Reasons for infertility

One of the most common causes of sub fertility is in fact unexplained, no cause found. Other common fertility problems include tubal disease and ovulatory problems in the woman and sperm problems in the man. It has been clearly proven that success of any fertility treatment declines as a woman gets older and it is therefore important to make a diagnosis on the cause of infertility so that appropriate treatment can be implemented if required.

Female issues

Ovulation problems in women can occur because of a few different underlying conditions, these are:

  1. Polycystic ovary syndrome – Due to cysts forming in the area the ovaries struggle to produce an egg. Polycystic ovary syndrome can be vastly improved in overweight women if they return to a more healthy weight, Ovulation stimulating drugs such as clomifene, gonadotrophins can help as well as IVF.
  2. Thyroid problems – overactive and underactive thyroids can prevent ovulation however your doctor can help control your thyroid function before you attempt pregnancy so that your chances of conceiving area higher.
  3. Womb and Fallopian tubes – The egg is fertilised as it travels through the fallopian tube and then forms fully once it is in the womb. Therefore these two areas are crucial to conception occurring naturally, several conditions in these areas can prevent pregnancy occurring correctly. For issues around ovulating, any condition that prevents the release of an egg from the ovary, ovulation-stimulating drugs can be used, suppressants like bromocriptine and IVF with fertility drugs can all help with achieving pregnancy.
    1. Pelvic or cervical surgery can leave scarring that damage the fallopian tube or the womb.
    2. Mucus in the cervix should become thinner so that sperm may travel through it easier so if there is an issue with the mucus it can inhibit fertility.
    3. Fibroids are non cancerous tumours, when they develop in or around the womb they can reduce the chances of conception. For further information on the best gynaecologist to help you with your fibroids can be found here.
    4. Endometriosis can affect your fertility because it causes parts of the womb to start growing in other places, this means that these sticky areas of tissue can interrupt the egg’s path. Treatment for Endometriosis is usually laparoscopic surgery to remove abnormal tissue or unblock tubes. In order to achieve pregnancy fertility drugs with intrauterine insemination for mild endometriosis or IVF for more severe cases are used.
    5. Pelvic inflammatory disease, which is often a result of an STI, causes damage and scaring to the fallopian tubes through infection. This makes it considerably harder for the egg to travel to the womb.
  4. Eggs that are damaged or develop chromosomal abnormalities cannot sustain a pregnancy, this problem is usually age related as egg quality declines in the late 30s. Poor egg quality can be solved by using donor eggs or embryos in IVF treatment
  5. Long term medication and drugs can also affect attempts at pregnancy. There are several types that have a serious affect, these are:
    1. The medication used for chemotherapy can sometimes cause damage to the ovaries
    2. Antipsychotic medicines for the treatment of psychosis can lead to missed periods or infertility.
    3. Medicine used to treat fluid retention like spironolactone can cause temporary infertility however everything should return to normal two months after the medication is stopped.
  6. After menopause a woman’s ability to become pregnant naturally diminishes however there are several other options, such as IVF, that can help pregnancy still be a reality.
  7. Asherman’s syndrome that is undiagnosed can often cause a miscarriage or problems with fetal growth due to the adhesions in the in the uterus. It can also affect fertility through the lack of menstrual periods caused by damage done to the uterine lining or by the obstruction of the cervix or lower portion of the uterus, therefore the menses are either retained in the uterus or cause endometriosis by flowing into the abdominal cavity.

Male issues

In men there are also several different factors that can make conception harder. These are usually due to issues in the testicles or the semen.

  1. In the semen there can be three different types of issues. The sperm can lack mobility, lack quantity or be abnormal in which case they struggle to reach and fertilise the egg. Fertility drugs may boost sperm production. Other options include intrauterine insemination and semen insemination or injecting sperm directly into the egg (ICSI).
  2. The reasons for the testicles to cause a problem in male fertility comes from a previous infection, testicular cancer or surgery, a congential defect of undescended testicles.
  3. Previous radical prostate cancer surgery also causes male infertility.
  4. Like with woman various medicines and drugs can cause problems.
    1. Anabolic steroids reduce sperm count and mobility if used over a long period of time.
    2. The medicines used in chemotherapy can reduce sperm production.
  5. Drinking to much alcohol and taking illegal drugs such as marijuana and cocaine can affect the quality of the semen.
    General issues
    For both men and woman maintaining a healthy weight, avoiding too much stress and refraining from smoking all can improve the chances of fertility.

More information & further reading

High concentrations of CA 125 in uterine flushings: influence of cause of infertility and menstrual cycle day. – 2002
Hamilton JA, Iles RK, Gunn LK, Wilson CM, Lower AM, Grudzinskas JG.