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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.

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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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