Infertility is often incorrectly viewed as a female-only problem, although it appears to be equally distributed between sexes. Infertility is the inability to achieve pregnancy when the couple is unable to conceive while having frequent unprotected sex for at least one year and the woman is up to 35 years old. In the event that the woman is over 35, the interval is one semester. Then, it is considered necessary to proceed with examinations.

Infertility in numbers

According to studies, after 1 year of unprotected sex, 12% to 15% of couples are unable to conceive.

In couples under 30 who are generally healthy, 40% to 60% are able to conceive in the first 3 months of trying. 9% of men and about 11% of women have experienced fertility problems during their reproductive years. In one third of infertile couples, the problem deals with the man, and in one third the problem deals with the woman. For rest infertile couples, the problem cannot be identified or concerns both the man and the woman.

Common causes

In addition to causes that are specific to either female or male due to anatomy of the reproductive system, there are common causes for both sexes that affect their fertility and include:

• Age; affecting men over 40 and women over 35
• Weight problems
• Diabetes
• Eating disorders
• Excessive alcohol consumption
• Excessive exercise
• Smoking
• Stress
• Use of substances
• Radiation therapy
• Therapy/ drugs to treat cancer
• Exposure to environmental toxins
• Sexually transmitted diseases

Infertility in women can involve:

• Fallopian tube problem; damaged or blocked fallopian tubes due to chlamydia inflammation or gonorrhoea.
• Systemic diseases; endometriosis, adhesions, polycystic ovaries, reduced egg supply.
• Hormonal problems; increased prolactin, hypothyroidism, hyperthyroidism.
• Problems in the uterus; fibroids, polyps.
• Narrowing or obstruction of the cervix, cervical mucus disorders, uterine malformations.
• Ovulation disorders; the ovaries do not produce or release eggs.
• Premature menopause; this is the premature exhaustion of follicles before the age of 40.

In men, infertility can happen due to:

• Infections such as mumps, an infectious epidemic viral disease, which can cause orchitis and more rarely infertility, and in some cases even sterility.
• Varicocele; it is the first cause of infertility in men and has to do with the enlarged veins of one or both testicles, resulting in an increase in temperature, the longer stay of harmful toxins in the testicle, causing long-term destruction of spermatozoa.
• Hormonal problems; disturbances in prolactin, testosterone, TSH, LH, FSH.
• Genetic mutations; cystic fibrosis genes, Kleinefelter, Kallmann, Young, Kartagener syndromes.
• Chronic and congenital conditions; cryptorchidism, high blood sugar, kidney failure, transplantation, obesity.
• Medicines; mainly concern chronic conditions such as psychotropics, chemotherapy, hormones, antidepressants, antiepileptics, for the thyroid.

Fertility tests for women

There are specific tests that are carried out by the gynecologist, so that the correct diagnosis can be made and in case there is an infertility problem, the appropriate treatment can be given.

The exams are about:

• A complete gynecological examination including the patient’s history, Pap test, breast examination.
• Blood test to check the fertility related hormones prolactin, progesterone, LH (Lutenizing hormone), a hormone related to the female reproductive process, thyroid and thrombophilia test.
• Vaginal ultrasound to examine the clinical condition of the uterus, ovaries and fallopian tubes.
• Hysterosalpingography which checks the patency of the fallopian tubes.
• Laparoscopy, which is used to check the fallopian tubes and also to identify foci of endometriosis.
• Ultrasound of the uterus and ovaries from the vagina for better visualization of the internal genital organs, in order to identify possible pathology of the uterus and ovaries such as ovarian cysts, fibroids, uterine polyps. In addition, information is obtained about the reproductive potential of each woman, examining her ovulation.

Fertility tests for men

And for the man there are specific tests that are carried out by the andrologist-urologist, so that the appropriate treatment can be given in case it is needed. The exams concern:

• Spermogram, which refers to the examination of sperm performed by specialized centers and doctors who measure the volume of the sperm, the concentration of sperm per ml of semen, the total number of sperm, their morphology and their motility.
• Family history to check for cystic fibrosis, androgen receptor deficiency, infertile first degree relatives.
• Medical-surgical history including, orchectomy (cancer, torsion), operations on the pelvis, groin or scrotum, operation on the bladder-prostate.
• Infections, specific such as tuberculosis, syphilis, smallpox, non-specific such as epididymitis, urethritis, prostatitis.
• Check of the prostate and penis to rule out abnormalities (phimosis, hypospadias, congenital flexion).
• Ultrasound examination to check the position, size and morphology of the testicles and epididymis
• Triplex, to control the blood flow in the vessels of the area so that to be diagnosed possible various pathological conditions, as well as if there is a varicocele.
• Laboratory test, during which the complete axis of the hypothalamus – pituitary gland – testicles is examined. The main hormones to investigate are testosterone, gonadotropin-releasing hormone (GnRH), FSH (Follicle Stimulating Hormone), LH (Lutinous Stimulating Hormone), Prolactin, TSH (Thyroid Stimulating Hormone), Estradiol and Cortisol.

Many couples, before beginning their attempts to have a child, decide to proceed with preventive tests, so that precious time is not lost. It would be useful for more couples to adopt this process, especially if their desire to become parents has arisen at an older age than what is considered ideal.