Infertility can be due to a problem in either the male or female partner or both. When there is an inability to conceive despite regular attempts for a period of 1 year, the first step is to identify the possible cause.
To become pregnant, each of the following factors is essential:
- Ovulation : Achieving pregnancy requires that your ovaries produce and release an egg, a process known as ovulation.
- Normal sperm count and motility
- You need to have regular intercourse. You need to have regular sexual intercourse during your fertile period.
- Open fallopian tubes and a normal uterus. The egg and sperm meet in the fallopian tubes, and the pregnancy needs a healthy place to grow.
Factors causing infertility in the female :
Problems with ovulation are common causes of infertility, accounting for approximately 25% of all infertility cases. Ovulation involves the release of a mature egg from one of your ovaries. If you have regular menstrual cycles, you are probably ovulating. Cycle lengths of approximately 24 to 34 days (from the beginning of one period to the beginning of the next period) are usually ovulatory. If you only have a period every few months or not at all, you are probably not ovulating or are ovulating infrequently.
These can be caused by hormonal problems either in the hypothalamus or the pituitary gland, or by problems in the ovary itself.
- Polycystic ovary syndrome (PCOS). In PCOS, complex changes occur in the hypothalamus, pituitary gland and ovaries, resulting in a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
- Hypothalamic dysfunction. The two hormones responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are produced by the pituitary gland in a specific pattern during the menstrual cycle. Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt this pattern and affect ovulation. The main sign of this problem is irregular or absent periods.
- Premature ovarian insufficiency. This disorder is usually caused by an autoimmune response where your body mistakenly attacks ovarian tissues or by premature loss of eggs from your ovary due to genetic problems or environmental insults such as chemotherapy. It results in the loss of the ability to produce eggs by the ovary, as well as a decreased estrogen production under the age of 40.
- Too much prolactin. Less commonly, the pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility.
Damage to fallopian tubes (tubal infertility)
When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
- Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to sexually transmitted infections
- Previous surgery in the abdomen or pelvis
- Pelvic tuberculosis
Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may obstruct the tube and keep the egg and sperm from uniting. It can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Uterine or cervical causes
Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage.
- Benign polyps or tumors (fibroids or myomas) are common in the uterus, and some types can impair fertility by blocking the fallopian tubes or by disrupting implantation.
- Endometriosis scarring or inflammation within the uterus can disrupt implantation.
- Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
- Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.
In some instances, all tests appear normal and an apparent cause for infertility is never found. It’s possible that a combination of several minor factors in both partners underlie these unexplained fertility problems.
Factors causing infertility in the male :
In approximately 40% of infertile couples, the male partner is either the sole or a contributing cause of infertility. Therefore, a semen analysis is important in the initial evaluation.
A semen analysis determines the volume (amount), sperm count, motility (movement), and morphology (appearance and shape) of the sperm. In general, two or three semen analyses may be recommended over two to six months, since sperm quality can vary over time. Other hormonal, imaging and genetic tests may be recommended as well depending on the type and severity of abnormalities found.
The Age Factor
Delaying marriage and subsequent pregnancy is a common choice for today’s modern urban women. The number of women attempting pregnancy and having babies in their 30s and 40s has increased in the last decade.
All women must be aware of the normal aging process of the ovaries. Your fertility begins to decline significantly in your mid 30s and accelerates in your late 30s. Some women even begin to experience a decline in their fertility in their late 20s and early 30s.
Fertility declines with age because fewer eggs remain in your ovaries, and the quality of the eggs remaining is lower than when you were younger.
This decline in fertility with age is in itself a major contributor to reduced fertility. Moreover older women do not respond very well to treatment methods and treatment success reduces as age advances.