FAQ

What is fertility ?

Fertility is defined as the ability to conceive a child. The chances of conception in normally fertile couples are about 20% per month. The “fertile window” refers to the period of the cycle when conception can occur, and depends on the length of the woman’s cycle. It is usually 5-6 days long, and ends on the day of ovulation. Indeed, normal sperm can survive for up to 3-5 days in the female genital tract, and an oocyte can be fertilized for a maximum of 12-24 hours after ovulation. Frequent intercourse is recommended during that period for couples trying to conceive.

What is infertility ?

Infertility is defined as the inability to conceive after 12 months (1 year) of regular and unprotected intercourse. A full infertility workup is therefore recommended when a couple has met this threshold. In women older than 35 years of age, and in certain cases with a positive history, a full evaluation is warranted earlier, after 6 months of intercourse. Infertility is considered “primary” when the couple has never conceived, and “secondary” when the couple has had at least one successful conception in the past.

What are the general causes of infertility ?

Infertility is a major health issue worldwide, affecting 10 -15% of couples (1 in 6-8 couples). There are several causes of infertility that can be grouped as follows:

Female factor: 35%

Male Factor: 30%

Combined: Male and Female (20%)

Unexplained: 15% (add Pie)

What are the female causes of infertility ?

Several factors impact a woman’s fertility:

1. Age/Ovarian reserve: A woman’s fertility progressively declines with age. Indeed, there is a significant age-related decrease in the quantity and quality of oocytes (referred to as ovarian reserve). In general, the peak fertility years extend from the early twenties till the early thirties, and continuously decline afterwards.

2. Ovulation disorders: Ovulation disorders – abnormal or absent ovulation – are a leading cause of female infertility. Dysfunctions of regulatory hormones or the ovary can lead to ovulation disorders, such as Polycystic Ovarian Syndrome, Hypothalamic dysfunction, hormonal imbalances (abnormal thyroid function, high prolactin…), premature ovarian insufficiency. Ovulation can also be impacted by external factors such as weight, exercise, medication…

3. Uterine and cervical factor: A normal uterus and endometrial lining are essential for adequate implantation and normal progress of pregnancy. Uterine fibroids (leiomyomas) and endometrial polyps can cause infertility and recurrent pregnancy loss, depending on their location and size. Other causes include uterine adhesions (synechiae), congenital uterine malformations, adenomyosis, cervical stenosis…

4. Tubal factor: Any damage to the Fallopian tubes can cause infertility, by blocking the sperm from reaching the oocyte for fertilization, or the embryo from reaching the uterine cavity for implantation. The tubes can be blocked due to abdomino-pelvic surgery, pelvic inflammatory disease, endometriosis…

5. Systemic illnesses: Severe systemic diseases (active autoimmune disorders, hormonal deficiencies, severe renal disease, uncontrolled diabetes…) and malignant disorders, as well as many chronic treatments (chemotherapy, radiotherapy, immunomodulators…) can be associated with infertility and/or recurrent pregnancy loss.

6. Environmental factors:

What are the male causes of infertility ?

Several factors may impact a man’s sperm production and fertility. They are classified as follows:

1. Testicular conditions: Sperm production occurs exclusively in the testes, and could therefore be significantly impacted by any testicular condition. Testicular causes of infertility can be congenital (Chromosomal abnormalities, cryptorchidism…) or acquired (varicocele, testicular tumors, testicular infection, a history of chemotherapy or radiotherapy, a history of testicular trauma or injury…).

2. Post-testicular conditions: After production, sperm cells move to the epididymis where they mature and are stored, before going through the vas deferens and the urethra during ejaculation. Anomalies in these ducts can be congenital (Cystic fibrosis, congenital absence of vas deferens…) or acquired (Infection (Chlamydia, gonorrhea), trauma or surgery, erectile/ejaculatory dysfunction…).

3. Pre-testicular conditions: Sperm production is under the control of the hypothalamic-pituitary axis via the gonadotropins (FSH and LH), as well as testosterone (in itself LH dependent). Disruptions of the axis can lead to abnormal sperm production, as seen with pituitary insufficiency (caused by tumors, surgery or radiation therapy), exogenous hormone intake (anabolic steroids, corticosteroids), hormone imbalances (thyroid problems, hyperprolactinemia), and some congenital conditions (Kallman syndrome)…

4. Age: Even though the impact of age on a man’s fertility is less pronounced than in women, recent studies have shown that sperm production decreases with age. The impact is more pronounced after the age of 45-50, and is accompanied by an increase in the risk of miscarriage and adverse outcomes in the offspring.

5. Environmental and lifestyle factors: There is increasing evidence that several environmental and lifestyle factors can significantly alter sperm production and decrease male fertility, such as obesity and a sedentary lifestyle , heavy alcohol consumption and smoking, exposure to chemicals and pollutants (pesticides, heavy metals…), electromagnetic waves and X-rays… The impact of these factors is related to the amount and duration of exposure and can be reversible.

What is unexplained infertility ?

Unexplained infertility accounts for approximately 15% of all infertility cases, and refers to the absence of an identifiable cause for the couple’s failure to conceive, despite a full work-up. Many cases of unexplained infertility can be caused by the presence of multiple factors that do not significantly reduce fertility on their own, but can have an impact when combined. Unexplained infertility requires active management in most cases, especially when the duration of infertility is long.