Symptoms of infertility and when to go in for a test

Nothing in this article is or should be construed as medical advice; for any medical questions, consult your healthcare professional.

From ultrasound photos and birth countdowns flooding your Insta feed to baby showers every other weekend, it seems like everyone you know is expecting. Everyone but you. And maybe you're just beginning your journey to parenthood, so you like every picture, and you happily attend every celebration...Or maybe you've been trying for a while now, and while your heart is filled with joy for your friends and family, it's also filled with concern.

What if? What if you can't get pregnant? What if you and your partner find yourselves among the 19% of couples who face infertility after a year of trying to conceive? ¹

What is infertility?

Millions of people around the world struggle with infertility, with the World Health Organization (WHO) estimating that 1 in 6 individuals experience infertility worldwide. ² It’s defined as the inability to conceive after 12 months or more of regular, unprotected intercourse. ² It can affect anyone and has many causes, some preventable, some treatable, and some unknown.

Symptoms of infertility

Research shows that in couples struggling to conceive, infertility causes are equally attributed to both partners: ³

• 30% due to female factors
• 30% due to male factors
• 30% due to a combination of both
• 10% due to causes unknown

While the primary sign of infertility is the inability to get pregnant, other symptoms may appear beforehand in both men and women.

Symptoms indicating infertility in women

Several factors can contribute to infertility. While the symptoms listed below reported by a patient may sometimes be precursors to future conception struggles, they can also be signs detected by a healthcare professional of other underlying health conditions. Therefore, consulting a healthcare professional, or even a fertility specialist, is always recommended.

These are the most common symptoms reported regarding infertility in women:

• Irregular periods⁴
  Irregular periods can hinder ovulation and potentially indicate conditions like polycystic ovary syndrome (PCOS), both of which impact fertility.
• Heavy or prolonged bleeding⁴
  A particularly heavy or long menstrual cycle can indicate endometriosis - a condition where endometrial-like tissue grows outside the uterus.
• Pain during sex⁴
  Painful sex (dyspareunia) can signal infections, endometriosis, or fibroids, which may affect fertility.
• Hormonal imbalances⁴
  Hormonal imbalances or changes can disrupt the reproductive health process, preventing pregnancy.
• Dark menstrual blood⁴
  Consistently dark menstrual blood can be a sign of endometriosis.

Symptoms indicating infertility in men

As with female infertility, male infertility has multiple causes and requires evaluation by a healthcare professional. These are the most common factors reported regarding infertility in men: 

• Erectile dysfunction⁴
  Erectile dysfunction (ED), due to hormonal, psychological, or physical issues, can prevent conception by hindering intercourse.
• Ejaculation problems⁴
  Hormonal changes, psychological factors, or physical issues may hinder intercourse and prevent conception.
• Changes in testicles⁴
  Healthy testicles are essential for male fertility and any changes such as swelling, pain, tenderness, or abnormal size may signal problems that can affect the sperm.
• Low libido⁵
  This can be caused by low testosterone which can signify a hormonal imbalance.
• Reduced sperm count or motility⁶
  Effective sperm motility is crucial for fertilization; immotile sperm may not reach the egg.

Are you overlooking these other key factors?

Beyond your family history and past medical issues, lifestyle choices can play a role in fertility. Things such as alcohol, tobacco or drug consumption, stress, and a poor diet can all wreak havoc on your body, impacting your ability to get pregnant. Here are key factors that may affect your fertility:

• Substance use⁷
  Drinking alcohol, smoking tobacco or marijuana, or using other drugs have been proven to reduce fertility in both men and women.
• Stress ⁷
  High blood pressure is associated with abnormal sperm morphology.
• Obesity ⁷
  Obesity negatively impacts sperm count and quality in men, while in women, it can lead to hormonal imbalances and exacerbate the symptoms of PCOS.
• Being underweight ⁷
  If your body weight is too low to be considered healthy, this may result in ovarian dysfunction.
• Excessive physical activity ⁷
  Strenuous exercise can negatively impact both sperm production and ovulation.
• History of STIs ⁸
  STIs can cause infections that spread, damaging reproductive organs and leading to infertility through scarring and inflammation.
• Age ⁹
  Fertility steadily declines for women after 35, while men's sperm quality decreases, especially after 60.

How is infertility diagnosed?

Because infertility can stem from either partner, diagnosis typically involves a comprehensive evaluation of both parties by a healthcare professional.

Female infertility diagnosis

During your initial consultation, a healthcare professional will review your medical and sexual history. In order to diagnose you, your doctor may recommend some tests, such as a pelvic exam, blood tests, a transvaginal ultrasound, and a hysteroscopy. These tests help provide a clearer picture of your reproductive health.¹⁰

Male infertility diagnosis

While female infertility diagnosis centers primarily on the woman's reproductive process, diagnosing male infertility is done by assessing sperm health. In addition to reviewing his medical and sexual history, this evaluation typically includes a semen analysis (to check sperm quality, quantity, and motility), blood tests, and scrotal and/or rectal ultrasound.¹⁰

What's next? Exploring your treatment options

If you're under 35 and haven't conceived after a year of trying, or over 35 and haven't conceived after six months, it's time to talk to your doctor.¹⁰ The risk of infertility increases with age and certain environmental and lifestyle factors, but there exist many treatment options to help you try and get pregnant.

Infertility treatments for women may include lifestyle changes (such as weight loss), fertility medications to stimulate ovulation, surgery to correct physical roadblocks (such as blocked fallopian tubes or polyps), and ovulation tracking.

For men, treatment options may include hormone therapy, erectile dysfunction medication, and surgery to correct blockages.

For some, depending on their circumstances, a doctor may recommend further treatments such as:

• In Vitro Fertilization (IVF)¹⁰
  Embryos, created in a lab by fertilizing retrieved eggs, are transferred to the uterus.
• Intrauterine insemination (IUI)¹⁰
  Also referred to as artificial insemination, sperm is placed directly into the uterus using a thin tube.
• Third-party assisted reproductive technology (ART)¹⁰
  The use of donor eggs, sperm, embryos, or surrogates.

Unraveling the complexities of fertility can be lengthy, but it’s important to stay positive. In 85-90% of cases, infertility can be successfully resolved through lifestyle changes, medication, assisted reproductive technology (ART), or surgery.¹⁰ Partnering with your healthcare professional to determine the best course of action for you is an important step in the right direction.

Related Articles

• https://www.clearblue.com/how-to-get-pregnant/age-and-fertility
• https://www.clearblue.com/how-to-get-pregnant/does-endometriosis-cause-infertility
• https://www.clearblue.com/fertility/can-hormonal-imbalance-cause-infertility