“Chemotherapy or pelvic radiation can cause rapid loss of eggs and some women may have an earlier menopause,” says Westphal. She recommends speaking with a fertility specialist prior to cancer treatment in order to discuss your fertility preservation options. (Some of these options include IVM, ovarian transposition, and ovarian tissue cryopreservation.)

Signs of Infertility in Men

Infertility in men can be more difficult to pinpoint due to a lack of obvious symptoms. However, according to Westphal, infertility in men accounts for roughly a third of all cases (another third are related to the female partner, with the final third pointing to both), and is just as important to diagnose and potentially treat.

Swelling or Pain In the Testicular Area

One of the easiest symptoms of infertility to diagnose is swelling or pain in the testicular area. There are a number of reasons for this (including infections, fluid buildup, trauma, and cancer), but not all necessarily indicate infertility.

Another cause, however, is varicoceles—an enlargement of the veins in the scrotum. “This can cause overheating of the testicles and lead to lower sperm production,” says Westphal. “About 15% of men have varicoceles, but most will have not had fertility problems.” If it is associated with infertility, surgery can likely correct it, she adds.

Ejaculatory Dysfunction

Men who experience ejaculatory dysfunction of any kind (such as premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation) may struggle with infertility.

Take retrograde ejaculation, which is when the sperm can stream into the bladder instead of out the penis. “Health problems like diabetes or a spinal cord injury can cause this, or previous surgery on the bladder, prostate, or urethra,” Westphal says. Medications can sometimes help, she explains, as well as finding other ways to retrieve the sperm to use for IVF.

As far as premature ejaculation, a study in Reproductive Medicine and Biology found it usually doesn’t affect fertility, but often co-occurs with fertility struggles. (Retrograde ejaculation and anejaculation are more likely to actually cause infertility.)

Low Sperm Count

Issues with semen and sperm count are sometimes related to ejaculatory dysfunction issues. Other times, low sperm counts are due to infections (like epididymitis, orchitis, and certain STDs).“Some infections can affect sperm production or cause scarring that could block the passage of sperm,” says Westphal. She also mentions that certain medications, like ones to treat high blood pressure, depression, arthritis, and cancer can affect both sperm production and/or delivery. “Testosterone replacement or medication to treat prostate enlargement (BPH) can reduce sperm, too. When possible, stopping or switching to another medication may help improve sperm,” she adds. Always talk to your doctor before making any changes in medication.

Additional causes include anti-sperm antibodies, hormone imbalances, chromosome defects, tumors, celiac disease, certain medications, and previous surgeries.

Fortunately, many of these causes of low sperm count and infertility are treatable. Infections (like gonorrhea) can be treated with antibiotics. Hormone treatments can be offered, surgeries can be performed to correct certain issues, and medications can be prescribed for others. Additionally, assisted reproductive technology can be used to obtain or extract sperm for IVF.

Unhealthy Lifestyle

Just like in women, taking lifestyle choices that negatively affect personal health can often cause issues that affect fertility in men. “Tobacco smoking, marijuana use, and alcohol use can decrease sperm production,” says Westphal.

Tobacco is well-known to negatively impact fertility, sometimes causing abnormal sperm morphology among other things. Alcohol also has deleterious effects on male fertility, including reducing testosterone levels and affecting other hormones. And studies have also shown that cannabis use can reduce sperm count and concentration, among other things. Additionally, obesity has been linked to hormone issues that can cause infertility, though these seem to be reversible. Overall, it’s advised to reduce or eliminate use of substances such as the ones noted, and actively make health-conscious lifestyle choices (such as exercising and reducing stress) in order to improve fertility.

Experiences of infertility always have one thing in common: uncertainty. The countless visits to doctors, the months (or years) of planning, the tens of thousands of dollars, never add up to a guarantee. Even under the best of circumstances, there’s only so much about a pregnancy you can plan, and in the midst of a global pandemic, the idea of planning anything seems foolish. For National Infertility Awareness Week, we’re exploring the uncertainty—and the hope.

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