What Is Infertility?

Overview

Facing infertility can be upsetting if you and your partner are considering starting a family. It can also create other problems concerning your own health depending on the root cause.

Different conditions cause infertility in those assigned male at birth (AFAB) - i.e. sperm production, hormonal deficiency or a structural defect in the reproductive organs - and those assigned female at birth (AFAB) - i.e conditions that affect the production of an egg from the ovaries and/or the implantation of a fertilised egg into the uterine lining.  

It is important to get diagnosed and receive treatment for any underlying health condition causing infertility. This can ultimately improve your chances of successfully conceiving in a natural way and will enable doctors to assess your suitability for fertility treatments. 

Causes of infertility

Male (AMAB) infertility

Problems with fertility can arise when sperm is not present in enough quantity in the ejaculate fluid and/or when sperm is not mobile enough to reach an egg for fertilisation. 

Hypergonadotropic hypogonadism 

People AMAB may be affected with hypergonadotropic hypogonadism (impaired response of the testes to hormones) and  experience a reduced testicular function due to low testosterone and other androgen hormone production.¹ This will ultimately result in low count and/or quality sperm that is less likely to successfully fertilise an egg during conception.  

Underlying health problems

Low count and low quality sperm could also indicate health problems including:

• Sexually transmitted infections (STIs)²  
• Autoimmune antisperm antibodies³ 
• Testicular tumours⁴ 
• Genetic conditions such as Klinfelter’s syndrome⁵

Structual problems in the reproductive organs

Infertility can also arise in men with defects in the structure and function of the reproductive organs.^6,7,8

Structural problems include:

• A varicocele 
• Undescended testicles 
• Absence of vas deferens (sperm duct) common in men with cystic fibrosis  

Surgery

You will also be unable to conceive naturally after certain surgeries, for example, a vasectomy or a prostatectomy. Radiation and chemotherapy can also reduce your sperm count and quality, affecting fertility.⁹

Female (AFAB) infertility

Primary ovarian insufficiency 

Primary ovarian insufficiency (POI) also known as early menopause can affect you while you are young and still going through your menstrual cycle.¹⁰ The main symptoms of POI are the absence of menstrual bleeding (period) and the failure of the ovary to release an egg. An absence of an egg during ovulation means there is little chance of falling pregnant from unprotected intercourse as there is no egg present to be fertilised by a sperm.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition that can affect anyone assigned female at birth (AFAB). Individuals with PCOS are likely to experience infertility due to:¹¹

• Abnormally high androgen hormone levels
• Irregular periods/menstrual bleeding 
• Ovarian cysts 

Endometriosis

Endometriosis is a condition that causes extra uterine tissue to grow outside of the uterus. Patients can experience painful, heavy and/or irregular periods.¹² Endometriosis often (somewhere between a third and a half of all cases) causes infertility due to excess endometrial tissue interfering with the functional structure of the reproductive system.  

Uterine Fibroids/Polyps 

Uterine fibroids are benign (non-cancerous) growths of muscle/fibrous tissue that occur inside and on the uterus.¹³ They can cause a number of symptoms including pelvic pain, abnormal periods and infertility.

Uterine polyps are a different diagnosis with similar symptoms.¹⁴ Polyps are made up of excess endometrial tissue and are mostly considered benign though some can become cancerous. 

Management and treatment for infertility

Male (AMAB) infertility

Infertility treatments for people AMAB mainly focus on counteracting low sperm count and/or low quality sperm caused by hypergonadotropic hypogonadism. This is done through gonadotropin therapy where patients are treated with two reproductive hormones (human chorionic gonadotropin and follicle stimulating hormone) which enhance sperm production.¹⁵

Assisted reproduction techniques are also used to improve the chances of sperm fertilising an egg including: 

• In vitro fertilisation (IVF) - where a specialised fertility clinic will use a sperm sample to fertilise extracted eggs in a lab and implant them into the uterus
• Intracytoplasmic sperm injection - similar to IVF but one sperm in injected into the egg in a lab to allow fertilisation before intrauterine implantation

If you don’t respond to treatment you might want to consider using a sperm donor. Sperm samples taken from donors are thoroughly screened for genetic and transmissible diseases so they are of the highest possible quality for fertilising an egg and producing a viable embryo. 

Female infertility

Hormone treatment is often recommended to patients with POI and PCOS to balance out the menstrual cycle and reduce symptoms associated with infertility.^10,11 

Endometriosis and uterine fibroids/polyps can be treated through surgery if necessary.^12,13,14

You may also be recommended for fertility treatment if you are struggling to conceive naturally while dealing with a reproductive health issue. Treatments include intrauterine insemination (IUI) or implantation of IVF embryos, though not all patients will be suitable for these kinds of treatments because the chance of successful implantation of a fertilised egg into the uterus with certain conditions is still low.

In such a case that you are unable to carry your own pregnancy you may consider surrogacy. This may be an option provided that your AMAB partner or sperm donor has no fertility issues themselves.

Risk factors

Other commonly identified risk factors for both AMAB and AFAB infertility include:¹⁶

• Drinking alcohol 
• Smoking 
• Obesity 
• Being extremely underweight 
• Stress 

Diagnosis of infertility

Doctors would consider you as having an issue with infertility if you have not been able to conceive after around 1 year of having consistent unprotected sex.¹³ 

You should contact your GP to discuss your symptoms if you believe you are suffering from infertility or an associated reproductive health issue. You will then most likely be referred to a doctor specialised in reproductive health and fertility.

Prevention

Preventing infertility will usually involve limiting your exposure to its risk factors such as limiting your consumption of alcohol, cutting your usage of cigarettes, following a healthy diet and exercise regime, and looking after your mental wellbeing.¹⁶

However, even with lifestyle changes infertility cannot be completely prevented if it is caused by, for example, a genetically inherited condition or another reproductive health issue that is hard to manage and treat. 

FAQs

How common is infertility

Infertility affects approximately 10% of couples across the world. It is equally as common in those AMAB as it is in those AFAB.¹⁷

When should I see a doctor

You should see a doctor if you are trying to conceive and are worried about you or your partner's reproductive health. Conceiving naturally can take up to a year to be successful so it is important to consider this before trying expensive and potentially invasive treatments.¹³

You should see your doctor if you are experiencing symptoms of any of the mentioned reproductive health conditions. Your doctor will be able to diagnose you, help you manage pain and avoid complications.

Summary

Infertility can be stressful and life-altering ailment to deal with. It is important that as well as receiving treatment for any physical symptoms of your reproductive health condition, you also look after your mental wellbeing. Don’t hesitate to reach out to your doctor, a counselling service and others like your partner, friends or family if you are struggling mentally. There are many supports and treatments available to increase your chances of successful pregnancy - your doctor or fertility clinic will be able to guide you in the direction that is best for your situation.