Infertility can be one of the most challenging experiences of our lifetime. For many, it can be an emotional and physically intense journey, that’s why we’re so proud you’re taking this first step 🤎

Let’s start off by saying that if you are having difficulty conceiving, or are simply anxious about infertility, nothing can replace seeing a professional. And having someone on your side can make the process and future options much clearer and easier.

So, how do you figure out where you stand in terms of reproductive health?

Read on to find out!

How do I know if I’m infertile?

As we’ve discussed before, if you’re unable to conceive after a year (or 6 months, if you’re 35+ of regular unprotected sex, you can consult a gynaecologist to get a diagnosis done.

While this is the part where you address the situation, there also may be signs and symptoms leading up to the year that could point to potential diagnoses.

These can be present in both male and female reproductive systems, so if you or a partner are feeling suspicious, just head to your doctor!

What are some signs of infertility in men?

For men, before a diagnosis of infertility is confirmed, an overview of their medical history (to check for any previous surgery, illness), sexual history (to check for any STIs, family reproductive history) and lifestyle history (to check for current/past use of alcohol, drugs) is taken. Let’s take a look at some of the more common causes of infertiliy in men:

1. Semen and sperm parameters

Semen and sperm quality play a key role in deciding male fertility. In terms of sperm quality, there are 4 key aspects- motility (speed), count (number), morphology (shape), and DNA fragmentation. Even with that in mind, infertility can be caused by various different factors.

1. Semen characteristics- Any issues around the viscosity of semen, it’s composition and ejaculation also matters. Issues such as aspermia (lack of ejaculate), [retrograde ejaculation](where the semen is redirected back to the urinary bladder) or hyperviscous semen (where the sperm are stuck in the semen due to its viscosity and are unable to disperse) are some issues that require medical intervention.

2. Sperm characteristics- Sperm are created and developed in the testicles. So as you can imagine, anything that might injure those organs can be potentially detrimental, including minor injuries, infections, chromosomal abnormalities, and even hormonal imbalances.

Any defects in the count, motility or DNA packaging in the sperm can also contribute to infertility. A common condition is azoospermia, where there is no sperm in the ejaculate. This could either be due to an obstructions (such as absence of a vas deferens, or infections in the genital tract) in the path of the sperm until ejaculation, or it could be due to severe decline in sperm production due to testicular failure. Lastly, even genetic factors can contribute to this. In such cases, assisted reproductive technologies such as IMSI, ICSI, testicular aspiration of sperm, can help.

2. Underlying Medical Conditions

Any pre-existing health conditions can also have an effect on fertility. A few important examples are:

• Varicocele - If you have enlarged veins in your scrotum, it could disrupt blood flow to the area. Not to mention that sperm production has to take place at a cooler than body temperature. Any additional warmth from your surroundings could affect sperm health. ~40% of infertility in men can be traced back to varicocele.

• Erectile Dysfunction - An erect penis is, unfortunately, a prerequisite for sperm to be transported. Any difficulty in maintaining that erection could negatively impact the overall outcome, i.e., your fertility

• Genetic issues- Genetic issues such as having Klinefelters syndrome, or deletions in the Y chromosome (remember, only men have this chromosome! Women have XX chromosomes, and men have XY) can lead to azoospermia.

What are some signs of infertility in women?

Now that we’ve discussed what challenges male infertility can pose, let’s talk about women. Unsurprisingly, our complex reproductive and endocrine system leaves a lot more room for error. And so female infertility can be caused by a number of factors.

Structural Issues with Reproductive System

Similar to men, any barriers or blockages in the fallopian tubes or uterus can prevent the sperm and egg from meeting. Early checkups (through a test like HSG - Hysterosalpingogram) could mean better options and even complete surgical removal in some cases.

1. Uterine Fibroids

While this does technically count as a barrier too, uterine fibroids are different in that they prevent implantation, not fertilisation. They’re a muscular tissue growth, and don’t always affect pregnancy.

2. Abnormal uterus shape

There are normal changes in the uterine position- which include retroverted uterus and anteverted. These do not affect fertility, but there are some congenital (acquired from birth) issues with your uterine shape that can affect your fertility. Common ones include bicornuate (partially split uterus), septate uterus (a tissue dividing the womb area into two), unicornuate uterus (when only one side of the womb is developed), didelphic uterus (two separate wombs, with separate cervix). These issues require careful examination and personalized protocol treatments for the affected population.

3. Endometriosis

This condition causes the uterine lining tissue to grow outside the uterus, around the pelvic area. These patches of tissue are called endometrial implants and act exactly the same way, including bleeding and shedding every month.

Experts aren’t sure why it exists as yet, and extreme stages of endometriosis can only be corrected through surgery. Globally, it affects 10% of women and girls and [can remain undiagnosed] for up to 10 years.

Infections

If not treated on time, infections like chlamydia or gonorrhea could leave thick scar tissue on the fallopian tubes, causing blockages and eventually even closure. Other diseases like syphilis also carry risk of causing stillbirth, and HPV (human papillomavirus) can alter cervical mucus, and make fertilisation harder by making it harder for the sperm to swim across.

Ovarian disorders and issues with ovulation

If you’ve been struggling with irregular or absent periods, chances are your ovulation isn’t going as planned either. Depending on your diet, lifestyle, hormonal imbalances, etc. your ovaries might decide to skip releasing an egg any particular month. This is called anovulation.

Anovulation isn’t something to immediately worry about. It happens to us all, but factors like age, hormone levels, medical conditions, etc. could make it more frequent and impact fertility negatively. Some other common issues include:

1. Polycystic Ovary Syndrome (PCOS) - Any hormonal imbalances that can cause irregular ovulation, elevated androgen levels, and/or ovarian growth can be included under the PCOS umbrella. Many experts believe that the ‘cysts’ are actually disordered ovarian follicles, causing diverse symptoms like skin & hair issues, weight fluctuations, and more. But worry not, there are several treatments out there that can aid your journey of resolving infertility caused by PCOS.

2. Primary Ovary Insufficiency (POI) - If the ovaries seem to decline in function before the age of 40, it’s termed Primary Ovary Insufficiency. Earlier, people thought it was ‘early menopause’, but up to 10% of women with POI can still conceive.

   
   

Hormonal and Autoimmune disorders

1. Autoimmune Disorders - Conditions like these happen when your immune system targets its own healthy body parts. For anyone aiming to conceive, it might even mean that your WBCs attack the reproductive system.

   Any inflammation can also disrupt conception, not to mention some types of medication, which can negatively impact fertility. It’s important to discuss with your doctor regarding the next course of action to take, in such cases.

2. Hormonal disorders- Any variations in hormonal levels can impact your fertility. The important ones to keep an eye out for include estrogen, progesterone, FSH, LH, AMH and Prolactin. Apart from these, thyroid disorders can also play a key role. Whether it’s hypo- or hyper-thyroidism, you can expect it to impact ovulation. Hypothyroidism can even disrupt the luteal phase, leading to higher miscarriage rates.

   
   

Quality of the egg and implantation issues

1. Poor Quantity or Quality of follicles

The most important part of the menstrual cycle is when the egg matures and then gets released. There’s a whole process named after it and stuff — ovulation.

However if the egg doesn’t mature, or there are lifestyle and genetic factors that affect its quality and quantity- fertilisation might be more challenging. Even if you have fewer eggs than needed, it can impact long-term fertility. It’s also why “poor ovarian reserve” (POR) or “diminished ovarian reserve” (DOR) affect your fertility, as even though we need one egg, the quality of the egg matters the most. Testing for your ovarian reserve can help you get a clearer picture on where you stand, in terms of reproductive age.

2. Implantation Failure

Any number of issues like a thin uterine lining, excessive scar tissue, inadequate progesterone levels, or even endometriosis can hinder the implantation process of an embryo.

Diagnosing infertility: How Arva can help

Now that we discussed all the potential pitfalls on your journey, we hope you remember that’s not all there is to see.

There are strides being made, and options being unlocked in the field every year.

It can be a long journey, but there’s always help and support. Being proactive about your fertility and taking fertiltity tests can help you understand your journey better.

At Arva, we strive to do the same by helping your on your journey with the right resources and options.

We’re always in your corner, your Fertility Bestie guiding the way. 🤎

TL;DR:

• If you’re unable to conceive after a year (or 6 months, if you’re 35+ of regular unprotected sex, you can seek an infertility diagnosis from a doctor.

• Some more common symptoms in men are:

  • Issues with sperm and semen quality

  • Underlying medical conditions (erectile dysfunction, etc.)

• Some common symptoms in women are:

  • Ovarian disorders and issues with ovulation

  • Structural Issues with Reproductive System

  • Hormonal and autoimmune disorders

  • Issues with egg quantity or quality and implantation failure