Causes of infertility
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There can be many reasons why couples fail to conceive. In 30% of cases there is a male factor involved; in 30% of cases there is a female issue. In some cases, the fertility problem is unexplained and it may not be possible to identify the precise cause
The main causes of fertility problems in women are due to the following:
The main causes of infertility in men are:
Around 25% of cases of female infertility are due to blockage of the fallopian tubes. Normally the fallopian tubes pick up the egg as it is released during ovulation. The sperm fertilizes the egg in the fallopian tubes. Damaged or obstructed fallopian prevent this movement so fertilisation cannot take place. Fallopian tubes can be damaged by:
There is a strong relationship between endometriosis and sub fertility. While some 10% of women suffer from the disease, this rises to 35% for women with fertility problems.
The disease gets its name from the word endometrium, which is the tissue that lines the inside of the uterus and which is shed each month during menstruation. Endometriosis is caused by the presence of this tissue in places other than the uterus.It is most frequently found in the ovaries, fallopian tubes, the ligaments which support the uterus and the lining of the pelvic or abdominal cavity. This tissue is sensitive to the hormonal changes that occur during menstruation, the source of the symptoms associated with the disease. Although some patients may not have any symptoms, the most common ones are pain and infertility. Pain may only occur during menstruation, but there can also be gastrointestinal and urinary symptoms, if endometrial tissue invades other areas such as the intestine, the bladder or the colon.
Infertility related to endometriosis can arise from the changes which occur in the pelvic anatomy of patients during their menstrual cycles. It can cause obstruction of the tubes or the formation of ovarian cysts, which sometimes require surgery and so result in the loss of ovarian tissue and decreased fertility. There are medical and surgical treatments available and in many cases becoming pregnant can check the progress of the disease.
Endometriosis is usually diagnosed by undergoing a surgical procedure called a laparoscopy. If endometriosis is present in the ovaries it can be sometimes be detected using ultrasound. Ovarian cysts caused by endometriosis are known as a chocolate cysts or endometriomas.
Whether or not surgery is essential before fertility treatment is something that you will need to discuss with your gynaecologist. It will depend on the size of the chocolate cysts and your ovarian reserve and on the response capacity of the affected ovary. IVF is an appropriate treatment for fertility associated with endometriosis when other techniques have not been successful.
There is a common belief that pregnancy can cure endometriosis. This is not true, but during pregnancy the symptoms of endometriosis may be temporarily suppressed.
Around 20% of women have polycystic ovaries (PCO). The term refers to the increase in the number of small cysts (antral follicles) on the surface of the ovary. These can be detected with an ultrasound scan. There are a great many women with PCO who have no problems ovulating and getting pregnant. However, some women who have this characteristic ultrasound scan pattern also have the condition known as Polycystic Ovarian Syndrome (PCOS). These women have irregular menstrual cycles or even a lack of menstruation and have problems getting pregnant.
Anovulation is when the ovaries fail to produce, mature or release an egg.
Factors that can contribute to anovulation include: stress, significant weight gain or loss, excessive production of prolactin (the hormone responsible for producing breast milk) and polycystic ovaries. Approximately 35% of women experience anovulation at some time during their lives. The origin of this hormonal disorder may be in the hypothalamus, a part of the brain that controls hormonal function, the pituitary gland, or in the ovary itself.
To study male fertility, the number, motility and shape of the spermatozoa are analysed. The World Health Organization (WHO) reference values for a normal semen analysis is a sperm count of at least 15 million sperm per ml, with at least 32% of the sperm having progressive motility and at least 4% having a normal shape. If the sperm count or motility is lower than this the chances of a pregnancy occurring naturally is reduced.
The main causes of a low sperm count are: problems in the glands in the brain (the pituitary gland and the hypothalamus) which produce the hormones regulating the formation of spermatozoa; genetic disorders (Klinefelter syndrome, alteration of the genes on the Y-chromosome that regulate the formation of spermatozoa, etc.); or various testicular problems such as lack of development, anomalous development, failure to descend into the scrotum, etc.
Spermatozoa can show anomalies in their motility (astenozoospermia), shape (teratozoospermia) or vitality (necrozoospermia).
