Harvard Mental Health Letter

Conditions that affect fertility

There are many reasons why a couple may have difficulty in conceiving a child. Disease, drugs, heredity, lifestyle habits or even exposure to certain toxins can affect fertility. Reasons for diminished reproductive capacity include:

  • Endometriosis — This condition affects a woman's pelvic cavity, where tissue fragments from the innermost lining of the uterus (the endometrium) grow and function outside the uterus. They are one of the causes of painful menstruation and infertility. These displaced pieces of tissue are not shed vaginally with normal menstrual blood but instead accumulate inside the pelvis on the surface of pelvic organs. If they cause scar tissue on the ovaries or at the ends of the fallopian tubes, the scar tissue can block the tubes and prevent the egg and sperm from meeting inside the tubes for fertilization. In some instances, endometriosis can be surgically removed. Drugs can reduce discomfort related to endometriosis but are less successful at improving fertility.
  • Reproductive tract infections — A leading cause of infertility in both men and women is sexually transmitted diseases (STDs) — particularly chlamydia and gonorrhea. If untreated — and many infected women have no symptoms — scarring or damage of the fallopian tubes may cause infertility. In men, an STD can lead to scarring and blockage of the ejaculatory ducts and other reproductive structures, thereby causing infertility.
  • Pelvic inflammatory disease (PID) — This infection of a woman's upper reproductive system involves the fallopian tubes, uterus and ovaries. The most common cause of PID is an STD, but it may also occur after complications from an abortion, dilatation and curettage (D&C) surgery, childbirth or even use an intrauterine device (IUD). A single episode of PID is associated with approximately a 15 percent risk of infertility. A second episode doubles infertility risk to about 30%. For three or more episodes, the risk rises to more than 50%.
  • Female hormonal imbalances — If your female hormones fail to transmit their chemical signals at precisely the right time, ovulation may be irregular, infrequent or fail to occur. Periods will likely be erratic and unpredictable. Female hormonal imbalances can often be treated with fertility drugs.
  • DES exposure. — Men and women exposed in the womb to diethylstilbestrol (DES), a drug used in the past to prevent miscarriages, may find that their fertility is compromised. DES daughters may have reproductive system abnormalities — including an unusually shaped uterus or vagina or abnormal fallopian tubes. These abnormalities can cause ovulation problems in some women, as well as an increased risk of miscarriage, premature delivery and ectopic pregnancy. The data related to sons with DES exposure are not conclusive. Some studies suggest an association with low sperm counts or abnormal sperm, undescended testicles or abnormal openings of the urethra.
  • Varicocele — This condition of dilated scrotal veins affects one or both testicles. These dilated, varicose veins are quite common in fertile as well as infertile men. This condition can raise the temperature in the testicles and alter sperm production, causing low sperm counts. Because varicoceles do not always explain a couple's infertility, a urologist will consider all the possible causes of infertility to evaluate whether corrective surgery has a reasonable chance of success.
  • Prostatitis — Another potential cause of male infertility, prostatitis is an infection in the prostate gland. Symptoms range from none to urgency, painful urination, and pain during or after ejaculation, with or without pain in the prostate. Prostatitis can usually be diagnosed though a physical examination and lab tests, and may be require treatment with antibiotics.
  • Caffeine — Some women who consume an excessive amount of caffeine — equivalent to five cups of coffee per day — take longer to get pregnant. In one study, those who consume the most caffeine had a 45% risk of waiting more than nine months before becoming pregnant.
  • Alcohol — For the mother-to-be, alcohol decreases conception rates and increases the risk of miscarriage.
  • Smoking — Chemicals in cigarette smoke may reduce a man's ability to conceive. Women who smoke also may have trouble getting pregnant and experience higher rates of miscarriage compared to women who don't smoke.
  • Social drugs — Marijuana and cocaine may reduce sperm count and motion, and increase the percentage of defective sperm.
  • Heat — There's also evidence that prolonged exposure to heat in hot tubs, saunas or steam rooms produces high scrotal temperatures, which may decrease the number and function of a man's sperm.

What You Can Do

Obviously, some cases of infertility — such as those caused by disease and heredity — can't be controlled without a physician's assistance, if at all. But in "borderline" cases of not being able to conceive, there are certain measures that can be tried. Besides giving up drugs, including smoking and alcohol, and altering other potentially negative lifestyle habits that may decrease fertility, some experts suggest that you and/or your partners try these self-help treatments:

Get new underwear

Hot water isn't the only way to produce high scrotal temperatures, which may decrease sperm production. When having trouble fathering a child the male partner may want to switch to boxer shorts, since briefs keep the testicles closer to the body. Having testicles "hang" can keep them cooler.

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