anyone, regardless of age or gender, said Laura Weppler, R.N., a fertility coach and the head of care management at Atlanta-based Future Family.

"It affects both women and men equally (approximately 35 percent of infertility is female-related and 35 percent male-related)," Weppler said. "About 40 percent of infertility is considered unexplained, with no clear diagnosis."

The American Society for Reproductive Medicine highlights three key facts regarding infertility:

• It is not merely an inconvenience
• It's not just a woman's problem
• It is not inevitable

Infertility affects approximately 6 percent of married couples in the United States, said Himali Maniar Patel, M.D., an India-based OB-GYN at Nisha Women's Hospital & IVF Centre.

"Also, infertility rates are higher among African American, Hispanic/Latino and Native American couples as compared to Caucasian couples," Maniar said.

There are many reasons why infertility can occur. None of them are your fault. Some common reasons include the following:

• Fertility declines with age, especially after age 35 in women and age 40 in men.
• Hormonal imbalances such as polycystic ovary syndrome (PCOS) or thyroid disorders can disrupt ovulation and fertility. In men, hormonal issues such as low testosterone can impact fertility.
• Structural issues in the reproductive organs, such as blocked fallopian tubes or uterine fibroids in women or undescended testicles or blocked vas deferens in men, can interfere with conception.
• Male factor infertility is often due to low sperm count, poor sperm motility or abnormal sperm morphology.
• Lifestyle factors, such as obesity, smoking, alcohol consumption and drug use, can all affect fertility.
• Underlying medical conditions, such as endometriosis, pelvic inflammatory disease (PID) or diabetes, can affect fertility.
• Environmental factors, including exposure to toxins, radiation or certain chemicals, can also impact fertility.

There can oftentimes be no explanation for infertility. In a significant portion of couples attempting to conceive, around 5 percent to 10 percent, standard tests show no abnormalities, and the cause of infertility remains unknown. In a larger percentage of couples, minor irregularities are detected, but these are not significant enough to explain infertility. This is called unexplained infertility.

It's important to note that infertility is a complex issue and often involves multiple factors. Therefore, it's essential to consult with a medical professional to determine the underlying cause and develop an appropriate treatment plan.

When should you see a specialist about infertility?

Age plays a major role in female infertility.

"It also plays a role in male fertility but is not nearly as significant," Weppler said.

As a woman ages, she said, the number of eggs she has remaining will decline. In most cases, this decline begins to occur more rapidly at age 35. Certain medical conditions and lifestyle factors (i.e., smoking) may cause this decline to occur earlier on. Genetic predispositions (such as Turner Syndrome) may also contribute to an early decline.

Recommendations are that couples in which the woman is under 35 try naturally for about a year before seeking help, Weppler said. Alternatively, in couples in which the woman is over 35, assistance is recommended after six months of trying to conceive naturally without success. There may be instances in which a couple should seek help sooner than the recommended time frame.

"It's always best to discuss concerns with a healthcare provider if someone thinks they need fertility assistance sooner than the above recommended time frames," Weppler said.

Couples trying to conceive should seek medical attention without delay if they experience any of the following signs or symptoms, as they may increase the risk of infertility:

In women:

• Irregular menstrual cycles
• Absence of periods
• Endometriosis
• A history of pelvic inflammatory disease
• Known or suspected uterine or tubal disease
• A history of multiple miscarriages
• Genetic or acquired conditions that lead to reduced ovarian reserve, such as chemotherapy or radiation therapy

In men:

• A history of testicular trauma
• Prior hernia surgery
• Prior use of chemotherapy
• A family history of cystic fibrosis
• A history of infertility with a previous partner
• Sexual dysfunction

Prompt medical attention can help identify and treat underlying medical conditions that may impact fertility, increasing the chances of successful conception.

What happens during fertility testing?

There are several tests available to both men and women, depending on the suspected cause of infertility. Maniar said that for women, these include the following:

• Ovarian reserve testing that measures the quantity and quality of eggs
• Hormonal analysis for any underlying conditions, such as PCOS or endometriosis
• Genetic testing for any chromosomal abnormalities
• Imaging tests, such as MRI or ultrasounds
• Laparoscopy—a surgical procedure to visualize the pelvic organs

For men, Maniar said that fertility testing includes the following:

• Semen analysis
• Hormone testing for testosterone levels
• Genetic testing for any chromosomal abnormalities
• Imaging tests such as MRI or ultrasounds
• Physical examination

By performing these tests, medical professionals can identify any underlying causes of infertility and develop an appropriate treatment plan. For some people, assisted reproductive technology (ART) could help them build a family.

What is Assisted reproductive technology?

Assisted reproductive technology involves handling eggs, sperm and/or embryos to assist an individual to get pregnant, Weppler said.

ART encompasses fertility treatments such as:

• In vitro fertilization (IVF). IVF involves fertilizing an egg with sperm outside of the body in a laboratory dish. Once fertilization occurs, the resulting embryo is transferred to the uterus.
• Intracytoplasmic sperm injection (ICSI). This involves injecting a single sperm directly into an egg in the laboratory dish to achieve fertilization.
• Gamete intrafallopian transfer (GIFT). This involves placing eggs and sperm into the fallopian tube, allowing fertilization to occur naturally inside the body.
• Zygote intrafallopian transfer (ZIFT). This involves transferring fertilized eggs (zygotes) to the fallopian tube.
• Donor eggs or sperm. If a woman is unable to produce viable eggs or a man has low sperm count or quality, donated eggs or sperm can be used to achieve fertilization.
• Surrogacy. This involves using a surrogate mother to carry a pregnancy for a couple or individual who is unable to carry a pregnancy themselves.
• Preimplantation genetic testing (PGT). This involves testing embryos for genetic disorders or chromosomal abnormalities before they are transferred to the uterus.

The choice of ART depends on various factors, including the underlying cause of infertility and personal preferences. The treatment plan is customized for each individual or couple, and the success rates can vary depending on different factors.

There are certain situations when ART may not be suitable, Maniar said—if the cause of infertility is unknown or untreatable or if there are any serious health issues that could complicate a pregnancy. Women over the age of 45 may not be viable candidates for IVF due to age-related decline in egg quality and quantity, Weppler said.

Conversely, they may be a good candidate for egg donation.

ART can be costly and may not be available in all countries or locations.

"It is important to discuss these issues in detail with your fertility specialist before deciding whether or not to pursue fertility treatments," Maniar said.

Everyone's fertility and family-building journeys are different. There are many options to explore. Make sure you seek support, not just medically but also emotionally, as it can be a long and complex journey for men, women and couples.