Infertility affects between 10% to 15% of couples within the reproductive years of their life. It can be the source of significant emotional stress and strain in interpersonal relationships as well as social stigma in certain countries. However, infertility is not “incurable”. With proper treatment and management, most cases of infertility can be successfully “cured” depending on the underlying cause and a host of other factors.
How To Spot Infertility
It is important to understand that infertility cannot be spotted by certain signs and symptoms as is the case with other medical conditions. Infertility is defined as the difficulty in falling pregnant after one year of unprotected intercourse. There is no specific guideline for the number of times intercourse is necessary but it should ideally be within the’fertile window’, the days when a woman is most fertile in the course of the menstrual cycle.
Contrary to popular belief, pregnancy will not always occur with a single episode of unprotected sexual contact. This is not an indictor of a fertility problem. However, if repeated intercourse particularly during the fertile window period does not yield the desired effects after one year then it needs to be investigated further. Fertility testing is dependant on age and medical history as well as the duration that a couple has tried to fall pregnant.
Why Can We Not Fall Pregnant?
The reasons for infertility varies among males and females. This may be caused by a host of medical conditions due to a range of different abnormalities. Some may be due to an anatomical problem. Others may be due to hormonal disorders, medication and it may even be linked to psychological factors at times.
Read more on fertility hormones.
For women the problem usually arises with:
- Lack of ovulation (release of an egg cell from the ovary)
- Uterine problems that hamper implantation.
- Blockage of a fallopian tube that prevents contact between the sperm and egg cells.
For men, the problem is usually linked to:
- Insufficient sperm cell production.
- Unhealthy sperm that are non-functional and/or unable to move properly.
- Blockage of sperm cells from reaching the semen.
Other factors like premature ejaculation or erectile dysfunction can also contribute to male infertility, however, this usually impacts on the act of intercourse rather than on the sperm’s ability to fertilize an egg cell.
Signs of Infertility In Women
As mentioned, there may be no specific signs and symptoms indicative of a fertility problem. Many couples only discover the problem after failing to fall pregnant despite repeatedly trying to do so. However, in women there may be some indication that a fertility problem is more likely to occur.
No Menses (Absent Periods)
The lack of menstrution (amenorrhea) is a very likely sign of infertility. It is usually associated with a lack of ovulation (anovulation). However, ovulation can still be absent in women who menstruate. Amenorrhea can be primary (when it has never occurred despite reaching pubertal age) or secondary (when it suddenly stops for more than 3 cycles) which can be due to various conditions, including pregnancy.
Abnormal Length of Menstrual Cyle
If the menstrual cycle is too long or too short then this can be an indication of an underlying fertiliting problem. This duration refers to the first day of the previous menstruation (period) up to and including the last day before the next period commences. The average duration is 28 days, and a few days less or more is not considered abnormal. However, if this duration is shorter than 21 days or longer than 35 days then infertility is more likely.
Read more on menstrual cycle.
Painful periods may not be a direct indiction of a fertility problem but it is a common symptom of several conditions that can lead to infertility. This includes endometriosis, pelvic inflammatory disease (PID), uterine fibroids and sometimes polycystic ovarian syndrome (PCOS). While some discomfort may be experienced during ovulation and menstruation (periods), this should not be pain and particularly severe pain.
As is the case with period pain, there may be there other signs and symptoms of various conditions that contribute to infertility. However, the presence of these signs and symptoms does not mean that every woman will experience fertility problems.
- Growth of thick hair on the face and chest
- Thinning or loss of scalp hair
- Reduced libido
- Weight gain
Signs of Infertility in Men
Overt signs and symptoms of conditions that may cause infertility in men may be absent or vague. Often there is little to no indication of a fertility problem until there is difficulty conceiving and both partners are tested.
Low Sperm Count
This is one of the more obvious signs of a potential fertility problem in men. A large number of sperm are required although only one sperm cell ovulates the egg cell. However, most sperm cells do not survive the passage through the female reproductive tract to reach this egg cell. A total sperm count less than 39 million per ejaculate or 15 million sperm cells per milliliter (mL) may be a problem.
Loss of Facial or Body Hair
Testosterone is responsible for secondary sexual characteristics like thick facial and body hair in men. This hormone is also necessary for stimulating sperm cell production in the testes. When the testosterone levels are low then sperm cell production is impaired. This may only be detected with a sperm cell count and blood test. However, low testosterone levels also affects the secondary sexual characteristics like facial and body hair.
A host of testicle symptoms may be indicative of conditions that can contribute to male infertility. This includes painful, swollen and small testes, as well a lump on one or both testicles. It may be a result of various diseases and disorders such as orchitis, epididymitis, hypogonadism, testicular torsion and testicular cancer. With these conditions, sperm production may be lowered or abnormal and the passage of sperm cells into the semen may be restricted.
Enlarged breasts in males is known as gynecomastia. Sometimes the conditions that cause gynecomastia can also have an effect on sperm production, mainly througha hormonal imbalance. In other words the testosterone levels may be lower than normal and this can affect sperm production. This does not occur with every case of gynecomastia and may not be a cause of concern in terms of infertility if it happens after birth, at the time of puberty or in older men.
These other signs and symptoms may occur with conditions that cause male infertility. However, as with testicular symptoms and breast enlargement, these other signs and symptoms in men may not always indicate a fertility problem.
- Loss of libido
- Erectile dysfunction
- Painful urination
- Blood in the semen