Subfertility refers to a reduced ability to conceive naturally, meaning it takes longer than expected to achieve pregnancy despite regular, unprotected sexual intercourse. It describes a situation where conception remains possible without medical intervention, though the process is prolonged compared to typical expectations.
Understanding Subfertility
Subfertility signifies a delay in conceiving, distinguishing it from infertility, which implies a complete inability to conceive naturally. In subfertility, the possibility of natural pregnancy still exists, though it may require more time than average. For instance, about 84% of couples typically conceive within one year, and 92% within two years of trying. Couples experiencing subfertility might eventually achieve pregnancy without specialized medical assistance.
Common Causes of Subfertility
Factors contributing to subfertility can originate from either partner or a combination of both. For women, problems with ovulation are a common cause, where an egg is not released or is released irregularly. Conditions such as Polycystic Ovary Syndrome (PCOS), diminished ovarian reserve, or thyroid disorders can disrupt the menstrual cycle and egg release.
Issues with fallopian tubes, such as blockages or damage, prevent sperm from reaching the egg or a fertilized egg from traveling to the uterus. These obstructions can arise from endometriosis, pelvic inflammatory disease, or scar tissue from previous surgeries or infections. Uterine abnormalities, including fibroids or polyps, can also affect the ability to conceive or carry a pregnancy to term.
For men, subfertility often involves issues with sperm production or function. This can manifest as a low sperm count, malformed sperm, or sperm that exhibit poor movement (motility). Factors like varicoceles, which are enlarged veins in the scrotum, or certain infections can impair sperm quality. Hormonal imbalances or blockages in the reproductive tract that hinder sperm delivery also contribute to male subfertility.
Lifestyle factors, including heavy alcohol consumption, smoking, or exposure to environmental toxins, can negatively impact both male and female fertility. Sometimes, thorough evaluations reveal no identifiable cause, leading to a diagnosis of unexplained subfertility.
Diagnosing Subfertility
Diagnosing subfertility typically begins with a thorough review of both partners’ medical and sexual histories. A physical examination is also performed for both individuals to assess overall health and identify any physical factors that might influence fertility.
For women, diagnostic tests often include blood tests to measure hormone levels, particularly those related to ovulation like progesterone, FSH, and LH. An ultrasound provides images of the reproductive organs to check for conditions such as ovarian cysts, fibroids, or other structural abnormalities. A hysterosalpingography (HSG) may be performed, which involves injecting a dye into the uterus and fallopian tubes to check for blockages or uterine shape irregularities. Hysteroscopy or laparoscopy may also be used to visualize the reproductive organs more directly or address specific issues.
For men, a semen analysis is a primary diagnostic tool, evaluating sperm count, motility, shape, and presence of infection. Blood tests may be conducted to assess hormone levels, such as testosterone, FSH, and LH, which influence sperm production. Imaging tests, including scrotal or transrectal ultrasounds, can help identify structural problems like varicoceles or blockages within the reproductive system. Genetic testing may also be recommended to identify chromosomal abnormalities that affect fertility.
Approaches to Managing Subfertility
Management of subfertility often begins with lifestyle adjustments, as these can significantly enhance the chances of conception. Maintaining a healthy body weight through balanced diet and regular exercise is beneficial, since being overweight or underweight can affect ovulation and sperm quality. Reducing or eliminating smoking, excessive alcohol consumption, and recreational drug use is also recommended, as these factors can impair fertility. Managing stress and avoiding exposure to environmental toxins are additional steps that support reproductive health.
Medical interventions are available when lifestyle changes alone are insufficient or when specific underlying conditions are identified. Ovulation induction, which uses medications like clomiphene citrate or gonadotropins, stimulates egg development and release for women with irregular or absent ovulation. These medications aim to produce healthy eggs, sometimes increasing the number of eggs released per cycle. Intrauterine Insemination (IUI) is another option, where prepared sperm are placed directly into the uterus around the time of ovulation. IUI is often considered for mild male factor subfertility or unexplained cases.
For more complex situations, Assisted Reproductive Technologies (ART) such as In Vitro Fertilization (IVF) may be recommended. IVF involves fertilizing eggs with sperm in a laboratory setting, and then transferring the resulting embryos into the woman’s uterus. This approach can address various causes of subfertility, including tubal issues, severe male factor subfertility, or unexplained cases.