Infertility

What causes infertility?
Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
There are two kinds of infertility – primary and secondary:
Primary infertility means that the couple has never conceived. Secondary infertility means that the couple has experienced a pregnancy before and failed to conceive later. Globally, most infertile couples suffer from primary infertility.
Sexually transmitted infections are the leading preventable cause of infertility by causing 70% of pelvic inflammatory diseases responsible for tubal damage. Low fertility is becoming more common worldwide, particularly in many urban settings where women are planning their first babies at older ages.
The inability to have children affects couples and causes emotional and psychological distress in both men and women. Despite the various social, psychological, economic and physical implications, infertility prevention and care often remain neglected public health issues, or at least they rank low on the priority list, especially for low-income countries that are already under population pressure. But in recent years there is increased awareness to integrate infertility prevention, care and treatment into the basic health care services.

For a woman, infertility can manifest itself as either :
the inability to become pregnant
an inability to maintain a pregnancy
an inability to carry a pregnancy to a live birth.

Causes
Infertility can be caused by both men and women factors. About a third of infertility problems are due to female infertility and another third are due to male infertility. In remaining cases infertility may be due to problems in both partners or the cause is unclear.

Female infertility can be caused by a number of factors:

  • Damage to fallopian tubes: Damage to the fallopian tubes (carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Pelvic inflammatory diseases (PID) caused by various infections, endometriosis, pelvic surgery may lead to damage to fallopian tubes. Sexually transmitted infections (STIs) are the common cause of PIDs.
  • Disturb ovarian function/hormonal causes: Synchronized hormonal changes occur during the menstrual cycle leading to the release of an egg from the ovary (ovulation) and the thickening of the endometrium (inner lining of the uterus) in preparation for the fertilized egg (embryo) to implant inside the uterus. Difficulty in ovulation is seen in following conditions –
    Polycystic ovary syndrome(PCOS)
    Polycystic ovary syndrome is the common cause of female infertility. PCOS interferes with normal ovulation.
    Functional hypothalamic amenorrhea: Excessive physical (common in athletes) or emotional stress may result in amenorrhoea (absence of periods).
    Diminished ovarian reserve or premature ovarian aging: women with diminished ovarian reserve may experience difficulty in conceiving, (though blood test will show elevated follicular stimulating hormones).
    Premature ovarian insufficiency: Female ovaries stop working before she is 40 years of age. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation.
  • Uterine causes: Abnormal anatomy of the uterus; the presence of polyps and fibroids may lead to infertility.
  • Cervical causes: A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal due to abnormal mucus production or a prior cervical surgical procedure.

Male factors causing infertility
More than 90% of male infertility cases are due to low sperm counts, poor sperm quality, or both. The remaining cases of male infertility can be caused by number of factors including anatomical problems, hormonal imbalances, and genetic defects. Sperm abnormalities include:

  • Oligospermia (low sperm counts) /Azoospermia (no sperms): sperm count less than 20 million/ml is termed as oligospermia whereas azoospermia refers to the complete absence of sperm cells in the ejaculate.
  • Asthenospermia (Poor sperm motility): If 60% or more sperms have abnormal motility (movement is slow and not in straight line) it is termed as asthenospermia and may cause infertility.
  • Teratospermia (abnormal sperm morphology): about 60% of the sperms should be normal in size and shape for adequate fertility.

Different factors including congenital birth defects, diseases (such as mumps), chemical exposure, and life style habits can cause sperm abnormalities.

Factors that affect the fertility of both sexes include the following:

  • Environmental/occupational factors
  • Toxic effects related to tobacco, marijuana, or other drugs
  • Excessive exercise
  • Inadequate diet associated with extreme weight loss or gain
  • Advanced age
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