Infertility is defined as one year of regular unprotected intercourse without conception.
It affects approximately 10-15% of couples.
What is responsible for the long-term decline in birth and fertility rates in Europe and the United States?
- Delayed childbearing
- Later marriage and more frequent divorce
- Greater interest in advanced education and careers among women
- Improvements in contraception
- Decreased family size
What is the correlation between fertility and age?
Several studies have shown that semen volume, concentration, sperm motility, and morphology of sperm significantly decrease with male age.
A British study that examined the effect of men’s age on time to conception found that increasing men’s age was associated with increasing time to conception and declining overall pregnancy rates; the time to conception was fivefold greater for men over age 45 than for men under age 25.
However, because there is little or no overall measurable decline in male fertility before age 45-50, male factors generally contribute relatively little to the overall age-related decline in fertility.
In contrast, female fertility is much more claimed by age. The oocytes are laid in the ovaries at embryonic age. Initially, there are millions of follicles, but over time, this pool of oocytes is used up.
In addition to the decreasing number of available oocytes, with advancing age, the rate of remaining genetically inconspicuous oocytes also decreases (23, X), which explains, on the one hand, the age-related decreased fertility and, on the other hand, the increase in miscarriages.
What is required for successful fertilization and implantation of the embryo?
- Sperm must be deposited at or near the cervix at or near the time of ovulation, ascend into the fallopian tubes, and have the capacity to fertilize the oocyte (male factor)
- Ovulation of a mature oocyte must occur, ideally on a regular and predictable basis (ovarian factor)
- The fallopian tubes must capture the ovulated oocytes and effectively transport sperm and embryos (tubal factor)
- The uterus must be receptive to embryo implantation and capable of supporting it.
What symptoms and signs may indicate reduced fertility in women?
Menstrual disorders such as amenorrhea (no menstrual periods) and oligomenorrhea (less than eight menstrual periods per year) may indicate ovulation disorders.
Dysmenorrhea, pain during micturition and defecation, and symptoms characteristic of the corresponding organs’ affection can indicate endometriosis.
The patient’s history of infections, such as chlamydia, could indicate tubal disorders due to scarring that impedes contact between sperm and oocytes.
History of drug use or treatment for cancer.
What does the diagnosis of female infertility include?
Anamnesis. Specific questions about the patient’s history (past infections, medication, treatments) and current situation must be asked. Questions about menstruation (length and frequency), nutrition, current medication, and duration of the desire to have children.
Gynecological examination. A bimanual examination is performed. The vagina, vulva, and cervix are evaluated to exclude anomalies characteristic of certain diseases (e.g., androgen excess, endometriosis). The breast is also examined to rule out lactation (hyperprolactinemia). Ultrasound helps diagnose uterine abnormalities and evaluate the ovaries (indicating PCOS? Endometriomas? Ovarian reserve determination).
Hormones. The Anti Mueller Hormone (AMH) and the antral follicle count (AFC) indicate the remaining ovarian reserve. The basal hormones (LH, FSH, estrogen, progesterone, and prolactin are part of basal hormone diagnostics. Thyroid functions diagnostics much also been included. TSH is here the gold standard.
Further imaging. The patency of the fallopian tubes should be checked, especially if there is a history of past infections, e.g., chlamydia. Mainly if the desire to have a child has been pursued for a long time and the partner’s spermiogram is fine. In addition, imaging of the uterine cavity using hysteroscopy should be performed, especially if abnormalities of the uterine cavity are suspected through ultrasound.
How can female infertility be treated?
Proper diagnosis and targeted treatment can help many couples achieve natural conception with their partner. For women with ovulation disorders such as PCOS syndrome, weight loss can restore regular ovulation in some women and fulfill the desire to have children.
Young women who do not have tubal patency and do not have other limitations of oocyte reserve have chances of success with assisted reproduction measures comparable to those of non-infertile women of the same age.
How to prevent infertility?
- A balanced diet, as well as plenty of exercise and sports, is crucial. Avoid overweight and obesity (obesity), and underweight because weight disorders are a risk for infertility. Seek professional help in time.
- In case of symptoms related to inflammation, infections, and other diseases should be treated in time.
- Thyroid and metabolic disorders, such as diabetes mellitus, should be adjusted as best as possible and controlled regularly.
- Refrain from smoking and the consumption of alcohol. If abstinence does not seem likely, try to reduce both. More potent drugs should be avoided altogether.
- Reduce stress. Autogenic training, muscle relaxation exercises, yoga, or similar can reduce stress in everyday life.
- Safe sex. Protect yourself from sexually transmitted diseases (STDs), such as chlamydia infection, as STDs can reduce fertility in both partners. Always get medical treatment of any illness (both partners).
- Ensure you have sufficient vaccination protection, especially for classic childhood disease mumps.
Would you like to have more information?
If you want a fertility test done or are unsure which treatment is best for you, please do not hesitate to contact us.
1 Kidd SA, Eskenazi B, Wyrobek AJ, Effects of male age on semen quality and fertility: a review of the literature, Fertil Steril 75:237, 2001.
2 Eskenazi B, Wyrobek AJ, Sloter E, Kidd SA, Moore L, Young S, Moore D, The association of age and semen quality in healthy men, Hum Reprod 18(2):447, 2003.
3 Eskenazi B, Wyrobek AJ, Sloter E, Kidd SA, Moore L, Young S, Moore D, The association of age and semen quality in healthy men, Hum Reprod 18(2):447, 2003.
4 Girsh E, Katz N, Genkin L, Girtler O, Bocker J, Bezdin S, Barr I. Male age influences oocyte-donor program results, J Assist Reprod Genet 25(4):137, 2008.
5 Hassan MA, Killick SR, Effect of male age on fertility: evidence for the decline in male fertility with increasing age, Fertil Steril 79(Suppl 3):1520, 2003.
