Infertility – Causes, Diagnosis and Treatment
Infertility is defined as the inability to achieve a pregnancy after 12 months of regular unprotected intercourse. It affects both men and women and has many possible causes.
Things worth knowing about "Infertility"
Infertility is defined as the inability to achieve a pregnancy after 12 months of regular unprotected intercourse. It affects both men and women and has many possible causes.
What is Infertility?
Infertility is defined by the World Health Organization (WHO) as a disease of the male or female reproductive system, characterized by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. A distinction is made between primary infertility (no previous pregnancy) and secondary infertility (inability to conceive after a previous pregnancy). Globally, an estimated 1 in 6 people of reproductive age are affected by infertility at some point in their lives.
Causes
Infertility can stem from female factors, male factors, a combination of both, or remain unexplained. Roughly one-third of cases are attributed to female factors, one-third to male factors, and the remaining cases involve both partners or have no identifiable cause.
Female Causes
- Ovulation disorders: such as polycystic ovary syndrome (PCOS) or thyroid dysfunction
- Fallopian tube damage: blockages caused by endometriosis or previous infections (e.g., chlamydia)
- Uterine abnormalities: fibroids, polyps, or congenital malformations
- Endometriosis: uterine lining tissue grows outside the uterus
- Diminished ovarian reserve: decline in egg quantity and quality with age
Male Causes
- Azoospermia: no sperm present in the ejaculate
- Oligozoospermia: low sperm count
- Asthenozoospermia: poor sperm motility
- Teratozoospermia: high proportion of abnormally shaped sperm
- Hormonal imbalances: e.g., low testosterone or elevated prolactin levels
- Varicocele: enlarged veins within the scrotum affecting sperm production
Combined and Unexplained Causes
- Immunological factors (e.g., anti-sperm antibodies)
- Genetic abnormalities
- Idiopathic (unexplained) infertility
Risk Factors
- Advanced age (particularly in women over 35)
- Smoking and excessive alcohol consumption
- Obesity or being underweight
- Chronic stress
- History of sexually transmitted infections
- Exposure to environmental toxins or radiation
Symptoms
The primary symptom of infertility is the inability to conceive despite trying. Additional symptoms may appear depending on the underlying cause:
- Irregular or absent menstrual periods (indicating ovulation problems)
- Pelvic pain or pain during intercourse (associated with endometriosis)
- Excess hair growth, acne, or weight gain (associated with PCOS)
- Erectile dysfunction or changes in ejaculation volume (in men)
Diagnosis
A thorough evaluation of both partners is recommended. Diagnostic steps include:
In Women
- Hormone tests (FSH, LH, estradiol, AMH, TSH, prolactin)
- Pelvic ultrasound to assess the ovaries and uterus
- Hysterosalpingography (HSG) to evaluate the fallopian tubes
- Laparoscopy if endometriosis is suspected
In Men
- Semen analysis (assessing sperm count, motility, and morphology)
- Hormone testing (testosterone, FSH, LH, prolactin)
- Testicular ultrasound
- Genetic testing (e.g., karyotyping)
Treatment
Treatment depends on the identified cause, the age of the individuals involved, and how long they have been trying to conceive.
Medical Treatment
- Ovulation induction: using medications such as clomiphene citrate or gonadotropins
- Hormone therapy: addressing thyroid disorders or elevated prolactin levels
Surgical Treatment
- Removal of fibroids, polyps, or correction of tubal blockages
- Varicocele repair in men
Assisted Reproductive Technologies (ART)
- Intrauterine Insemination (IUI): placing prepared sperm directly into the uterus
- In Vitro Fertilization (IVF): fertilizing eggs outside the body in a laboratory setting
- Intracytoplasmic Sperm Injection (ICSI): injecting a single sperm directly into an egg, used in severe male infertility
- Cryopreservation: freezing eggs or sperm for future use
Lifestyle Modifications
- Achieving a healthy body weight
- Stopping smoking and reducing alcohol intake
- Stress reduction techniques
- Balanced diet and adequate sleep
Psychosocial Aspects
Infertility can place a significant emotional and psychological burden on individuals and couples. Feelings of grief, guilt, and social pressure are common. Psychological counseling or couples therapy can be beneficial in supporting emotional well-being throughout the treatment process.
References
- World Health Organization (WHO): Infertility. Fact Sheet. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/infertility
- Zegers-Hochschild F et al. - International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the WHO revised glossary of ART terminology, 2009. Fertil Steril. 2009;92(5):1520-1524.
- Vander Borght M, Wyns C - Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018;62:2-10.
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