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Infertility is defined as the failure to conceive after a year of unprotected and unrestricted intercourse. In women over 35, the period is defined as six months. Primary infertility is when a couple has never had children, whereas secondary infertility refers to couples who have had children together but are at present unable to conceive.

Causes of infertility

The causes of infertility are equally split between male, female and unknown causes.

Male causes

• Oligospermia/azoospermia
• Varicocele
• Prostatic infection
• Majority of sperms are inactive or non-motile
• Blockage of the reproductive tract, following surgery or injury

Reduction in sperm quality or quantity may be idiopathic, or a result of conditions such as:

• Congenital – Klinefelter’s syndrome
• Acquired:
  • Infections of the male reproductive tract
  • Alcohol or drug abuse
  • Exposure to environmental pollutants
  • Smoking
  • Following mumps orchitis
  • Chronic illnesses such as kidney disease
  • Testosterone underproduction
  • Medications
  • Chemotherapy/ radiation
  • Heat exposure to the testes, such as overly warm tubs, use of a laptop on the lap for long periods, varicoceles.
  • Impotence or premature ejaculation

Female causes

• Anovulation
  • Polycystic ovarian syndrome, a metabolic disease in which infertility is often associated with diabetes and obesity.
  • Primary ovarian failure
• Blockage of the fallopian tubes, due to endometriosis, pelvic inflammatory disease, ectopic pregnancy, or surgery.
• Uterine developmental abnormalities, fibroids, or adhesions.

Anovulation may be due to many factors, including:

• Age
• Smoking
• Alcohol abuse
• Stress
• Obesity
• Malnutrition

Diagnosis of the cause of infertility

In men, testing starts with semen analysis, and hormonal assays if indicated, as when sperm counts are very low.  

In women, ovulation is tested for, either at home, using means such as basal body temperature or cervical mucus tests, or in hospital, with an ultrasound or blood tests.

If ovulation is present, tests may be performed to rule out tubal or uterine blockages and assure normal uterine anatomy.

If ovulation is absent, hormonal levels are checked, as well as metabolic parameters.

Treatment

Treatment is based on:

• The couple’s age
• The period of infertility
• The test results, showing any abnormalities, if present.
• The health of the couple

Treatment includes:

• Medication for obvious problems, such as anovulation or infection.
• Surgery for blockages or for varicoceles.
• Impotence or premature ejaculation require behavioral and medical therapy.
• Other modes of treatment such as:
  • Artificial insemination
  • Assisted reproductive technologies, such as in vitro fertilization, intracytoplasmic sperm injection, or gamete intra-fallopian transfer.

ART is costly, time-consuming and carries a relatively higher risk of certain birth defects, such as heart, digestive and cleft lip/palate problems.

More modern choices include the use of a surrogate mother or a gestational carrier.

References

• https://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.html
• http://www.hhs.gov/opa/reproductive-health/general-reproductive-health/infertility/
• https://www.health.ny.gov/publications/1128/
• https://www.nlm.nih.gov/medlineplus/infertility.html
• http://umm.edu/health/medical/reports/articles/infertility-in-women

Further Reading

• All Infertility Content
• What Causes Infertility?
• Infertility Prevalence
• Infertility Treatments
• Infertility Ethics

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.