What is Infertility?

Infertility occurs when natural conception (pregnancy) cannot occur. Just over 15% of couples have trouble conceiving and many single or single-sex couples also cannot conceive, often leading to couples needing some form of fertility treatment to help solve the problem and help them conceive and start or expand their family.

In heterosexual couples there are two types of infertility:

  1. Primary – No previous children
  2. Secondary – Previous conceived children

Infertility is typically diagnosed after a year of unsuccessful attempts at natural conception or six months if the female is over 35 years of age.

Infertility affects millions of people of reproductive age across the globe. It can have severe consequences on an individual’s sense of self, their future aspirations as well as their families and relationships. One third of causes of this infertility are due to the female, one third due to the male and one third due to unknown causes.

What is Fertility and How Does it Work?

Fertility refers to when an egg and sperm join (or ‘fuse’) in the process of conception, in order to fertilise a female egg, which is then implanted in the female womb lining, developing into an embryo and ultimately a foetus and then a baby.

This requires healthy male sperm to be ejaculated or injected into a healthy egg, either via a test tube insemination, for example in the case of in-vitro fertilisation treatment (also known as ‘IVF Treatment’) or via sexual intercourse, whereby the sperm enters the uterus and is then propelled, via contractions up and into the fallopian tubes.

Egg and womb lining development is controlled and influenced by the female hormones FSH (follicle stimulating hormone), LH (luteinising hormone), Oestrogen and Progesterone.

FSH is produced by the pituitary gland and causes the egg to mature in the ovary and stimulates the ovaries to release Oestrogen. Oestrogen is produced by the ovaries and repairs and thickens the uterus lining to help stimulate LH release.

LH is produced by the pituitary gland and triggers the release of the egg at day 14 of the menstrual cycle. Progesterone is produced by the ovaries and maintains the uterus during the middle part of the menstrual cycle and during pregnancy. If a woman becomes pregnant, the placenta produces Progesterone to support the development of the baby and prevent a miscarriage. Testosterone is also needed in females for breast development.

How Do Male Fertility and Infertility in Men Work?

Most males have two testes. The testes make the hormone Testosterone in response to LH. FSH stimulates testicular growth and sperm cell development. Testosterone is required for the development of male sexual characteristics such as the development of a deeper voice, body hair and muscle mass and growth.

Testosterone also triggers the production of sperm from the vas deferens in the scrotum. When sperm is ejaculated during sexual arousal or intercourse, it joins with a lubricating liquid and prostatic fluid and becomes ‘semen.’

Oestrogen is also needed by males for healthy sperm development, the ability to have an erection, and sex drive (libido).

Male infertility is very often due to issues with sperm count, Testosterone levels or ejaculation malfunction. Testosterone naturally decreases as men age, whilst Oestrogen hormone levels increase and so, although men can have children later into life than females, age is still a limitation for healthy conception.

Typically (although not always) the older you are, the less likely you are to have healthy offspring and, as people age, particularly in women over 40, the chances of problems and issues in relation to conception as well as potential problems with the pregnancy typically increase.

What Can Cause Infertility in Women?

Female infertility can occur at any stage of the pregnancy process.

Female hormonal problems and problems with the womb or fallopian tubes are very common causes of female infertility. As a woman ages, her FSH and Oestrogen levels diminish, and her egg stores and health are reduced. Over the age of 35, fertility rate decreases by up to half compared to that of age 25.

Furthermore, diabetes, eating disorders such as anorexia and bulimia and obesity, over-exercising and stress also reduce hormonal levels.

How Do Oestrogen and Progesterone Affect Fertility?

Oestrogen and Progesterone are made of cholesterol. Cholesterol is converted to Pregnenolone and this is then converted to either Progesterone or DHEA (Dehydroepiandrosterone), which is converted into Oestrogen and Testosterone (both females and males have Oestrogen and Testosterone as they are needed for fertility and bone health but to varying levels.)

Therefore, a diet too low in dietary cholesterol, or a body too athletic (one with too low a level of body fat and high levels of muscle mass) in men and women (such as in long distance runners or bodybuilders), may well have insufficient body fat levels to make these key hormones, which are vital when it comes to fertility.

Very low body fat levels can also cause body temperature to decrease, as food is needed for energy including thermodynamic energy; the heating of the body. Body fat is also needed for heat insulation and therefore, a low body weight can cause lower body temperature which can, in men cause testes scrotal hypothermia; decreasing sperm count.

 

 

cholesterol-formation-pathway-infertility
Female and male sex hormone production. (Source: Diotel et al, 2018)

 

How Does Stress Affect Fertility?

A high stress lifestyle can also reduce levels of Oestrogen, Testosterone and Progesterone. This is due to the body’s response when it comes to the “fight or flight” mechanism, which is intrinsic to humans. When it comes to undergoing any form of fertility treatment in the UK or around the world, external factors affecting fertility need to be addressed. However, with waiting times for fertility treatment in the UK potentially quite long, it is important to do so sooner rather than later, before undergoing the treatment in question.

The human body was built to survive and as such to protect humans from external stressors and threats. This means that it prioritises defence from stress over all other body mechanisms.

Thus, an acutely stressful situation or chronic pre-apprehensive stress (anxieties and worries) puts the body in defence mode and deprioritises the digestive (food breakdown and nutrient absorption), immune (defence against disease) and reproductive (sexual) systems which, when it comes to survival are secondary to the vital organs and the muscles needed for ‘fight or flight.’

In this reprioritisation, the DHEA made from the cholesterol is converted to Cortisol stress hormone instead of Oestrogen and Testosterone. This process is called “Cortisol steal.”

Therefore, stress and anxiety diminish Oestrogen and Testosterone levels. For those suffering with infertility, measures to reduce environmental or mental stressors (worries) in both the female and male, must be taken to improve hormone health.

Common Causes of Infertility

Other commonly-cited causes of infertility include obesity, as increased fat cells (adipocytes) and raised blood glucose levels (insulin resistance due to too high dietary sugar and fat) cause levels of Oestrogen to increase and decreased Progesterone and Testosterone production.

In males, this can cause erectile dysfunction and a low sperm count. High Oestrogen can also cause impotence in men. Obesity also increases body temperature (as we eat for energy and for thermogenesis, to heat our bodies, and body fat provides insulation).

High testes temperature can cause scrotal hyperthermia; decreasing sperm count. Increased adipocytes also increase body inflammation increasing sperm DNA fragmentation and decreasing sperm health. Therefore, obesity is a major cause of infertility in men in the Western world.

Just as having too low levels of Oestrogen in females can cause infertility, too high Oestrogen is also unhealthy as it can lead to a process called ‘Oestrogen dominance,’ which stops the egg being released in the menstrual cycle.

Low Progesterone levels can also prevent womb development, preventing the implantation of an egg and development of an embryo and causing miscarriage. Obesity also puts females at higher risk of polycystic ovaries (PCOS) and ovarian cysts, which are other major causes of infertility in women.

Other causes of infertility include substance and drug abuse, smoking, diabetes, sexually transmitted diseases and genetics.

Thyroid disease can also cause infertility, as thyroid hormone is needed for human metabolism and therefore, both hyperthyroidism (too much thyroid hormone) and hypothyroidism (too little thyroid hormone) can influence fertility by affecting ovulation (the release of the egg) and the menstrual cycle in females and affecting sperm count in males.

Kidney disease also disrupts hormone levels and can cause increased LH levels in men, reducing sperm count overall, and decreased LH in females, disrupting the menstrual cycle egg release.

Blocked fallopian tubes in the womb, pelvic inflammatory disease, coeliac disease, and ovarian or testicular cancers, also cause infertility. High heat exposure from tight clothing or frequent use of saunas, also decreases sperm count.

How Can GlobMed Help?

GlobMed recognises that fertility is a finely-tuned science. Therefore, we ensure that we have the best clinicians available worldwide to help prevent and diagnose infertility.

We believe that every person deserves the right to create life. Our expert team, who have extensive experience with both private and NHS care, work with industry leaders and innovating academics, to find the best treatment providers from around the world to help our clients access the life-giving privilege of the best fertility treatments available.

Our medical partners can tailor treatment plans to individual clients and their needs and find the right people to help those suffering from the pain of conception and miscarriage chaos, beat the fertility odds and have the best possible chance of becoming a parent.

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