Living with Infertility: What You Need to Know

At Female Health & Fertility, much of our focus is on reproductive health, looking at how your health can affect your chances of getting pregnant. And for many, these health issues are manageable and don’t stop people from conceiving. But what about those who find they are doing all they can but they are unable to?

In this article, we will delve into the world of infertility, how to get tested for it, and options for starting a family. 

What is infertility?

There is a misconception that infertility is something that affects very few of the population and it is often seen as a problem primarily affecting female reproductive organs. However, under the current WHO definition, infertility is a “disease of the male or female reproductive system defined by a failure to achieve pregnancy after 12 months”.  

The NHS has defined the most common causes of infertility are a lack of menstrual cycle affecting the release of eggs, blockages to the fallopian tubes, and poor semen quality. However, studies have shown there can also be a direct correlation between stress and infertility. What is that old adage; the more you try to get pregnant and stress about it, the less likely it will happen?

WHO states that infertility affects 1 in 6 (about 17.5%) of the global adult population at any time, however, depending on what causes your infertility, this doesn’t have to mean having a child is off the books for you in your future. There are multiple causes of infertility and different types of treatment to help people overcome it and have the family they want.  

What causes infertility? 

As stated above, medical experts have found there are multiple causes of infertility in men and women, including a lack of a menstrual cycle, poor semen quality, stress, and blockages in the fallopian tubes. Below we have set out some of the most common causes of infertility that people can face. 

For women, some of the main causes of infertility include:

• Ovulation disorders: Endometriosis and polycystic ovarian syndrome (PCOS) are both known for causing infertility in women
• Poor egg quality
• Hormone imbalances 
• Fallopian tube problems: sometimes, the fallopian tubes can develop diseases or blockages, making it hard for the egg to be fertilized
• Anatomical factors: fibroids and uterine abnormalities can impact the uterine cavity, causing problems with fertility
• Age: our fertility naturally decreases as we get older 
• Abnormal cervical mucus: this hinders the passage of sperm to the uterus and fallopian tubes

For male infertility, some of the leading causes can be:  

• Sperm quality: this can be brought on by several issues, including taking drugs, stress, alcohol, smoking, and poor diet. As well as this the body may produce antibodies that attack the sperm
• Varicocele: A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility
• Hormone imbalances
• Tumours: cancerous and benign tours, depending on where they are, can have an impact on blood flow, the release of hormones, and even sperm count and quality
• Blockages to the epididymis this can prevent sperm from being ejaculated normally
• Undescended testicles can also impact fertility in men

In some cases, your doctor may even find that you suffer from none of the above; this is then called unexplained infertility, or you may find it is a mixture of both male and female fertility problems causing you to be infertile. When you go to the doctors, they will test you to see what could be the cause of your infertility and refer you for treatment. 

How to get tested for infertility

If you and your partner have been trying to conceive for over a year and are finding it hard, you may wish to speak with your GP/doctor about your options, and they may refer you to fertility clinics near you or to speak to a specialist gynecologist or reproductive endocrinologist (sometimes referred to as an RE, this is different to a obstetrician/gynecologist (OB/GYN) physician). At these clinics, you may undergo a series of different tests to understand what may be causing your infertility before you go on to seek treatment options. 

The main things your doctor is likely to look at are sperm count, ovulation problems like PCOS or endometriosis, and any fallopian issues that could be causing infertility. However, there are a range of different tests for infertility for men and women that you may be offered, including: 

• Semen analysis: where your doctor will look at samples of your/your partner’s semen to understand if the quality is poor 
• Hormone testing: You may get a blood test to check your levels of testosterone and estrogen and even pituitary hormones, which control the processes involved with having a baby
• Genetic testing: This may be done to find out whether a genetic defect is the cause of infertility
• Testicular biopsy: this is where the doctor removes a small amount of testicular tissue, although this is rarely done outside of instances of IVF to collect sperm
• Ovulation testing: This is where you undergo a series of blood tests to measure the amount of hormones and check if you are ovulating
• Imaging: such as an MRI or ultrasound – this is done to check your uterus, scrotum or reproductive organs, and even glands to make sure there are no blockages, cancer, or other tumors to see if there are other underlying causes for infertility 
• Thyroid function test: This is to check if your body produces the correct amount of thyroid hormones, as too much or too little can impact infertility
• Hysterosalpingography: This checks the condition of the uterus and fallopian tubes. It also looks for blockages or other problems. A special dye is injected into the uterus, and an X-ray is taken
• Ovarian reserve testing: This looks at how many eggs you have or ovulation and is often done with hormone testing during the early stages of a menstrual cycle

Once it has been determined where the causes lie, your GP doctor or the specialist fertility clinic you have attended will look at the treatments they can offer you. There are three main types of infertility treatments that we will discuss below.

Are there any infertility treatments? 

Getting an infertility diagnosis can feel absolute. However, that is not necessarily the case. Currently, there are three main ways that you can be treated for infertility within the medical world. These are medication, surgery, and assisted conception.

Medicines: 

There are a few different options available but two main types of medicine offered are clomifene and tamoxifen. These medications are given to help encourage the monthly release of an egg in women who do not ovulate regularly or cannot ovulate at all. 

Alternatively, if you have PCOS, then you may be offered metformin to stimulate ovulation. Interestingly, this has been seen to help improve fertility in men as well so it may be offered in cases of male fertility. Finally, for hormone problems, gonadotrophin may be prescribed, which releases hormone and dopamine agonists.  

The aim of the medicines is to help the body trigger ovulation and become fertile without the need for more intrusive forms of treatments. However, in other cases, surgery may be prescribed to help.  

Types of surgery for infertility: 

For women with PCOS, submucosal fibroids or endometriosis, laparoscopic surgery or laparoscopic drilling may be carried out to destroy or remove the fluid-filled sacs in the uterus or even heat-filled lasers to destroy part of the ovary. Other forms of surgery may include fallopian tube surgery to unblock or remove mucus to help the egg and sperm move through them. 

For male infertility you may receive a sperm extraction, which is usually to correct things when the epididymis becomes blocked, preventing sperm from being ejaculated normally.  

Assisted conception: 

And finally, depending on whether surgery or medication is suitable or works, you may receive the option of assisted conception. Although IVF is the main one that we all know about, there are a few other procedures you can receive, such as:

• ICSI: this is similar to IVF and is used for male infertility – this is where a single sperm is inserted into a retrieved egg
• IUI: this is where the fertility clinic will collect sperm from the male partner, remove the seminal fluid, and insert the sperm directly into the uterine cavity
• Assisted Hatching: This technique makes it easier for embryos to “hatch” out of certain layers of protein before implanting in the woman’s uterus
• GIFT: The harvested egg and sperm are implanted into the fallopian tube for fertilization
• ZIST: This is the same as GIFT however, the egg is fertilized before transfer to the fallopian tube in a Zygote intrafallopian transfer

Studies have found that assisted conception like IVF can be one of the best treatments for infertility, however, health and age can be huge deciding factors on what types of treatment work best. 

Before we conclude, as well as looking at the types of treatment you could potentially get for infertility, let’s look at the alternative options available for living with infertility. In the final section, we have put together three ways that you can still plan a future with a family, no matter your fertility diagnosis.

Living with infertility: what other options are there? 

Although getting an infertility diagnosis can be devastating, it is important to understand it doesn’t have to mean the end of your journey if having a child is a part of your and/or your partner’s dreams for the future.

Although treatment is available, it can have side effects or might be too intrusive and painful for you and/or your partner to go through with. So, we have briefly listed some of the alternative options for living with infertility if you are considering an alternative route to having a child. 

• Adoption 
• Fostering
• Surrogacy 
• Sperm, egg, or embryo donation 

However, choosing the right option for you can be a tough one, so always speak to your partner and a doctor and gain medical and legal advice to understand your rights as a parent in your country if you choose the surrogacy or donor options.  

Conclusion

Science has come a long way and an infertility diagnosis doesn’t have to mean being childless. However, it is important to understand that the alternative options may not result in a child, and they may be intensive, intrusive, and painful procedures for both male and female infertility. If you are in a relationship, it is important to talk with your partner about which one you would be most interested in to ensure you are on the same page. 

As well as this, when battling infertility, it is beneficial to have a strong support system around you. From joining groups of people in the same situation as you to looking at therapy, surrounding yourself with people who can empathise with what you are going through is important. 

References: 

Armstrong, S., & Akande, V. (2013). What is the best treatment option for infertile women aged 40 and over?. Journal of assisted reproduction and genetics, 30(5), 667–671. doi.org/10.1007/s10815-013-9980-6 

Dr. Jhutty S. (2024) Adoption vs Egg Donation. Family by CO. cofertility.com/family-learn/adoption-vs-egg-donation 

Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in clinical neuroscience, 20(1), 41–47. doi.org/10.31887/DCNS.2018.20.1/klrooney

WHO. (2023). 1 in 6 people globally is affected by infertility. WHO. .who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility 

Winston, R., & Margara, R. (1987). Effectiveness of treatment for infertility. British medical journal (Clinical research ed.), 295(6598), 608–610. doi.org/10.1136/bmj.295.6598.608-b