Infertility

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Overview

Infertility is the inability to conceive after having unprotected intercourse for 1 year at the time of ovulation. It occurs in about 10%–15% of couples and can result from physiological problems in either partner. Infertility also may result from unknown causes.

Couples who are unable to conceive should have a complete medical examination by a reproductive endocrinologist to determine the cause of the infertility. In men, this includes a physical examination, laboratory tests, and a semen analysis. In women, this involves a physical examination (including a full gynecological exam) and appropriate laboratory tests.

In men, infertility generally is caused by a lack of sperm in the semen (azoospermia), deformed or structurally abnormal sperm, sperm that lack the ability to reach and fertilize a female egg (immotile sperm), genetic disorders, endocrine disorders, or dilation of the veins that bring blood to the testes (varicocele).

Common causes of infertility in women include luteal-phase deficiency (resulting from abnormal progesterone action or production), lack of menstruation (amenorrhea), irregular menstruation (caused by conditions such as hypothyroidism), hyperprolactinemia, polycystic ovary disease, abnormalities in cervical mucus or in the uterine cavity, disorders of the fallopian tubes, and autoimmune disorders.

Women who have markers for MTHFR, hyperhomocystenemia, lupus-like anticoagulant, PAI-1 insufficiency, Factor 11, Factor V Leiden, or activated natural killer cells are all prone to either infertility or repeated pregnancy loss. Ultimately, these disorders cause inappropriate blood clotting and prevent appropriate blood flow to the placenta, resulting in intra-uterine growth retardation, intra-uterine fetal death, pre-eclampsia, and eclampsia. Activated natural killer cells spray tumor necrosis factor on embryos, thereby killing them.

All of these disorders are treatable with blood thinners (e.g., heparin, lovenox) and/or immunosuppressive therapy. Acupuncture and herbal medicine have also been show to help regulate (or in this type of scenario, down-regulate) the immune system, thereby facilitating a greater opportunity for a full-term pregnancy.

Conventional medical treatment for infertility focuses on identifying the primary cause for the condition and correcting it. Treatment options include surgical intervention and drug therapy. Men diagnosed with varicocele may be treated surgically, although varicocelectomy only yields improvement in 50% of cases. Women with polycystic ovary disease may be treated with drugs such as clomiphene citrate (Clomid®, Serophene®) and glucophage. Glucophage has been shown to sensitize insulin and help PCOS patients who are obese to lose weight. It has been shown that a loss of 10% of body fat can increase fertility outcomes significantly. Additionally, glucophage can reduce LH and androgen levels, which can help preserve and improve ovarian function.

There are many assisted reproduction techniques available as well, including the following:

• Artificial insemination (semen is implanted in the woman)
• In vitro fertilization (an egg is fertilized outside the woman's body to produce an embryo that is implanted in the uterus)
• Direct injection of sperm into an egg
• Transfer of semen and eggs into a woman's distal fallopian tubes so fertilization can occur

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