Infertility | Causes and treatment

Infertility is a very common problem that involves about 20% of couples; in this article, we will talk about the causes of infertility in men and women and tell you about the best ways to treat infertility.

What is infertility?

Couples with infertility are those who after one year of sexual intercourse without using any contraceptives, cannot have a baby. The prevalence of infertility is about 10-20% of couples. Couples should know that pregnancy takes time, and there is a 30% chance of pregnancy in each ovulation period. The likelihood of infertility increases with increasing frequency of sexual intercourse so that the chance of fertility even in a healthy couple reaches 85% at the end of the first year and 93% at the end of the second year.

What age is best suited for fertility?

The best time to get pregnant is before the age of 30. Fertility decreases gradually with age. Increasing age and prolonged use of contraceptives reduce the chance of pregnancy and successful infertility treatment.

When is the right time to check the fertility of couples?

In women under 35, couples are advised to see a doctor if pregnancy does not occur after one year of unprotected intercourse. If a woman is between 35 and 39 years old, couples should consult their doctor after 6 months of marriage to assess their fertility and if a woman is over 40 years of age, they should do it immediately.

Causes and Factors Affecting Infertility

Infertility has different reasons. Men and women each accounted for 40% of infertility cases, and in 10% of cases, both couples were infertile, and in the remaining 10%, no cause was found.

infertility for woman

Causes of infertility in women

Age

Age-related changes in the reproductive system, especially the ovaries, plays a major role in infertility. Aging also increases the risk of miscarriage. Most spontaneous early abortions occur after 35 years of age due to genetic abnormalities. The risk of spontaneous abortion is less than 10% for those under 30, but it is 34% for those over the age of 40. Studies have shown that the eggs of older women are less fertile, and with age, some diseases that cause infertility are more likely to increase.

Disorders of the Female Reproductive Tract

The female internal reproductive organs include four main parts, including the ovaries, uterus (womb), cervix, and fallopian tubes, and infertility in women may be mainly related to one or more of them.

a. Ovulation disorders

Half of all infertility cases in women are due to ovulation disorders. Regular menstruation is a good indicator of the health status of internal hormones, especially those trigger ovulation. This mark is better than any other expensive tests. If menstruation is irregular, ovulation is not desirable and necessary evaluations should be performed.

Polycystic ovary syndrome (PCOS) is one of the causes of ovulation disorders. Women with the disease may experience weight gain, loss or irregularity of menstruation, and abnormal body hair growth on the inner surface of the legs, face, and breasts. These patients are also susceptible to mood and emotional changes.

b. Blocked fallopian tubes

The fallopian tubes also known as uterine tubes, deliver the sperm within a few seconds from the uterus to the egg released from the ovary and transfer the fertilized egg into the uterus. Abnormalities in the functioning and shape of the uterine tubes are a cause of infertility in women. The blockage of these tubes at any point in their length prevents ovulation. The most common cause of obstructed fallopian tubes is the genital tract infection, especially as a result of sexually transmitted infections. Therefore, one of the most important ways to infertility treatment is the proper treatment of infections.

c. Intrauterine abnormality

Intrauterine abnormality can occur for a variety of reasons, including:

  • Benign tumors of the uterus such as fibromas: Fibromas are very common and fortunately most of them do not cause infertility.
  • Congenital uterine malformations: Most uterine malformations do not cause infertility, but some of them cause recurrent miscarriages, which are somehow a problem in fertility.
  • Intrauterine adhesions: Resulting from intrauterine manipulations, untreated uterine infections, and recurrent curettage.

Physical and chemical changes of the cervix

The cervix is ​​the passage of sperm. When motile sperms from semen enter the vaginal acidic environment, the cervical secretions neutralize this acid. This protects the sperm and then directs it to the uterus and fallopian tubes.

Abnormal infections and secretions, and chronic inflammation of the cervix, as well as the presence of the anti-sperm compound in the cervical secretions, cause the sperm to become immobilized and prevent it from being transmitted to the upper part of the uterus. These conditions are another reason for infertility in women.

infertility in men

Causes of infertility in men

Spermatogenesis abnormality

One of the most frequent causes of infertility is a defect in spermatogenesis (production of spermatozoa by the testes). It can be a:

  • Azoospermia:  It’s the complete absence of spermatozoa in the ejaculate. There are several causes: Klinefelter syndrome (XXY karyotype), congenital absence of testis, cryptorchidism (testicles not descended in the bursa), pituitary hypogonadism, nutritional deficiencies, cancer chemotherapy, radiation, poisoning (alcoholism, marijuana, exogenous testosterone …), prolonged fever, chronic exposure to heat, idiopathic azoospermia. The diagnosis is based on testicular biopsy, hormonal assays, and the karyotype.
  • Oligospermia:  The number of spermatozoa is less than 30 million / ml. Oligospermia is defined by a number of sperms less than 30 million / ml. The causes are numerous including varicocele, chronic infection, various general diseases (alcohol and tobacco poisoning, drug addiction), endocrine diseases (diabetes, obesity, hypothyroidism, adrenal hyperandrogenic, and hypogonadism).
  • Asthenospermia:  The mobility of sperm is insufficient. Asthenospermia is defined by less than 40% of mobility. Its causes are linked to oligospermia.
  • Teratospermia: There are too many abnormal sperm. Teratospermia is defined by the presence of more than 60% of abnormal sperms. The causes are genetic and detected by the karyotype.
  • Spermatic tract abnormalities

Obstructions or malformations of the spermatic passages

Obstructions or malformations of the spermatic passages are also one of the main causes of male infertility, whether congenital or caused by trauma. In this case, an obstacle in the genital tract prevents sperm from mixing with the seminal fluid during ejaculation.

The testicular twists, intratesticular hematoma, injuries to the spermatic artery can cause abnormal sperm transport.

Sperm deposit abnormality in the vagina

Another reason for infertility in men is not getting sperm into the vagina. Male sexual function may be impaired for various reasons (hypospadias, premature ejaculation, impotence …) which can prevent sperm from reaching the female genital tract. Retrograde ejaculation is also a form of male sexual dysfunction in which the semen enters the bladder rather than exiting from the penis. Surgery on the prostate or bladder neck may resolve this problem.

can infertility be treated

Infertility treatment

The treatments offered obviously depend on the causes of infertility found during medical investigations. They also adapt to the couple’s age, medical history and the number of years they have suffered from infertility. Despite the variety of treatments available, some causes of infertility cannot be treated.

Infertility treatment in women

In women, hormonal therapy for menstrual cycle disorders can be effective. Treatments like clomiphene citrate (Clomid, taken orally) is prescribed to stimulate ovulation. This medication is effective in the case of hormonal imbalance since it acts on the pituitary gland, a gland that secretes the hormones that trigger ovulation. Several other hormones can be prescribed by injection to stimulate ovulation. In the case of hyperprolactinemia, bromocriptine may also be prescribed.

In some cases, surgery may be necessary. If the fallopian tubes are blocked, an operation can treat this disorder. However, these treatments are not successful in 15% to 20% of infertile couples and assisted reproductive technologies are required to treat infertility. These include in vitro fertilization (IVF), intrauterine insemination (IUI), or gamete intrafallopian transfer (GIFT).

In vitro fertilization (IVF)

IVF initially developed to allow women with an abnormality of the fallopian tubes to be pregnant, but the application of this technique has gradually developed and included infertility treatment in cases like endometriosis, spermatogenesis abnormalities, and even unexplained infertility cases.

The principle of in vitro fertilization (IVF) is to stimulate the ovaries by repeated injections of gonadotropins (recombinant FSH obtained by genetics or a mixture of FSH and LH of human origin). These hormones stimulate the development of follicles that are used here in high doses in order to obtain a multi follicular response. This stimulation must be monitored by ultrasound and hormonal assays.

When follicular maturation seems reached, the triggering of ovulation is decided and an injection of hCG is prescribed.

The follicle puncture must be done 36 hours later, vaginally and under ultrasound control. In the follicular fluid thus collected, there are the oocytes which will be cultured with pure, quality sperm in order to achieve fertilization.

Two to five days later, two embryos (as a rule) are transferred to the patient’s uterus.

Infertility treatment in men

In men, medication or behavioral therapy can treat certain ejaculation disorders and allow the couple to conceive a baby. If there is an insufficient number of sperms in the semen, hormones can be prescribed to correct this problem or surgery can sometimes be proposed (to correct a varicocele, a dilation of the spermatic veins, located in the testicles, by example). If they do not result in pregnancy, sperms are removed from testicular tissue and injected to the eggs in the laboratory (ICSI).

Intra Cytoplasmic Sperm Injection (ICSI)

The microinjection or ICSI (Intra Cytoplasmic Sperm Injection) begins as a conventional IVF but, instead of culturing the oocytes and sperm and waiting for fertilization, the biologist injects a quality sperm directly in each oocyte under a microscope.

The ICSI is used mainly for major sperm abnormalities (sperms with a very small number and/or very low mobility). The spermatozoa obtained by testicular biopsies are “micro-injected” in the ICSI procedure.

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