Infertility 101: Everything You Need to Know

By Heidi Hingtgen, OTR/L Published on — Medically Reviewed and Certified by Dr. Robert Kiltz

Table of Contents

Did you know that one in eight couples has trouble becoming pregnant?

Infertility can affect anyone — it doesn’t discriminate against sex or ethnicity. Struggling with infertility can be an agonizing experience. But, thankfully, this condition is often treatable.

Read on to learn all about infertility and how you can improve your chances of conceiving.

What Is Infertility?

Infertility is most often defined as the inability to conceive after 12 months of regular unprotected intercourse (if under the age of 35). However, many factors including medical history and results of specific tests can lead to a clinical diagnosis of infertility long before a year of trying to conceive.

Signs of Infertility

The most obvious sign of infertility is the inability to become pregnant. But there may be earlier signs that point to underlying reproductive problems.

Signs of infertility in men may include:

  • Erectile dysfunction 
  • Small volumes of semen 
  • Pain, swelling, or a lump in the testicles 
  • Abnormal breast growth 
  • Decreased facial and body hair 
  • Low sperm count 
  • Inability to smell 
  • Chronic respiratory infections

Signs of infertility in women may not be as obvious. The following symptoms may indicate problems in the endocrine and reproductive systems:

  • Irregular or absent menstrual periods 
  • Painful intercourse
  • Excess facial and body hair 
  • Heavy, painful periods 
  • Acne

Male Infertility Causes

Contrary to popular belief, infertility is not just a woman’s problem. Around 50% of couples fail to conceive due to male infertility. Many factors can contribute to low sperm production, impaired sperm function, and blockages that prevent the release of sperm. However, 30% of male infertility cases are caused by unexplained reductions in sperm quality.

Male Infertility Risk Factors

Factors that can increase the risk of male infertility include:

  • Age 40 years or older
  • Obesity
  • Smoking tobacco
  • Heavy alcohol use
  • Testosterone exposure
  • Radiation exposure
  • Frequent exposure of the testis to high temperatures
  • Exposure to environmental toxins 

Medical Conditions

Many medical conditions can cause infertility in men. Male infertility causes may include infection, injury, anatomic anomalies, chromosomal abnormalities, systemic diseases, and sperm antibodies. These conditions can negatively impact male fertility by disrupting hormonal levels, impairing sexual function, and reducing testicular function.

Varicoceles

Varicoceles are a common medical condition that causes infertility in 35 to 40% of infertile men. Varicoceles are abnormally swollen veins within the scrotum that resemble varicose veins. Blood pools in these veins, which increases heat in the scrotum and reduces the production of sperm.

Poor Overall Health

Men with multiple health conditions are more likely to struggle with fertility problems. One study found that poor health is associated with reduced semen quality and high levels of follicle-stimulating hormone (FSH). Elevated FSH levels in men are a sign of testicular malfunction.

The following diseases have been found to increase infertility in men:

  • Renal disease
  • Liver failure
  • Hemochromatosis
  • Chronic obstructive pulmonary disease (COPD)
  • Cystic fibrosis
  • Multiple sclerosis

Exposure to Toxins: Male Infertility

Environmental exposure to a variety of chemicals can also lead to male infertility. Alarmingly, most of these chemicals are widely available in our everyday lives.

The following chemicals can induce male infertility by lowering sperm count and motility and impairing the size, shape, and appearance of sperm:

  • BPA
  • Phthalates 
  • Air pollution 
  • Dioxins
  • Pesticides 
  • Fracking chemicals
  • Parabens

A small 2008 study looking at the effects of environmental toxins on 61 participants, found that exposure to toxins is often a factor in male infertility.  

Of the 30 male participants who were infertile, 23 were exposed to toxins at work like solvents, glue, and silicones. Of the 31men with normal sperm, only 10 were exposed to occupational toxins.  

Other Lifestyle Factors

Many lifestyle factors also influence male fertility. One study found that obesity can lead to infertility due to hormonal changes from excess fat tissue. In fact, higher body mass is associated with lower sperm concentration and semen volume.

Taking prescription and nonprescription drugs can also have negative side effects on fertility such as decreased sperm production, reduced sperm quality, and sexual dysfunction. The following drugs can impair fertility in men:

  • Antidepressants
  • Antipsychotics
  • Antihypertensives
  • Anti-parkinsonian drugs
  • Recreational drugs
  • Steroids, ecstasy, tobacco, alcohol
  • Proton pump inhibitors
  • Testosterone replacement therapy

These medications are commonly prescribed without regard for their effects on fertility.

Female Infertility Causes

In the United States, around 10% of women aged 15 to 44 years have difficulty conceiving or staying pregnant.  Female infertility can be traced to a number of factors which we’ll look at next. 

Medical Conditions

Medical causes of female infertility may include ovulation disorders, uterine abnormalities, tubal obstruction, peritoneal factors, and cervical factors.

The following medical conditions are common causes of female infertility:

  • Endometriosis is a painful condition that causes the tissue that lines the uterus to grow in other parts of the body such as the fallopian tubes and ovaries. Endometriosis can increase infertility in women younger than 35. But around 83% of women with endometriosis can conceive by age 40.
  • Premature ovarian failure (POF) is a condition that causes the cessation of ovarian function before 40 years of age. This condition prevents the ovaries from producing eggs and hormones.
  • Polycystic ovary syndrome (PCOS) is a condition that causes persistent hormonal imbalances, which lead to the development of ovarian cysts and an irregular menstrual cycle. Around 5–15% of women worldwide have PCOS.
  • Tubal blockages can be caused by endometriosis, pelvic inflammatory disease (PID), scar tissue from pelvic surgery, and infection. One study found that around 19% of women with primary infertility, and 29% of women with secondary infertility have tubal blockages that prevent pregnancy.

Exposure to Toxins: Female Infertility

Environmental exposure to chemicals can significantly reduce fertility in women.

Women with high BPA exposure are more likely to have implantation failure when undergoing IVF.  

Air pollutants such as tobacco smoke contain many toxic metals and chemicals that impact infertility. Smoking tobacco also increases the rates of ectopic pregnancies, spontaneous abortions, and stillbirths.

Sometimes, you may unknowingly expose yourself to environmental toxins. For example, living near a busy highway can cause infertility due to passive exposure to air pollutants.

Other Lifestyle Factors

Physical or mental stress can increase infertility in women. High levels of the stress hormone cortisol are linked to menstrual disturbances in women with anxiety, depression, malnutrition, eating disorders, and chronic exercise.

Excess Body Weight

Excess body weight can also influence your reproductive health. Obesity can contribute to menstrual dysfunction as a result of hormonal changes. This can lead to a loss of ovulation and infertility. 

Women with obesity also experience insulin resistance and inflammation, which can reduce pregnancy rates. Additionally, obesity can result in poorer outcomes for assisted conception treatments.

Overview of Risk Factors for Female Infertility 

Risk factors for female infertility include:

  • Age 30 years or older
  • Extreme weight gain
  • Very low body fat
  • Chronic diseases
  • Abnormal pap smears requiring treatment
  • Hormonal imbalances
  • Multiple miscarriages
  • Smoking tobacco
  • Alcohol use

Infertility Testing

If you’ve been trying to conceive and haven’t been able to, you’re likely wondering when you should plan to see a doctor. An infertility specialist can diagnose and treat problems related to infertility. Read on to discover what tests an infertility specialist may perform to assess your fertility.

Men

You should receive male infertility testing if you are unable to conceive after one year of unprotected intercourse. If you have known risk factors for infertility, consult an infertility specialist after six months of trying. You should also see an infertility specialist if you notice any of the following symptoms:

  • Erectile dysfunction (ED)
  • Ejaculation problems such as delayed ejaculation or retrograde ejaculation
  • Low sex drive
  • Genital pain or swelling

Your doctor will start the evaluation by discussing your medical history to determine factors that may affect your fertility. 

These factors may include your overall health, sexual history, previous fertility, pelvic or inguinal surgeries, systemic diseases, and environmental exposures. Your doctor will also perform a physical examination to check for any irregularities such as hormone imbalances or structural abnormalities. 

Next, you will most likely undergo a semen analysis. This test involves providing a sample of your semen for laboratory analysis. The laboratory will assess certain characteristics of your semen including:

  • Sperm size, shape, and appearance
  • Total sperm count
  • The percentage of live sperm in the sample
  • Sperm motility
  • Semen volume

If your semen sample possesses any abnormal characteristics, your doctor may recommend additional testing. Other male infertility tests include testicular biopsy, genetic testing, hormone testing, and imaging.

Women

Women should also see an infertility specialist after unsuccessfully trying to conceive. Women experience a decline in fertility after age 30. If you’re younger than 35 years old, you should see a doctor after one year of unprotected intercourse. While women 35 years and older should see a doctor after six months.

An infertility specialist will first obtain a comprehensive medical history including the following factors:

  • Menstrual history
  • Timing and frequency of intercourse
  • History of contraception
  • Previous pregnancies
  • Pelvic infections
  • Medications
  • Environmental exposures
  • Alcohol consumption
  • Tobacco use
  • Previous surgery

You will then undergo a physical examination to assess for any abnormalities of the endocrine and reproductive systems such as endometriosis or pelvic inflammatory disease (PID). 

Your doctor will also want to confirm ovulation with a serum progesterone test, which measures the levels of progesterone in your blood. Progesterone is a hormone that your body produces after ovulation.

Your doctor may also check the levels of other hormones that are essential for reproduction such as the anti-mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol. This combination of hormone tests determines your ovarian reserve — a woman’s fertility potential.

Depending on the findings of your examination, your doctor may recommend additional testing. Other common female infertility tests include:

  • Pelvic ultrasound. This test checks for structural abnormalities such as fibroids in the uterus and ovaries.
  • Hysterosalpingography. This is a type of X-ray that screens for tubal occlusion and uterine abnormalities.
  • Hysteroscopy. This test uses an endoscope to examine your cervix and uterus.
  • Laparoscopy. This is a surgical procedure that examines your abdominal organs with a scope and camera.
  • Endometrial biopsy. This is a surgical procedure that removes a small sample of tissue from the lining of the uterus. Your doctor may perform this test if you have chronic endometritis or neoplasia.

Natural Infertility Treatments 

Finding the right infertility treatments depends on the root causes of your infertility. Treatments may include surgery, fertility drugs, hormone therapy, in vitro fertilization (IVF), and diet and lifestyle modifications. Below, we’ll discuss infertility treatments that can improve your ability to conceive naturally.

Acupuncture

Acupuncture is an effective treatment for both women and men undergoing intrauterine insemination (IU) and IVF. The insertion of needles through the skin at precise points triggers the brain to release endorphins that reduce stress and balance hormone levels. 

Acupuncture can improve fertility in women with endometriosis, PCOS, and ovarian reserve issues. This treatment can also boost sperm quality in men.

The combination of acupuncture with other fertility treatments can improve pregnancy rates and live birth rates. Remarkably, acupuncture may increase your odds of pregnancy by up to 65%.

Yoga

Light exercise like yoga can naturally improve a woman’s ability to conceive. Practicing yoga can reduce anxiety in women with infertility and strengthen the immune system.

Yoga also increases blood flow to the reproductive organs, which provides nutrients that are vital for conception.

Men with infertility can also benefit from yoga. One study found that yoga and meditation can increase sperm count and motility and decrease sperm DNA damage. This can result in better pregnancy outcomes and healthier offspring.

Fertility Massage

Fertility massages provide gentle pressure to the muscles and connective tissues of the reproductive organs. They may help improve blood flow and remove blockages in women with infertility. For men, fertility massages may improve sperm quality.

Currently, no research supports the use of massage to increase fertility. However, fertility massages can improve anxiety in couples struggling with infertility.

Getting a massage can improve your mindset when trying to conceive. But it may not be the reason you get pregnant.

Keto: The Fertility Diet

The keto diet for fertility is the best natural treatment for fertility because it targets the root causes of many other disorders viewed as causes for infertility. 

A keto diet reduces inflammation and stabilizes hormone levels, which creates the optimal environment for conception.

A keto diet is a low-carb, high-fat, and moderate protein diet that reduces your carb intake to less than 50 grams per day. This transitions your body into ketosis, a metabolic process that switches your body from using sugar, to using fat for fuel. Being in a state of ketosis offers many health benefits, especially for fertility.

Many studies confirm that a low-carb diet can improve pregnancy rates in women with PCOS by reducing insulin levels, alleviating chronic inflammation, balancing hormones, and resuming ovulation. Other benefits of a keto diet for infertility include weight loss and improved cholesterol levels.

A keto diet revolves around healthy fats. Research shows that eating healthy fats can lower your risk of anovulation, which is the absence of ovulation. 

Higher dietary intake of healthy fats can also increase luteal-phase progesterone levels. This helps prepare your body for a possible pregnancy.

There are a number of different ways to implement a keto diet for fertility depending on your comfort level and eating habits. Versions of the keto diet include:

If you want to improve your fertility, a keto diet is the best place to start!

Tips to Boost Your Fertility 

You can practice several strategies to increase your chances of pregnancy.

Couples

Couples should have regular unprotected intercourse several times around the time of ovulation. Ovulation, the release of an egg, usually occurs halfway through a woman’s cycle. But timing can vary from cycle to cycle. 

Home ovulation predictor kits can measure the hormones in your urine to determine when you’re ovulating. 

Men

Men should practice the following tips to improve their fertility:

  • Avoid tobacco use
  • Avoid heavy alcohol consumption
  • Avoid high temperatures found in hot tubs and hot baths
  • Avoid exposure to industrial or environmental toxins
  • Limit medications that may impact fertility
  • Exercise regularly to maintain a healthy weight
  • Eat a low-carb diet to reduce inflammation and balance hormones

Women

For women, the following strategies may increase the chances of becoming pregnant:

  • Quit smoking. 
  • Avoid alcohol
  • Limit caffeine consumption
  • Get regular, light exercise
  • Avoid strenuous exercise that can increase stress levels in the body
  • Maintain a healthy weight

Infertility: The Takeaway

Infertility is a worldwide problem that affects both men and women. The cause of infertility varies from person to person, but common factors include medical conditions, environmental exposure to toxins, and unhealthy lifestyle factors.

If you are unable to conceive after one year of having regular unprotected sex, you should visit your doctor. Infertility testing can lead to the diagnosis and treatment of fertility problems.

Many natural treatments for infertility can improve your chances of becoming pregnant. The keto diet, also known as the fertility diet, optimizes your endocrine and reproductive systems for conception.

Everyone’s infertility journey is unique. Having the right infertility treatment plan can get you a big step closer to having the family of your dreams.

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