Infertility is defined as inability to conceive even after having frequent, unprotected intercourse for a period of minimum 1 year.
Most of the couples trying to have a child get pregnant within first 6 months. Almost 90% of the couples surely conceive within a year. The remaining 10% of the couples are then said to be suffering from infertility.
In 30% of the cases, the females are suffering from infertility; another 30% is because of male infertility, around 20% is because of combined causes and in around 10% of the patients the cause cannot be established. It is known as unexplained infertility.
- Sexually transmitted disease: STD’s like syphilis, Chlamydia, gonorrhoea have a negative effect on the fertility.
- Cancer treatments: if any of the partners is suffering from cancer, the radiotherapy or chemotherapy might render them infertile.
- Smoking and alcohol: smoking and alcohol consumption in females as well as males has a negative impact on the fertility.
- General diseases: diseases like Diabetes and thyroid problem may affect the fertility.
- Hormonal problems: abnormal levels of hypothalamic and pituitary hormones in the brain can also affect fertility.
- Life style disorders: obesity can lead to problems in fertility in both males and females.
- Psychological problems: stress is also an important factor to be considered while diagnosing the cause of infertility.
- Cancer of reproductive organs: it may make the patient infertile.
- Advanced age: As the age of the female advances, the number of good quality eggs in her ovary decrease, this makes it difficult for her to conceive.
- Ovulation problems: in order to achieve a pregnancy a female should be able to ovulate. Problems in ovulation may lead to infertility. E.g. PCOS (polycystic ovarian syndrome).
- Tubal causes: the fallopian tubes connect the ovaries and the uterus. If they are obstructed, the pregnancy cannot occur.
- Uterine abnormalities: the uterus may have some congenital structural deformities. E.g. uterine septum. Other pathologies like fibroids, endometriosis, and polyps cause problems with implantation rendering the patient infertile.
- Adhesions: if there are intrauterine adhesions, they can render the female unable of conceiving.
- Cervical causes: some of the females have abnormal mucus, which might lead to killing of the sperms in the cervix itself leading to infertility.
- Infections: females may not be able to conceive if they have infections in pelvic region like pelvic TB.
- Genetic abnormalities: some of the genetic abnormalities if present make the woman infertile. E.g. Turner’s syndrome.
- Other diseases: some diseases like Cushing’s disease, celiac disease can lead to amenorrhoea (absence of menstruation) which in turn leads to infertility.
Problems with the sperm production:
- Sperm abnormality: low count, or abnormal shape and decreased motility may contribute to infertility.
- Varicocele: Varicocele is an abnormal collection of dilated veins above the testes. It’s found in almost 40% of cases.
- Infections: Infections in the testicle (orchitis) and epididymis can lead to infertility in males.
- Undescended testicles: if the testicles are Undescended then the sperm production is hampered.
- Anti androgen medicines: use of some medicines can make the patient infertile. E.g. anabolic steroids
- Mumps: history of mumps in childhood may render the patient infertile in the adulthood.
- Genetic abnormalities: some of the genetic abnormalities if present make the man infertile. E.g. klinefelter syndrome.
- Trauma: any kind of trauma may render the patient infertile depending on the extent of the injury.
- Antibodies against sperm: these antibodies kill the sperms and decrease the count.
Problems with the sperm transportation:
- Prostate enlargement: enlargement of the prostate gland results in obstruction in flow of the semen.
- Infections: infections in prostate gland (prostitis) can cause infertility.
- Absent vas deferens: If the tubes that carry sperms are absent, the patient can become infertile.
- Vasectomy: a patient if has undergone vasectomy, he becomes permanently infertile.
- Retrograde ejaculation: when the semen gets ejaculated in the bladder instead of outside via urethra.
- Ejaculatory duct obstruction: in this condition one or both the tubes may be obstructed.
Also, sexual problems like premature ejaculation and erectile dysfunction can lead to infertility though only in 1% of the cases.