There is no way to prevent infertility, per se, because there are many factors that contribute to your ability to ovulate, conceive and carry a pregnancy to term. Likewise, your male partner also has numerous factors — natural and environmental — that can contribute to infertility. The condition is not exclusively a woman's problem. About one third of infertility cases involve male factor problems alone, and approximately one third of cases involve problems with both partners.
Infertility Factors in Women
- Excessive, or very low, body fat, which can affect ovulation and fertility.
- Chronic, debilitating diseases, such as unregulated diabetes, lupus or thyroid problems, that can interfere with normal ovarian function. Also, some medications such as high-dose steroids, can interrupt ovulations. If you have a chronic condition, be sure to discuss it with your health care professional. Most women with chronic conditions can become pregnant, have a healthy pregnancy and deliver a healthy baby.
- Polycystic ovarian syndrome. Symptoms include lack of periods, excessive facial hair, weight gain and acne
- Treatment for abnormal pap smears, including cryosurgery or cone biopsy that can affect the structure of the cervix.
- Your mother's use of DES when she was pregnant with you. Tell your health care professional so an x-ray can be performed to assess the size and shape of your uterus.
- Hormonal imbalances that cause periods exceeding six days and cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles; or very heavy periods.
- Multiple miscarriages (two or more early pregnancy losses).
- Environmental factors, such as cigarette smoking or alcohol consumption and exposure to workplace hazards or toxins.
- Age — even if your fertility does not seem at risk now, remember that fertility declines with age; a woman in her late 30s is about 30 percent less fertile than she was in her early 20s.
- Sexually transmitted diseases (STDs), which occur at a rate of 12 million cases each year in the U.S. Some STDs don't cause symptoms at first but, if left untreated, can lead to pelvic inflammatory disease (PID) — an infection of the upper genital tract that may compromise fertility. Complications from STDs are more common in women, including subsequent scarring, adhesions, blocked fallopian tubes, ectopic pregnancy and miscarriage. Ultimately, infertility can be a consequence of STDs. To decrease this risk, using latex condoms during sex and have any unusual symptoms checked out and treated early — and make sure both partners are treated simultaneously.
- Fallopian tube disease accounts for about 20 percent of infertility cases treated. If you are having trouble conceiving, or are worried about your future fertility, be sure to tell your health care professional if you have had pelvic pain, unusual vaginal discharge, bleeding or fever; pelvic surgery for ruptured appendix, ectopic pregnancy or ovarian cyst; have used an IUD for contraception; or have had two or more abortions.
- Endometriosis, a disease in which uterine tissue is found outside of the uterus, on the ovaries, fallopian tubes and often on the bladder and bowel. It can occur in menstruating women of all ages, including teens. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and some improvement in fertility (though not all the way to normal). Be sure to report these symptoms: painful menstrual cramps that may be worsening with time, extremely heavy menstrual flow, diarrhea or painful bowel movements (especially around the time of your period) and painful sexual intercourse.
Infertility Factors in Men
For men, there are a variety of factors that could lead to infertility. Many researchers believe the causes of declining male fertility during this century are environmental; they include pesticide and chemical exposure, drug use, radiation and pollution. Risks include:
- exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity and X-rays
- cigarette or marijuana use
- heavy alcohol consumption
- prescription drugs for high blood pressure (calcium channel blockers), ulcers, and psoriasis
- DES exposure in utero
- exposure of the genitals to elevated temperatures, such as hot baths, whirlpools and steam rooms
- medical risks, including hernia repair, undescended testicles, history of prostatitis or genital infection and mumps after puberty
- Some STDs can lead to epididymitis (inflammation of the duct which carries sperm). Ultimately, infertility can be a consequence of STDs. To decrease this risk, practice safe sex by using latex condoms. Have any unusual symptoms checked out and treated early — and make sure both partners are treated simultaneously.
Fertility researchers have developed a technique that may help reduce the failure rate of in vitro fertilization (IVF) by identifying chromosomal abnormalities in embryos. The technique, called "comparative genomic hybridization" is performed on a single cell obtained from the early developing embryo. And all of the cell's chromosomes are evaluated for abnormalities.
There has been a great deal of excitement and interest in the claim that Viagra® (sildenafil citrate), the popular breakthrough treatment for impotence in males, can now be used in treating some fertility problems in women. The theory is that since Viagra increases blood flow, it may also improve endometrial thickness, since a thin uterine lining prevents embryos from successful implantation. While results of one small study, initiated at the Sher Institute for Reproductive Medicine in Las Vegas, appeared to confirm the theory, critics pointed out that the study was limited to only four individuals acting outside of a controlled research environment. Clearly, further study is warranted. There is, in fact, concern among researchers and health care professionals that false claims made now will lead women to use the drug on their own, without their physician's advice, and before more concrete research is conducted.
At the 57th Annual Meeting of the American Society for Reproductive Medicine (Oct. 20-25, 2001, Orlando, FL) researchers at the University of Toronto, Canada presented results of a study investigating letrazole as a single-dose treatment of infertility in polycystic ovary syndrome (PCOS) patients and patients with unexplained infertility. Unlike clomiphene, it has no adverse, antiestrogenic effects on the endometrium. Currently, it is available in the United States as an adjuvant treatment for breast cancer. Further large, prospective studies will have to evaluate letrazole as an ovulation-inducing agent, but the data presented so far are promising. Letrazole could become another treatment option for unexplained infertility and PCOS. However, safety data is limited.