Infertility Overview Tips

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How do hormones impact infertility?

Hormonal Causes of Infertility

Infertility is a complex issue that has many different factors requiring considering in both diagnosis and treatment. Structural, mechanical, external and internal causes all play a role in infertility. One of the most common internal contributors to infertility is abnormal hormone controls.

There are five (5) primary hormones involved with fertility, all of which are found in both men and women. These hormones are:

  • Gonadotropin-releasing Hormone (GnRH)
  • Follicle stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)
  • Estrogen
  • Testosterone
Gonadotropin-releasing hormone stimulates the release of FSH and LH. Without GnRH, we cannot become fertile, because FSH and LH govern the production of "germ" cells in both men and women. These "germ" cells are the immature precursors to sperm and ova.

Estrogen and Testosterone aid in developing the gender-appropriate reproductive parts, control GnRH production, and promote development of the germ cells into mature sperm and ova.

Other hormones play smaller roles in reproduction, such as prolactin, which is produced by the pituitary and which inhibits GnRH production, resulting in decreased fertility.

Since these hormones work so closely and precisely in the reproductive cycles of both men and women, small variations in hormone levels can significantly impact fertility, including: immature sperm cells, immature ova, failure of the uterine lining to get ready for ova implantation after fertilization, and suppressed libido.

Tests for hormone levels may be performed by your Fertility Specialist, to determine if hormone variations are contributing to your inability to conceive. And it is easier to manage hormonal fluctuations than many other causes of infertility.

How are sperm and eggs produced?

Stages of Conception Related to Infertility

In both men and women, there are stages of conception which, if completed appropriately, lead to fertility and conception. These stages are distinct and precise, so if there are any anomalies, missed steps or interruptions, infertility can occur.

In men, the stages of conception include:

  1. Sperm is produced in the seminiferous tubules, which are lined with approximately 13 rows of baby sperm cells, in different stages of development. These baby sperm cells are called "stem" cells.
  2. These stem cells being to divide to create "daughter" cells which will eventually mature into spermatocytes (sperm-at-oh-sites) or something like "toddler" sperm. This is in response to testosterone.
  3. The "toddler sperm" will continue to mature to become spermatids (sperm-ah-tids) or "teenage" sperm.
  4. The "teenage sperm" continue to mature to become adult sperm or spermatozoa (sperm-at-oh-zoh-uh), though they are not very mobile at this time.
  5. The adult sperm are carried to the epididymis - tubes where they will develop defined heads and tails, and where they will be stored until needed. They can hold approximately 440 million sperm.
  6. There are 6 distinct parts to that maturation of sperm, which take a total of 74 days to complete.
In women, there are also specific stages in conception:

  1. Women are born with all of the eggs or ova that they will ever have, these eggs are stored in the ovaries, in an immature state, and number approximately 400, 000 at time of puberty.
  2. In response to a hormone called "follicle-stimulating hormone" or FHS, the ovary begins to mature about 20 ova, inside small follicles in the ovary. This process stimulates the production of estrogen.
  3. As the estrogen level rises, it signals the uterus to begin reproducing the cells in its lining, in preparation for receiving an ova.
  4. A third hormone, called luteinizing (loo-tin-eye-zing) hormone or LH, then encourages the ripening of the follicle, and stimulates it to rupture, to release the mature ova.
  5. The mature ova travels into the fallopian (fuh-lo-pee-an) tube, where it hopes to become fertilized. Fertilization must occur within 72 hours of release, or the ova will die.
  6. If fertilized, when it reaches the uterus, it will attach to the wall of the uterus and being to divide, creating a fetus. If it is not fertilized, it will reach the wall, the wall will recognize the hormonal signature of non-fertilization, and the lining of the uterus will shed, causing a "period."
As you can see, the stages of conception involve many complex steps that, if one step is altered, can result in infertility. Your Infertility Specialist can evaluate you to determine if there are errors or alterations in your stages of conception which are preventing pregnancy.

Why do I feel inadequate because I have fertility problems?

Psychological Impact of Infertility

Infertility is more than just a physical condition. The inability to conceive children, or carry a child to term, has emotional impact, as well.

Common feelings associated with infertility can include:

  • Guilt
  • Depression
  • Frustration and anger
  • Feelings in inadequacy
Guilt can play a role in infertility, in that a man or woman is unable to fulfill the perceived expectations to provide their parents with grandchildren, or that they have done something, during their life, for which they are being "punished" by not being "allowed" to have children. Though these perceptions may not reflect acurately upon the infertility situation, guilt is a strong emotion, which can ovewhelm logic.

Depression is a result of grief. Each type of loss, whether emotional or physical, elicits feelings of grief. Even positive change can contribute to grief, since change represents loss. When you desire children, but are having difficulty conceiving or carrying them to term, you "lose" the opportunity to become a parent, which results in feelings of grief and depression.

Frustration and anger may also be present, with infertility. The monitoring, timing and effort that is expended in attempting to achieve conception and birth, can be stressful. Failure to conceive, when a child is so greatly desired, contributes to anger - at ones' self and perhaps at society - for not being "allowed" to have a child, when others conceive so easily.

Feelings of inadequacy are frequently present, when one is coping with infertility. During the initial stages of assessment and testing, each partner wonders whether they is something "wrong" with THEM, which is preventing conception. Men and women, alike, may feel less than whole or adequate, if they are the one with the fertility problem.

Infertility Counselors are a wonderful resource for helping to sort out feelings related to infertility and infertility treatment, and to assist in developing additional coping mechanisms to ease the feelings of guilt, depression, frustration, anger and self-inadequacy.


Emotional Contributors to Infertility

There are myriad contributors to infertility, and some of them can be effectively managed with medications and surgical interventions, however there are some causes of infertility that cannot be addressed with a pill or a scalpel.

Emotions play a huge role in our overall well-being. Whether we are angry, depressed, anxious, exhilarated or content, our bodies respond to these feelings with internal changes that can include:

  • altered blood flow
  • constriction or relaxation of muscles
  • constriction or relaxation of blood vessels
  • release of hormones and regulatory chemicals
  • changes in brain wave patterns

What causes infertility?

Causes of Infertility

There are a myriad of medical conditions that can contribute to infertility - a common condition that affects both men and women.

For women, health conditions such as poly-cyctic ovarian disease - a condition where the ovary grows cysts which interfere with normal ovary function, history of sexually transmitted diseases and structural problems within the female organs, can prevent conception.

In men, low sperm count, structural problems within the male organs, hormonal problems, and the inability to achieve erection contribute to male fertility problems.

In some cases, it is both the man and the woman who have medical conditions that are contributing to the difficulty in conception, and it is the role of the medical practitioner to assess each of the potential causes, and find ways to overcome them.

What is the definition of infertility?

Defining Infertility

In the medical community, the term "infertility" means the inability to conceive children within one year if the woman is under 35 years of age, or within 6 months of the woman is over 35. It does not define whether the inability is related to the man or the woman. It also does not explain the reason for the infertility, only that conception is not possible.

There is, however, a concern among health care professionals who treat infertility, that there is no consistent definition. Some reference it as a "condition," while others refer to it as a "disease." Practitioners in the field of treating infertility feel that the most reasonable definition must include 1) infertility is a disease of both men and women and 2) that it results in the inability to conceive a child, or to carry a pregnancy to term.

Regardless of how you define it, infertility affects both men and women, and impacts not only physical health, but also psychological well-being of those affected by it.

How does the structure of my reproductive organs impact fertility?

Structural Causes of Infertility

In both men and women, the structure of the reproductive system can significantly impact each person's fertility and ability to conceive children. The reproductive system is like other body systems, and must be intact and in good health, in order to function properly.

For women, some structural causes of infertility can include:

  • blockage of fallopian tubes by scarring, congenital malformation or by tubal ligation - does not allow travel of the egg to the uterus or to contact sperm
  • misshaped uterus - uteri with more than one "head" makes it difficult for a fertilized egg to implant and develop
  • presence of tumors or cysts on the ovaries - tumors or cysts can interfere with egg production, transport of the egg, and can impact hormonal control of ovulation
  • blocked cervix - prevents passage of sperm into the uterus
For men, structural problems which can contribute to infertility may include:

  • undescended testes - tend to be smaller, with poor sperm production
  • blockage of ducts by scarring, congenital malformation or vasectomy, twisting or torsion of ducts - inhibits movement of sperm
  • missing testes - impairs ability to produce sperm
  • hypospadias (the opening normally at the tip of the penis is on the underside of the penis) - can make it difficult to adequately direct the ejaculation into the vaginal vault
  • tumors or cysts on the testes - impact hormonal control of sperm production and can block sperm travel pathways
In terms of infertility treatment, the majority of structural causes of infertility can be easily corrected to help promote conception. The first step to determining if you have a structural cause for your infertility is to be evaluated by an Infertility Specialist, who can assist you in identifying the cause of your infertility, and being treatment to help you achieve conception and birth of your child.

What are some external causes of infertility?

External Causes of Infertility

Since infertility affects both men and women, it is reasonable that there are many different causes. The majority of these causes are internal, such as structural problems within the reproductive organs, while others are related to external factors.

Some of the more common external factors related to infertility include:

  • trauma to the genitals or pelvis
  • surgical complications or incidents
  • acquired infections
  • chemicals or medications
Trauma to the genital organs or pelvis can be caused by straddle injuries, car accidents or falls that result in pelvic fractures, kick injuries to the groin, assaults and even sports injuries. Injuries that can occur as a result of trauma, include, but may not be limited to:

  • torn or crushed ducts
  • bruising, swelling and edema of the scrotum and testicles
  • nerve injuries from crushing of the groin tissues
  • lacerations/tears of the external genitalia which can cause scarring and impede sexual relations
  • lacerations/tears of the fallopian tubes or uterus
  • stab or bullet injuries to the scrotum or uterus
Surgical complications which can decrease fertility include:

  • accidental severing of pelvic nerves
  • accidental tearing or severing of blood vessels in the pelvis, leading to the reproductive organs
  • surgery related scarring (adhesions) which cause blockages in tubes and ducts
  • post-surgical infections of the internal genital organs
  • hemorrhage (uncontrolled bleeding) which results in emergent removal of reproductive organs
Acquired infections can include:

  • sexually transmitted diseases: chlamydia, syphilis or gonorrhea which can cause scarring, inflammation and tissue death
  • peritonitis - infection in the abdominal/pelvic cavity usually following surgery or rupture of an organ (appendix)
  • pelvic inflammatory disease, in women, which can cause scarring of the fallopian tubes
  • urethritis - infection of the urethra usually in men, which can cause erectile problems
Chemical or medication causes of infertility can include: exposure to heavy metals or environmental poisons, and some prescription medications such as high blood pressure medication, antidepressants and narcotics, all of which can effect libido, erection, sperm and ova production and the ability to carry a fetus to term.

Though the internal causes of infertility may be more numerous, we cannot forget to examine the external causes, as well, to best assess and address infertility. Talk to your Infertility Specialist about other causes of infertility and the best way to treat them.

Why do people questions couples who don't have children?

Social Perceptions of Infertility

Within most societies, there is an expectation that when people marry, or become a couple, children will soon follow. Society, in general, expects couples to reproduce in order to maintain both population and social status.

In many countries, children are needed to help support the family, assist with farm labor and, sadly, to replace children who have died due to prevalent disease. When couples do not have children, those around them may question their relationship, or motives, for not conceiving.

For couples who wish to have children and cannot do so, due to infertility, the situation becomes more than simply a social one. Questions by friends, family and others, produce not only pain, but embarrassment, as if infertility were a choice, rather than a medical disease. And these questions are sometimes hard to respond to, with understanding and without anger or frustration.

Though community education about infertility, and the growing societal awareness about the disease, is making strides in limiting the sometimes prejudicial impressions voiced by those who cannot understand the pain of infertility, it still requires the couple dealing with infertility, to provide education to family and friends about the impact of the condition, and of the questions.

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Guru Spotlight
Barbara Gibson