Causes of Infertility

Pregnancy is an important part of womanhood. For those who wish to have a baby, it becomes a special time of anticipation and preparation to bring new life. Unfortunately for many women, getting pregnant can be a daunting task filled with countless trials, numerous visits to the doctor and continuous regret. It is important to understand that the process of getting pregnant is both delicate and complicated; it requires proper timing, a hospitable internal environment and even still luck.

Male Factor

Infertility is medically defined as the inability to conceive after multiple sustained attempts of unprotected sex for at least 12 months. This condition has multiple causes, both male and female. Surprisingly the most common cause is attributed to male abnormalities rather than female. Semen analysis remains the cornerstone for evaluation in male partners. It is a simple non-invasive procedure, which analyses the semen for sperm concentration, sperm motility, sperm morphology, and various other parameters.

Female Factor: Tubular Dysfunction

Female causes of infertility can be exhaustive; however the most common female cause of infertility is tubular dysfunction. Scarring of the fallopian tubes due to surgery, or pelvic inflammatory disease, can lead to a blockade within the fallopian tubes thus preventing the fertilised egg from implanting properly within the uterus. Diagnostic tests which are helpful in diagnosis, include a hysterosalpingogram and a laparoscopy. A hysterosalpingogram is a fancy type of X-ray, which uses special contrast dyes to highlight structural abnormalities. A laparoscopy is a special video camera, which is tunneled through the vagina, up the uterus and through the fallopian tubes to visualise the structural defects. This procedure is highly invasive and requires the use of anesthetics.

Female Factor: Uterine Dysfunction

The uterus is another important component in the female reproductive system. It is the site where the fertilised egg will implant and continue to grow for nine months. Abnormalities in the uterus can also be a common cause for infertility. Fibroids are benign tumors of the uterus, which can grow substantially in size leading to infertility.

Endometritis, and endometriosis are different conditions, which affect the lining of the uterus. In these conditions scar tissue can form which can effect the implantation and thus be a cause for infertility. Ultrasound, hysterosalphingogram and laparoscopy can help detect these conditions too.

Female Factor: Ovarian Dysfunction

Ovarian causes of infertility can be divided in to primary and secondary. Primary conditions are often diagnosed in the early adolescent years when patients fail to menstruate. This may be due to nonfunctional ovaries as in Turners syndrome, or the absence of internal reproductive structures altogether (gonadal dysgenisis). These cases are rare, but need to be evaluated with chromosome analysis. Secondary causes can be due to hormonal abnormalities such as thyroid dysfunction, advanced maternal age i.e. over 35 and disease of the ovaries such as ovarian cancer and polycystic ovarian disease. In such cases a full endocrine work up needs to be done, to check hormone levels within the blood. If ovarian disease is suspected a pelvic ultrasound will be needed in addition to more specific and more invasive procedures to establish a specific ovarian cause.

Female Factor: Cervical Dysfunction

Cervical mucus is a substance secreted within the vagina in response to various hormones within the blood. The characteristics of this substance change in response to reproductive hormones such as oestrogen. Inappropriate changes in the cervical mucus can lead to a hostile environment for the sperm. Cervical mucus incompatibility accounts for approximately 5% of female infertility. A post-coital test is done hours after intercourse and can help assess weather the cause of infertility is related to cervical mucus incompatibility. This test analyses the mucus for volume, consistency, PH and viscosity. If the PH is too acidic as in bacterial and yeast infections, the sperm will die off prematurely. If the cervical mucus is highly viscous then the sperm will have a difficult time penetrating their way to the egg.

Communicate with Your Doctor

Infertility is an extremely serious condition effecting couples of all ages. Its cause is rooted in both partners; as such both partners need to be evaluated. Providing a detailed medical history can lend the evaluating physician a guiding light towards unveiling the cause. By determining the cause of the infertility, different options can be explored specific to each individual couple. Recent advances in medicine have led to effective treatment methods for infertility such as, in-vitro fertilisation, sperm banks and medications. It is important to discuss these options as well as the associated risks with your doctor. With a little knowledge, a loving environment and a lot of luck, the dream of becoming pregnant may soon become a reality.