The Evaluation of Infertility: Types, Causes, Diagnosis and Treatment

Infertility is a condition where the couple trying to get pregnant is unable to conceive even after a year of regular, unprotected intercourse. Couples that do not meet the criteria of the specified duration can also seek the advice of a medical practitioner to assess their fertility levels. The causes of infertility can span physical, hormonal, and environmental factors among males, females, or both.

Various conditions can cause infertility. Healthcare providers run a series of tests to diagnose infertility in couples. A general physical examination, assessment of medical history, hormonal profiles, ultrasound scans, and so on form the diagnosis to assess infertility.

Types of Infertility

Infertility evaluation starts with a general assessment of the patient’s medical history. Based on this, infertility is divided into two types.

Primary Infertility

It refers to couples who have never conceived previously and are not on any form of contraception.

Secondary Infertility

It indicates those couples who have previously had a successful pregnancy and are not able to conceive in the second attempt

The nature of infertility can be of three types depending on the couple

1. Male infertility - issues with the male reproductive system
2. Female infertility - issues with the female reproductive system
3. Unexplained infertility - when the definitive cause cannot be pointed out

Infertility Causes: What are The Main Reasons?

A complete examination of both partners involved can help diagnose and treat the cause of infertility from its root. Some common causes of infertility in males and females include the following:

1. Age - Age is a decisive factor in the reproductive potential of both males and females. For males, the age of over 40 can lead to a potential reduction in the quality of the sperm. For women, the age of over 35 can lead to a decrease in the quality and number of eggs.
2. Lifestyle factors - Exposure to chemicals, pesticides, sedentary lifestyle, smoking and consumption of alcohol affect fertility.
3. Medical history of surgery - Any form of surgery in the pelvic region and reproductive organs impacts the ability to conceive.
4. Genetic issues - Mutations in the Y chromosome, Klinefelter's syndrome, Fragile X syndrome, any chromosomal aberrations, single gene variants, microdeletions of genes and so on are also responsible for fertility issues.

What Causes of Infertility in Males?

For fertilization to take place, the male must contribute the sperm that fertilizes the female's egg. Defects in the production of sperm, abnormal shape or appearance of the sperm, disruptions to ejaculation, hormonal defects and so on can be a barrier to getting the partner pregnant. 

Hence, proper interventions can be decided for male infertility with the right diagnosis. Based on medical, past, and hormonal history, a fertility evaluation can be done. The main causes of male infertility include

1. Genetic disorders relating to cystic fibrosis, Y microdeletions, Congenital absence of the vas deferens
2. Obstructive disorders in the male reproductive system such as varicocele
3. Injury or surgery in the pelvic region or testicles 
4. Misuse of steroids and excessive consumption of drugs and alcohol disrupt the level of hormones in the body
5. Retrograde ejaculation (where the ejaculate is directed back to the bladder)
6. Any form of cancer in the reproductive system
7. Cryptorchidism (a congenital defect where the testis is undescended)
8. Exposure to chemicals and high heat from saunas or tanning beds can affect the testicular temperature and production of sperm

Infertility screening -Male and individual hormonal testing can further help in diagnosis of infertility in men. 

What Causes of Infertility in Females?

The type of examinations to evaluate female infertility are personalized on the basis of their age, regularity of the menstrual cycle and previous medical history. Some of the common signs of infertility in women include

1. Irregularities in the menstrual cycle 
2. Genetic anomalies such as fragile X syndrome and sickle cell anaemia 
3. Pelvic inflammatory diseases 
4. Ovarian insufficiency - less number of follicles in the ovary 
5. Hormonal imbalance or pituitary gland disorders
6. Any blockage or polyp in the fallopian tubes 
7. Endometriosis - the growth of the endometrium outside the uterus 
8. Fibroids or myomas in the uterus 
9. Anti-sperm antibodies that can affect the sperm entering the uterus 
10. Polycystic ovarian syndrome, cysts and ovarian anomalies 
11. Ovarian cancer or effects of chemotherapy 

Diagnosis of infertility

Based on the tests conducted for the male and the female partner, the medical practitioner concludes the type of diagnosis to be given. In the case of male infertility, the type of tests conducted may include

1. Blood tests - These determine the hormonal levels of Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) and testosterone.
2. Semen analysis - A routine semen analysis is often the first step to evaluate the characteristics of semen. Qualities such as the total sperm count, volume of semen, and sperm morphology are noted.
3. Karyotyping - This is a genetic test to check for suspected chromosomal abnormalities that may be passed on to the child.
4. Chromosomal array - This technique is superior to karyotyping in terms of faster results and less issues with no-results.
5. Ultrasound or testicular biopsy - It involves removing a little portion of the testicular tissue through a tiny cut in the scrotum.

In the female partner, the healthcare provider may start with some basal investigations such as

1. Blood tests - to record the oestrogen, FSH and LH levels, and a progesterone test
2. Transvaginal ultrasound - to check the volume of the ovary, Antral follicle count, anatomy of the uterus, and any anomalies
3. Hysterosalpingogram - to check if the fallopian tubes are free from blockages or if polyps or fibroids are present
4. Laparoscopy - recommended in some cases to detect damage and blockage of pelvic structures, ovaries, uterus and fallopian tubes 

Treatment for Male and Female Infertility

A wide range of treatment options is available for both males and females. Based on the diagnosis, the type of treatment is personalized such that the best results are achieved. In some cases, fertility drugs or antioxidants are recommended to boost the health of the reproductive system. In others, surgery is recommended in females to remove any blockages in the ovaries or fallopian tubes and in men to treat conditions such as varicocele.

If the tests detect a higher severity of infertility, the couple may require advanced treatment. It may involve intrauterine insemination (where a processed semen sample is inserted into the uterus). In some cases, vitro fertilisation (IVF, where the egg and sperm are cultured and fertilized in the lab) and intra cytoplasmic sperm injection (ICSI, where a single, morphologically normal sperm is selected to be injected in the oocyte and grown in the lab) may be recommended. 

Some couples may even opt for third-party reproductive options such as using donor semen, donor egg, or choosing a gestational carrier or surrogate. 

Summary

Hence, a thorough evaluation is needed to diagnose and detect the root cause and treat infertility effectively. It's best to consult health providers for a fertility assessment for routine health diagnosis or concerns related to infertility and the health of the reproductive system.