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The causes of Infertility

By Dr. Meenakshi Dua, Fertility Consultant at the ART Fertility Clinics, Gurugram.

The desire to have a child, one’s own offspring is the strongest among human race. This desire never goes away. But, sadly one in four couples are facing problems in conceiving as per WHO

That means, 15 % of couples in reproductive age group (15-45y) are struggling to have a healthy baby.  Infertility is defined as inability to conceive after 12 months of regular unprotected intercourse. This duration is cut short to 6 months if a woman’s age is more than 35 years.  If a woman’s age is > 40 years then one is advised to contact soon after they start planning.

Infertility affects men and woman equally

Around 40% of infertility is due to men and another 40% is due to women. The remaining 20% is either due to both of them or unexplained. For a conception to happen, a healthy embryo formed from healthy gametes should travel through patent fallopian tubes in the female body and get implanted in her uterus at the right time. Any problems with gametes (sperm or egg), or their fusion or uterus can lead to infertility.

Let us understand little bit more in detail about causes of male and female infertility

Main reasons for female infertility:

  • Defects in ovulation: The most common cause of female infertility is ovulatory dysfunction. It can vary from no egg formation to premature/no egg release. This is seen in patients with polycystic ovarian syndrome(PCOS), hyperprolactinemia (usually high during lactation), thyroid disorders, pelvic inflammatory diseases, endometriosis, morbid obesity, premature ovarian failure, early menopause, hypothalamic dysfunctions, athletes and patients with eating disorders.
  • Blockage/damage of Fallopian tubes: Fallopian tubes are needed for passage of egg from ovary to tube and for fusion of egg with sperm. Also, embryo once formed stays in fallopian tube for another 5 days before going to uterus. Infections (sexually transmitted disease) can ascend up from vagina to uterus and tubes. They are the most common cause for tubal blockage /damage. Damage to tubes can also present as hydrosalpinx ( fluid collection in tubes).
  • Poor ovarian reserve: Women are born with basket of eggs and soon after birth they start losing them with time. Loss can increase exponentially after 35 years of age. Surgical loss of ovarian tissue leading to poor ovarian reserve is understandable and still gives good outcome if treated properly. However, due to environmental factor, pollutants and urban life style, many women are coming up in younger years (<35y) with very low ovarian reserve. This is something which need immediate medical attention and can be managed. Patients with genetic disorders, exposure to chemo/radiotherapy can even present with early menopause.
  • Problems with Uterus: A woman nurtures a baby in her uterus for nine months. Any problem with uterus is going to cause infertility. It can be anomalies in uterus present since birth or benign tumors like fibroid, adenomyomas or endometrial lining It can mechanically affect on implantation of embryo.

Male infertility can be due to:

  • Abnormal semen parameters: It is one of the most common reason for infertility. It can vary from low counts and motility to nil counts and motility. Most common cause for it is varicocele. Other causes are genetic disorders, infections of genital tract, sexually transmitted diseases, obstruction to the outflow tract of semen, general health conditions like uncontrolled diabetes, hypertension, morbid obesity, anti cholesterol tablets, and many a times environmental/occupational hazard. Undescended testis can also present as absence of sperms in semen. Patients with addictions like alcoholism, drugs and smoking can also affect semen parameters and quality.
  • Coital difficulties: It is commoner than its thought of. At times it can be the major concern among couples. Problems like erectile dysfunction, premature ejaculation, retrograde ejaculation can affect fertility. Morbid obesity & diabetes can add to this problem.
  • Damage due to cancer treatment: At times chemotherapy and radiotherapy required for cancer treatment can also add to infertility.

In 20% of cases, infertility can be unexplained at the beginning but with advanced investigations and testing cause can be found out. Many a times immunological causes of infertility appear as unexplained infertility. Various therapies are available to correct immune factors.

What ever the cause may be, it’s good to know that infertility is treatable

Treatment modalities may range from simple antibiotics to treat infections, oral medicines for ovulation induction to intrauterine insemination(IUI) and In vitro fertilization- with embryo transfer(IVF-ET). Even patients without a uterus can have their own genetic child with help of surrogacy. Women without eggs can also deliver a child with help of donor eggs. With advancements in assisted reproductive techniques, everyone can fulfil their dream of parenthood.

If you would like to speak to a member of the team at ART Fertility, click here

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