Infertility

Last Updated: August 16, 2022

Infertility is usually defined as the inability to have a pregnancy that does not result in stillbirth or miscarriage after trying for at least one year.

Infertility falls under thePregnancy & ChildrenandWomen’s Healthcategories.

What is infertility?

Infertility means not being able to become pregnant after a year of trying with unprotected and frequent sex. Infertility is fairly common, occurring in about 15% of couples. There are treatments specific to men or to women, and ones used for both partners. About 50% of couples treated for infertility go on to have babies.[1]

How is infertility diagnosed?

An evaluation for an infertility diagnosis is usually started after inability to achieve pregnancy after 12 months of unprotected and frequent intercourse. People with a past medical history of infertility and women older than 35 years may also choose to be evaluated for a diagnosis. An evaluation usually involves recording the patient’s history (e.g., sexual practices, exposure to toxins or certain medications, surgeries), physical examination and imaging of reproduction organs, and certain laboratory tests (e.g., semen analysis, ovulation hormone levels).[2]

What are some of the main medical treatments for infertility?

Medical treatment for “unexplained” infertility can include induction of ovulation with medications, intrauterine insemination (IUI), or the two treatments together. IUI involves removing chemicals from semen that may slow the movement of the sperm and physically placing the sperm into the uterus with a catheter. Other infertility treatments include injectable ovulation hormones, in vitro fertilization (sperm and egg fertilization is done in a test tube and then delivered into the uterus for implantation), surgery to fix anatomical blockages and irregularities, and other methods. Treatments for individuals are usually specific to the factors causing infertility and vary from person to person.[2]

Have any supplements been studied for infertility?

Supplements have been usually studied in combination with medical infertility treatments. Small studies suggest that males with infertility that take dietary supplements like zinc, vitamin E, or L-carnitine may have improved sperm motility and/or increased success with assisted reproductive technologies.[2] Many other dietary supplements have been studied for infertility with no good evidence of benefit. Some of these supplements include black seed oil, ginger, coenzyme Q10, and vitamin D.[3]

Are there any other treatments for infertility?

In the case that the infertility is “unexplained” by anatomical or other causes, couples may benefit from altering their lifestyle and behaviors. For example, couples may engage in timed-intercourse during the period of the highest fertility for the woman. This usually involves using kits that detect the increase of hormones to signify ovulation (luteinizing hormone surge) and helps to predict the days that the woman has the highest fertility.[2]

Lifestyle factors that can help with infertility include stopping smoking and alcohol and substance use, as well as maintaining a healthy weight, since obesity is correlated with a higher risk of infertility.[2]

What causes infertility?

Causes of infertility include male factors, female factors, and “unexplained” factors. Common causes of infertility usually involve abnormalities within the female or male reproductive organs.

In males, 40%–50% of infertility cases have an unknown cause; 30%–40% are caused by primary hypogonadism (where the testes produce little-to-no testosterone); the remaining 10%–20% are caused by things such as impaired sperm transport due to obstruction, erectile dysfunction, and retrograde ejaculation. For female infertility, 40% of cases are caused by ovulation disorders attributed to aging, low ovarian reserve, endocrine disorders, polycystic ovary syndrome (PCOS), etc.; 30% are caused by obstruction of the fallopian tubes due to pelvic inflammatory disease, surgery, etc.; the remaining cases are caused by endometriosis and other conditions.[2]

What causes erectile dysfunction?

At its core, ED is caused by a deficit in NO release, cyclic GMP (cGMP) and calcium signaling, or smooth muscle relaxation. However, many overlapping mechanisms can interrupt this signaling cascade.

Psychogenic or sympathetic-mediated ED is caused by stress, depression, or anxiety about sexual performance. Neurogenic ED is caused by a deficit in nerve signaling to the penis, which may be secondary to spinal cord injury, traumatic brain injury, or surgery. Vasculogenic ED — the most common form of ED — is caused by underlying vascular disease, endothelial dysfunction, and structural changes to the arterial walls. Iatrogenic ED is most often the result of pelvic surgery or the use of medications. Finally, endocrine causes of ED include low levels of androgens (e.g., testosterone) and other hormones.

A number of medications have been linked to ED, including antihypertensives (blood pressure medications); 5𝛼-reductase inhibitors, anti-androgens, luteinizing hormone-releasing agonists and antagonists (used to treat prostate cancer), antidepressant medications, and opiates.[4]

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References
  1. ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
  2. ^Tammy J Lindsay, Kristen R VitrikasEvaluation and treatment of infertilityAm Fam Physician.(2015 Mar 1)
  3. ^Michael P Rimmer, Ruth A Howie, Venkatesh Subramanian, Richard A Anderson, Ricardo Pimenta Bertolla, Yusuf Beebeejaun, Pietro Bortoletto, Sesh K Sunkara, Rod T Mitchell, Allan Pacey, Madelon van Wely, Cindy M Farquhar, James M N Duffy, Craig NiederbergerOutcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic reviewHum Reprod Open.(2022 Mar 4)
  4. ^Yafi et alErectile dysfunctionNature Reviews Disease Primers.(February 2016)
Examine Database References
  1. Sperm Quality - Ahmad MK, Mahdi AA, Shukla KK, Islam N, Rajender S, Madhukar D, Shankhwar SN, Ahmad SWithania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile malesFertil Steril.(2010 Aug)
  2. Sperm Quality - Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre AClinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot StudyEvid Based Complement Alternat Med.(2013)
  3. Sperm Quality - Nasimi Doost Azgomi R, Nazemiyeh H, Sadeghi Bazargani H, Fazljou SMB, Nejatbakhsh F, Moini Jazani A, Ahmadi AsrBadr Y, Zomorrodi AComparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple-blind randomised clinical trialAndrologia.(2018 Sep)
  4. Sperm Quality - Gupta A, Mahdi AA, Shukla KK, Ahmad MK, Bansal N, Sankhwar P, Sankhwar SNEfficacy of Withania somnifera on seminal plasma metabolites of infertile males: a proton NMR study at 800 MHzJ Ethnopharmacol.(2013 Aug 26)
  5. Luteinizing Hormone - Abbas Ali Mahdi, Kamla Kant Shukla, Mohammad Kaleem Ahmad, Singh Rajender, Satya Narain Shankhwar, Vishwajeet Singh, Deepansh DalelaWithania somnifera Improves Semen Quality in Stress-Related Male FertilityEvid Based Complement Alternat Med.(2009 Sep 29)
  6. Sperm Quality - Moradi M, Moradi A, Alemi M, Ahmadnia H, Abdi H, Ahmadi A, Bazargan-Hejazi SSafety and efficacy of clomiphene citrate and L-carnitine in idiopathic male infertility: a comparative studyUrol J.(2010 Summer)
  7. Sperm Quality - Andrea Garolla, Matilde Maiorino, Alberto Roverato, Antonella Roveri, Fulvio Ursini, Carlo ForestaOral carnitine supplementation increases sperm motility in asthenozoospermic men with normal sperm phospholipid hydroperoxide glutathione peroxidase levelsFertil Steril.(2005 Feb)
  8. Sperm Quality - Balercia G, Regoli F, Armeni T, Koverech A, Mantero F, Boscaro MPlacebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and L-acetylcarnitine in men with idiopathic asthenozoospermiaFertil Steril.(2005 Sep)
  9. Sperm Quality - Jonathan P JarowUse of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trialJ Urol.(2003 Aug)
  10. Sperm Quality - Lenzi A, Lombardo F, Sgrò P, Salacone P, Caponecchia L, Dondero F, Gandini LUse of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trialFertil Steril.(2003 Feb)
  11. Sperm Quality - Najme Moslemi Mehni, Ali Asghar Ketabchi, Ebrahim HosseiniCombination effect of Pentoxifylline and L-carnitine on idiopathic oligoasthenoteratozoospermiaIran J Reprod Med.(2014 Dec)
  12. Sperm Quality - Gholamreza Pourmand, Mansooreh Movahedin, Sanaz Dehghani, Abdolrassul Mehrsai, Ayat Ahmadi, Maryam Pourhosein, Marzieh Hoseini, Marzieh Ziloochi, Fariba Heidari, Laleh Beladi, Mohammad NooriDoes L-carnitine therapy add any extra benefit to standard inguinal varicocelectomy in terms of deoxyribonucleic acid damage or sperm quality factor indices: a randomized studyUrology.(2014 Oct)
  13. Sperm Quality - Giorgio Cavallini, Anna Pia Ferraretti, Luca Gianaroli, Giulio Biagiotti, Giovanni VitaliCinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermiaJ Androl.(Sep-Oct 2004)
  14. Sperm Quality - Sigman M, Glass S, Campagnone J, Pryor JLCarnitine for the treatment of idiopathic asthenospermia: a randomized, double-blind, placebo-controlled trialFertil Steril.(2006 May)
  15. Sperm Quality - Khaw SC, Wong ZZ, Anderson R, Martins da Silva Sl-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility.Reprod Fertil.(2020-Jul)
  16. Fertility - Xuebao Zhang, Yuanshan Cui, Liying Dong, Miao Sun, Yong ZhangThe efficacy of combined l-carnitine and l-acetyl carnitine in men with idiopathic oligoasthenoteratozoospermia: A systematic review and meta-analysisAndrologia.(2020 Mar)
  17. Sperm Quality - Safarinejad MR, Shafiei N, Safarinejad SA prospective double-blind randomized placebo-controlled study of the effect of saffron (Crocus sativus Linn.) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasthenoteratozoospermiaPhytother Res.(2011 Apr)
  18. Sperm Quality - Mohammad Heidary, Sepideh Vahhabi, Jahanbakhsh Reza Nejadi, Bahram Delfan, Mehdi Birjandi, Hossein Kaviani, Soudabeh GivradEffect of saffron on semen parameters of infertile menUrol J.(Fall 2008)
  19. Sperm Quality - Roya Modarresi, Alireza Aminsharifi, Farzaneh ForoughiniaImpact of Spirulina Supplementation on Semen Parameters in Patients with Idiopathic Male Infertility: A Pilot Randomized TrialUrol J.