Not many are aware that infertility is a common issue among couples in Canada. According to Infertility Awareness Association of Canada (IAAC), one in six Canadian couples struggles to conceive. This problem can range from being unable to conceive to having difficulties bearing children.
“More and more women and couples are delaying childbearing and facing infertility in the later years,” says Dr. Sonya Kashyap, Medical Director of Genesis Fertility Centre. She further explains that couples are putting childbearing on hold to achieve a comfortable life. “Often, infertile couples are educated successful couples whose education, career and partner prospects have led them to delaying childbearing into their later years. Immigrants also delay childbearing until their lives are settled in their new country.”
Factors attached to infertility:
Before moving on to the medical causes of infertility, a few other factors that are connected to this problem need to be addressed – age being one of them. Age is a significant cause of infertility. “As a woman ages, beginning as early as 32 years old, we see fertility declines. The rate of decline is seen to increase at age 35 and even more so past the age of 40. This is due to the egg quantity and quality decreasing with older age,” explains Dr. Gunwant Warraich, Reproductive Endocrinology and Infertilty Specialist at Olive Fertility Centre.
Stress, being another factor in women, may affect natural pregnancy rates especially by affecting ovulation. Also, weight (high or low body mass indices) can affect fertility. “We see higher rates of ovulation problems, sperm abnormalities, increased miscarriages and birth defects due to weight gain,” says Dr. Warraich.
Smoking too has a strong link with infertility. “There is a longer time to conception in smokers versus non-smokers, women who smoke tend to have lower egg counts and earlier menopause, and male smokers have decreased sperm parameters,” shares Dr. Warraich.
Another important factor is the lack of awareness on the problem. Despite infertility being a common problem among Canadian couples, people do not have enough knowledge about it. One of the reasons for this could be due to the stigma attached to infertility. “Unfortunately, infertility is still considered one of those “hush-hush” topics. The most common stigma I see with infertility is that if a couple isn’t conceiving, this is something to be ashamed of,” reveals Dr. Warriach, adding, “I feel that infertility is a medical condition just like any other ‘illness’; there should never be any disgrace associated with it.”
“Obtaining early consultation and education is important,” asserts Dr. Kashyap, adding that infertility is not entirely the woman’s fault as it is equally due to male or female problems. Dr. Warriach agrees saying, “About 40 percent of cases of fertility are caused by female factors, another 40 percent is due to male issues, and the remainder of the time it is a combined female and male issue.”
Causes of infertility
Dr. Kashyap points out some of the medical causes of infertility in men and women:
In Women:
» Obstruction of fallopian tubes occurs most commonly through infection including sexually-transmitted infections. Surgery and endometriosis can also contribute to obstruction of the fallopian tubes.
» Abnormal ovulation for some women means there is no egg released regularly in a menstrual cycle and in some cases, there are no eggs released. Abnormal ovulation is caused by hormonal issues such as thyroid and can be affected by being underweight or overweight leading to weight issues such as polycystic ovarian syndrome.
» Previous cancer treatment particularly chemotherapy and radiation can cause permanent damage to eggs, ovaries and the uterus.
» Egg age: As women age, so do eggs. It becomes harder to become pregnant after age 36-37 and miscarriage rates increase.
In Men:
» A varicocele is an abnormal dilation of veins within the scrotum and is detected on physical examination. It is more common on the left but it can occur on both sides. In addition to infertility, a varicocele can cause discomfort. Generally, it is controversial whether or not a varicocele be corrected if a man is infertile, has an abnormal semen analysis, and there is little or no infertility issue in the female partner.
» Obstruction, or a blockage in the reproductive tract. In addition to varicocele, the most common reason is vasectomy, but other conditions such as trauma, infection or congenital abnormalities can also lead to blockage.
» Medical conditions such as cancer (chemotherapy), diabetes and others affect male fertility in addition to hormone abnormalities and ejaculation problems.
» Disorders in sperm count, motility (swimming ability) and morphology (shape) of sperm are other factors causing infertility in males.
Treatment methods
Both doctors advise seeking medical help or consultation if couples experience trouble conceiving. “Seek help immediately if you are over 38-39 years; six months if you are more than 35 years old; and one year if less than age 35.”
Dr. Warraich adds, “Being referred to a fertility clinic for evaluation is the best initial step. If you know or have been told that you may have difficulty conceiving, my advice would be to not wait the full year and seek help sooner.”
Dr. Kashyap points out some of the treatments available for infertility:
In vitro fertilization (IVF) is the most effective treatment for infertility, although not all cases of infertility require IVF. A thorough consultation and diagnostic work up is needed prior to determining if IVF is the best treatment.
IVF treatment involves taking hormone injections for an average of 10-14 days. During the time of injections, frequent blood tests and ultrasounds are needed to monitor the woman’s response to the injections. At the optimum time, the eggs are retrieved from the ovaries with a needle through the vagina under ultrasound guidance. Later, sperm is added or injected into
the eggs.
The fertilized eggs (embryos) are monitored and one of the embryos of highest quality is transferred at either the 3rd or 5th day of development to the woman’s uterus through the vagina using a fine catheter (tube). Two weeks later, a blood test will determine if there is pregnancy.
Intracytoplasmic sperm injection (ICSI) is used in conjunction with IVF to override low sperm counts or sperm abnormality. A single sperm is injected into the mature egg to increase the chances of fertilization. For men with severely low sperm production, another procedure can be used in addition to ICSI where the sperm are retrieved directly from the testes or epididymis.
Early embryonic viability assessment (EEVA) is used to enhance the selection of the highest quality embryos. This involves continuous time lapse monitoring together with a decision logic model.
Comprehensive chromosomal screening (CCS) or genetic testing of embryos created in vitro can maximize the chance of a success by transferring a chromosomally normal embryo. With this technology, success rates approach 70-80 percent.
Egg freezing is used for women who are about to have cancer treatment. Egg freezing is also an option for women who wish to have children in the future but don’t have a partner or need to delay having children due to the demands of their career. The treatment is the same as IVF with the exception that the eggs are quick frozen (vitrification) after being retrieved. At a future time when the woman is ready, the eggs are thawed, fertilized and one of the highest quality embryos is selected; the same as for IVF.
“Treatment really depends on the cause of infertility and what the couple feel comfortable doing. For some, an intrauterine insemination combined with fertility pills may be the answer. In other cases, IVF may be the only treatment the couple can do,” says Dr. Warriach, however adding that none of the fertility treatments can overcome a woman’s natural age-related decline in fertility.
Infertility clinics also have counsellors to help the couple through the treatment process. Treatment period is usually one to two months. Cost of treatment can range from $500 to $12,000 plus medication costs. “In Canada, consults and work-up for infertility are most often covered, though the treatment may not be,” adds Dr. Kashyap.
“Know you are not alone and there are many ways to help,” sums up Dr. Kashyap. “Treatment options doesn’t mean that the couple should delay having children till they are much older,” warns Dr. Warriach in conclusion.
Some Myths about fertility:
Women should go on bed rest following fertility treatment:
Unless you are told to do this by your doctor, this is not advised.
The birth control pill will lower your fertility:
It is not true. Once you are off the pill for six months, your periods should return to how they were before starting the pill, if this isn’t the case you need to see your doctor.
You can plan on the gender of the baby by having intercourse on certain days:
This method of planning simply does not work; it’s a 50/50 chance of having a girl or a boy.
