Infertility

2 March 2017.

Note: Infertility is not exactly a hormone-related symptom, but it is connected to the menstrual cycle and associated conditions such as Polycystic Ovary Syndrome (PCOS).

Infertility is when a heterosexual couple can’t get pregnant (conceive), despite having regular unprotected sex. About 84% of heterosexual couples will conceive naturally within one year if they have regular unprotected sex (every two or three days) [1].

Infertility is only usually diagnosed when such a couple haven’t managed to conceive after one year of trying. There are many possible causes of infertility, however, in a quarter of cases it isn’t possible to identify the cause.

Risk factors;

  • age – female fertility and male fertility decline with age
  • weight – being overweight or obese (having a body mass index (BMI) of 30 or over) reduces fertility; in women, being overweight or severely underweight can affect ovulation
  • sexually transmitted infections (STIs) – several STIs, including chlamydia, can affect fertility
  • smoking – can affect fertility in both sexes: smoking (including passive smoking) affects a woman’s chance of conceiving, while in men there’s an association between smoking and reduced semen quality; read more about quitting smoking
  • alcohol – for women planning to get pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum; for men, drinking too much alcohol can affect the quality of sperm
  • environmental factors – exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men
  • stress – can affect your relationship with your partner and cause low libido; in severe cases, stress may also affect ovulation and sperm production

Infertility in people with a menstrual cycle can also be caused by several hormone-related conditions e.g. Polycystic Ovary Syndrome (PCOS), endometriosis, fibroids, or thyroid problems (over or under-active) [1].

Main symptoms: Lack of conception (pregnancy) after at least 1 year of regular unprotected heterosexual sex.


Causes of female infertility [1]…

1. Ovulation– Female infertility is most commonly caused by problems with ovulation, the monthly release of an egg. Some problems stop an egg being released at all, while others prevent an egg being released during some cycles but not others [1].

Ovulation problems can be a result of:

2. Scarring from surgery- Pelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb. Cervical surgery can also sometimes cause scarring or shorten the neck of the womb (the cervix) [1].

3. Cervical mucus problems- When you’re ovulating, mucus in your cervix becomes thinner so sperm can swim through it more easily. If there’s a problem with the mucus, it can make it harder to conceive [1].

4. Fibroids– Non-cancerous growths called fibroids in or around the womb can affect fertility. In some cases, they may prevent a fertilised egg attaching itself to the womb, or they may block a fallopian tube [1].

5. Endometriosis- a condition where small pieces of the womb lining (the endometrium) start growing in other places, such as the ovaries. This can damage the ovaries or fallopian tubes and cause fertility problems [1].

6. Pelvic inflammatory disease- Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries. It’s often caused by a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb [1].

7. Sterilisation- Some women choose to be sterilised if they don’t want to have any more children. Sterilisation involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb. It’s rarely reversible – if you do have a sterilisation reversed, you won’t necessarily become fertile again [1].

8. Medicines and drugs- The side effects of some types of medicines and drugs can affect your fertility.

These include:

  • non-steroidal anti-inflammatory drugs (NSAIDs) – long-term use or a high dosage of NSAIDs, such as ibuprofen or aspirin, can make it more difficult to conceive
  • chemotherapy – medicines used for chemotherapy can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly
  • neuroleptic medicines – antipsychotic medicines often used to treat psychosis; they can sometimes cause missed periods or infertility
  • spironolactone – a type of medicine used to treat fluid retention (oedema); fertility should recover around two months after you stop taking spironolactone

Illegal drugs, such as marijuana and cocaine, can seriously affect fertility and make ovulation more difficult [1].

Causes of male infertility [1]…

1. Semen and sperm– The most common cause of infertility in men is poor quality semen, the fluid containing sperm that’s ejaculated during sex.

Possible reasons for abnormal semen include:

  • a lack of sperm – you may have a very low sperm count, or no sperm at all
  • sperm that aren’t moving properly – this will make it harder for sperm to swim to the egg
  • abnormal sperm – sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an egg

Many cases of abnormal semen are unexplained.

There’s a link between increased temperature of the scrotum and reduced semen quality, but it’s uncertain whether wearing loose-fitting underwear improves fertility.

2. Testicles- The testicles produce and store sperm. If they’re damaged, it can seriously affect the quality of your semen.

This can happen as a result of:

  • an infection of your testicles
  • testicular cancer
  • testicular surgery
  • a problem with your testicles you were born with (a congenital defect)
  • when one or both testicles hasn’t descended into the scrotum, the loose sac of skin that contains your testicles (undescended testicles)
  • injury to your testicles

3. Sterilisation- Some men choose to have a vasectomy if they don’t want children or any more children. It involves cutting and sealing off the tubes that carry sperm out of your testicles (the vas deferens) so your semen will no longer contain any sperm. A vasectomy can be reversed, but reversals aren’t usually successful.

4. Ejaculation disorders- Some men experience ejaculation problems that can make it difficult for them to release semen during sex (ejaculate).

5. Hypogonadism- an abnormally low level of testosterone, the male sex hormone involved in making sperm. It could be caused by a tumour, taking illegal drugs, or Klinefelter syndrome, a rare syndrome where a man is born with an extra female chromosome.

6. Medicines and drugs- Certain types of medicines can sometimes cause infertility problems.

These medicines are listed below:

  • sulfasalazine – an anti-inflammatory medicine used to treat conditions such as Crohn’s disease and rheumatoid arthritis; sulfasalazine can decrease the number of sperm, but its effects are temporary and your sperm count should return to normal when you stop taking it
  • anabolic steroids – are often used illegally to build muscle and improve athletic performance; long-term abuse of anabolic steroids can reduce sperm count and sperm mobility
  • chemotherapy – medicines used in chemotherapy can sometimes severely reduce sperm production
  • herbal remedies – some herbal remedies, such as root extracts of the Chinese herb Tripterygium wilfordii, can affect the production of sperm or reduce the size of your testicles

Recreational (and illegal) drugs, such as marijuana and cocaine, can also affect semen quality.


Managing hormone-related infertility:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. One study found that people who followed a ‘fertility diet’- higher monounsaturated to trans-fat ratio, vegetable over animal protein, high-fat over low-fat dairy, a decreased glycemic load, and an increased intake of iron and multivitamins had lower rates of infertility due to ovulation disorders [2].

Maintain a healthy weight– Obesity reduces fertility in both males and females; for females, obesity is associated with a higher incidence of ovulatory disorders and idiopathic infertility [3] and those under treatment for infertility may face additional problems, such as the need for higher doses of drugs to induce/stimulate ovulation, reduction in fertilization and implantation rates, and embryo quality [3] [4]. Compared to those of normal body weight, obese females submitted to IVF may present reduced rates of clinical pregnancy and live births, with an increased rate of abortion [5].  Male obesity has been linked to reduced rates of pregnancy and live births [6].

Eat less meat and more fresh fruit and vegetables– one study found that overall, replacing carbohydrates with animal protein was demonstrated to be detrimental to ovulation [7]. Adding just one serving of meat was correlated with a 32% higher chance of developing ovulatory infertility, particularly if the meat was chicken or turkey [7]. However, replacing carbohydrates with vegetable protein demonstrated a protective effect [7].

Eat more oily foods (unsaturated fats)- consuming saturated trans fats in the diet instead of monounsaturated fats has been demonstrated to drastically increase the risk of ovulatory infertility [8].

Reduce alcohol and caffeine– High consumption of alcohol [9] or caffeine [10] have been linked to reduced fertility.

Try a nutritional supplement– Females who take multivitamins are less likely to experience ovulatory infertility [11].


Moderate exercise has been shown to improve fertility when coupled with weight loss in obese women [12]. However, excessive exercise can negatively affect the reproductive system [13]. When energy demand exceeds dietary energy intake, a negative energy balance may occur and may lead to menstrual cycle problems, particularly among female athletes [14].

 


Boost self-esteem and reduce stress hormone levels– Infertility itself is stressful, and can damage a couple’s self-esteem, due to the societal pressures, testing, diagnosis, treatments, failures, unfulfilled desires, and even the financial costs with which it is associated [15].

Males who experienced more than two stressful life events before undergoing infertility treatment were more likely to be classified below WHO standards for sperm concentration, motility, and morphology [16].

There was a higher conception rate for females who were part of a cognitive behavioral intervention group (55%) or a support group (54%) than for those who were not receiving any intervention (20%) [17]. Females who receive support and counseling may reduce their anxiety and depression levels, and increase their chances of becoming pregnant [18].

A possible explanation for these associations may lie in stress hormone levels [19]. This study also suggests that couples attempting to conceive should try relaxing and reducing exposure to stress triggers, in an effort to increase fertility [19].


In the UK, unexplained infertility accounts for around 25% of cases of infertility. This is where no cause can be identified in either the woman or man. If a cause for your fertility problems hasn’t been identified, talk to your doctor about the next steps.

The NICE guidance has more about unexplained infertility.

Find out more about fertility tests and how problems are diagnosed.

If you have tried the suggested tips and tricks for at least 1 year, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing hormone-related infertility- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

  1. NHS. (2017) Infertility. [ONLINE] Available at: http://www.nhs.uk/Conditions/Infertility/Pages/Causes.aspx. [Accessed 20 April 2017].
  2. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. (2007) Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol Nov;110(5):1050-8. PubMed PMID: 17978119
  3. Broughton DE, Moley KH. (2017) ‘Obesity and female infertility: potential mediators of obesity’s impact’. Fertil Steril Apr;107(4):840-847. doi: 10.1016/j.fertnstert.2017.01.017. Epub 2017 Mar 11. Review. PubMed PMID: 28292619.
  4. Practice Committee of the American Society for Reproductive Medicine. (2015) Obesity and reproduction: a committee opinion. Fertil Steril. Nov;104(5):1116-26. doi: 10.1016/j.fertnstert.2015.08.018. Epub 2015 Oct 1. PubMed PMID: 26434804
  5. Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, Goldfarb JM, Muasher SJ. (2016) Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008-2010 Society for Assisted Reproductive Technology registry. Fertil Steril Mar;105(3):663-9. doi: 10.1016/j.fertnstert.2015.11.008. Epub 2015 Nov 25. PubMed PMID: 26627120
  6. Campbell JM, Lane M, Owens JA, Bakos HW. (2015) Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reprod Biomed Online Nov;31(5):593-604. doi: 10.1016/j.rbmo.2015.07.012. Epub 2015 Aug 10. Review. PubMed PMID: 26380863
  7. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2008). Protein intake and ovulatory infertility. American Journal of Obstetrics and Gynecology, 198(2), 210.e1–210.e7. http://doi.org/10.1016/j.ajog.2007.06.057
  8. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. (2007) Dietary fatty acid intakes and the risk of ovulatory infertility. Am J Clin Nutr 85:231–237
  9. Eggert J, Theobald H, Engfeldt P. (2004) Effects of alcohol consumption on female fertility during an 18-year period. Fertil Steril Feb;81(2):379-83. PubMed PMID: 14967377
  10. Hakim RB, Gray RH, Zacur H. (1998) Alcohol and caffeine consumption and decreased fertility. Fertil Steril Oct;70(4):632-7. Erratum in: Fertil Steril 1999
    May;71(5):974. PubMed PMID: 9797089.
  11. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. (2008) Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertil Steril. 89:668–676. doi: 10.1016/j.fertnstert.2007.03.089
  12. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. (1998) Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod Jun;13(6):1502-5. PubMed PMID: 9688382
  13. Redman LM. (2006) Physical activity and its effects on reproduction. Reprod Biomed Online May;12(5):579-86. Review. PubMed PMID: 16790101
  14. Warren MP, Perlroth NE. (2001) The effects of intense exercise on the female reproductive system. J Endocrinol Jul;170(1):3-11. Review. PubMed PMID: 11431132
  15. Anderson K, Nisenblat V, Norman R. (2010) Lifestyle factors in people seeking infertility treatment – A review. Aust N Z J Obstet Gynaecol Feb;50(1):8-20. doi: 10.1111/j.1479-828X.2009.01119.x. Review. PubMed PMID: 20218991
  16. Gollenberg AL, Liu F, Brazil C, Drobnis EZ, Guzick D, Overstreet JW, Redmon JB, Sparks A, Wang C, Swan SH. (2010) Semen quality in fertile men in relation to psychosocial stress. Fertil Steril Mar 1;93(4):1104-11. doi: 10.1016/j.fertnstert.2008.12.018. Epub 2009 Feb 24. PubMed PMID: 19243749
  17. Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, Freizinger M. (2000) Impact of group psychological interventions on pregnancy rates in infertile women. Fertil Steril Apr;73(4):805-11. Erratum in: Fertil Steril 2000 Jul;74(1):190. PubMed PMID: 10731544
  18. Terzioglu F. (2001) Investigation into effectiveness of counseling on assisted reproductive techniques in Turkey. J Psychosom Obstet Gynaecol Sep;22(3):133-41. PubMed PMID: 11594714
  19. Buck Louis, G. M., Lum, K. J., Sundaram, R., Chen, Z., Kim, S., Lynch, C. D., … Pyper, C. (2011). Stress Reduces Conception Probabilities across the Fertile Window: Evidence in Support of Relaxation. Fertility and Sterility, 95(7), 2184–2189. http://doi.org/10.1016/j.fertnstert.2010.06.078

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