|Between 2 and 10% of couples worldwide are unable to
conceive a child and a further 10 - 25% experience secondary
infertility, in other words, they are unable to conceive a
second or subsequent child.
Infertility in Females
|The causes of infertility in Females|
|Let's take a
look at the causes of infertility in women, which can take
One area that lies at the root of a range of causes is age, and we'll address that broad issue separately here: Impact of Age.
However, the direct underlying causes of female infertility fall into four main categories:
ovulation is the single most common cause of infertility in
females. Over 40% of women who are infertile have ovulatory
problems. The normal ovarian cycle is so complex that even
small deviations may disrupt the cycle and prevent
ovulation. However, with modern treatment there is a very
good chance that pregnancy will eventually be achieved in
Before considering the reasons for dysfunction or failure of ovulation, it is important to review the physiology of the normal ovarian cycle.
The normal cycle is under the control of the pituitary hormones, FSH (follicle stimulating hormone) and LH (luteinising hormone). The secretion of these hormones is influenced by GnRH (gonadotropin-releasing hormone) from the hypothalamus, and by circulating levels of oestrogen and progesterone.
A summary of the main stages of the ovarian cycle is shown below and is discussed in detail in Understanding Infertility.
|Disorders of the female sex organs are much more common than those of the male. This is especially true of infection and inflammatory conditions. Due to its anatomy, the female genital tract is more vulnerable to pathogens than the male tract.|
Female sex organs
can arise in disorders where there is an abnormal number of
sex chromosomes. For example, a missing X chromosome results
in a condition known as Turner's syndrome, which affects
Approximately one in every 3,000 girls is born with this syndrome. The main features include shortness of stature, absence or very retarded development of secondary sexual characteristics. These people are unmistakably female in appearance and identity, although full female sexual characteristics never develop.
Menstruation can be induced by oestrogen drugs, but sufferers continue to be infertile.
Other Causes (Idiopathic)
Cervical problems are a relatively uncommon cause of infertility. They may include:
Unexplained infertility is defined as failure to conceive after one year, even though the cycle is normal, semen is normal, laparoscopic findings are normal and there is normal sperm-mucus penetration. In about 10-15% of couples, a cause for infertility may not be found even after thorough investigation of both partners.
The results of empirical hormonal treatment have been encouraging in some female patients whose infertility is undiagnosed after thorough investigation.
In women, unlike men, fertility declines with age from the age of about 35 years. Clinical subfertility, defined as delay in conception of more than 12 months, is therefore closely associated with increasing age.
Other lifestyle factors such as diet, exercise, alcohol and use of prescribed or illegal drugs may influence fertility, but their importance is uncertain.
Infertility in Males
|Infertility: What Every Man Should Know|
Difficulty conceiving a child comes as a surprise to most
couples. Many have no medical history to suggest a fertility
problem, and may, in fact, have spent years trying to
prevent pregnancy. They assume that once birth control is
stopped, conception will soon follow. While this is true for
many couples, others discover that having a baby is not as
simple as they expected.
Infertility is just as likely to be related to male factors as female factors.
Potential male factors are described throughout this section of the site. Whatever the cause, coping with infertility is never easy. Many men feel robbed of their virility when they discover a fertility problem, and some struggle with feelings of poor self-esteem. These responses are normal. The key to overcoming them is mutual support within a primary relationship. Whether difficulty conceiving is related to male factors, female factors, or both, infertility is a couple's shared challenge.
About 85% to 90% of infertility can be treated with conventional therapies, such as medication or surgery. Success rates are continually improving. Use the information in this section of Fertility.com as a starting point for talking to your doctor about the best course of action for you.
Before we consider the causes of male infertility, let's take a look at a couple of important considerations relating to sperm:
cause of male infertility is failure to produce enough
healthy sperm. Azoospermia (complete absence of sperm in the
semen) and oligospermia (in which too few sperm are
produced) both cause infertility.
It is important to note here that, although only one sperm is required for fertilisation, enzymes from many sperms are required to break down the protective tissues around the ovum and so allow the fertilising sperm to penetrate into the cytoplasm of the ovum.
considerable range of anatomical causes of male infertility.
Here are some of the major causes, including environmental
factors can that impact upon the anatomy.
Implications of Infertility
need to tell you that, for most couples, infertility is more
than just a physical condition. A diagnosis of infertility
often carries intense emotional and social burdens as well.
Infertile couples commonly experience anger and frustration,
a sense of a loss of control, isolation from friends and
family, depression, and grief. These emotions may at times
seem overwhelming - and the inevitable outcome is stress.
That's why you are here - and that's where we can help. Here we outline some of the common experiences and issues encountered by couples coming to terms with their infertility, and ways to help you cope.
We hope that exploring these experiences will help you in coping with your own feelings and in coming to a resolution that is right for you.
Please bear in mind that this advice is not meant to substitute for professional medical advice, diagnosis or treatment. As always, you should make decisions regarding your healthcare in consultation with a physician who understands your specific situation.
The Doctor's Visit
You must remember, as you prepare to see a fertility specialist, that total infertility is rare and the inability to conceive is generally the result of some degree of 'sub-fertility'.
Infertility can often be overcome, and it is therefore important that you seek the advice of a fertility specialist as soon as possible.
Today, there is a wide range of treatment available to infertile couples: from hormonal therapy, donor insemination and Artificial Reproductive Technology (ART) through to microsurgery and laser surgery.
Correct diagnosis is a crucial step in determining the appropriate therapy, and a variety of procedures can be used, ranging from simple blood tests to more complicated analytical methods.
A fertility specialist, when evaluating a couple, is endeavouring to determine which of the four essential conditions required for pregnancy are not functioning correctly.
These four essential conditions are:
Female Specialist Tests
exam consists of a general physical exam, breast exam, and
comprehensive pelvic exam.
During the pelvic exam, the specialist determines the size, shape and position of your reproductive organs. This may include a pelvic ultrasound.
Many doctors do a routine Pap test to rule out cervical cancer and detect infection. Many also test for immunity to rubella (German measles) and will vaccinate you if you are not immune.
Male Specialist Tests
investigation of infertility in the male is often simpler
than in the female - the male sexual organs are located
outside the body and in most cases, sperm samples are easily
obtained. However, the causes of male infertility are
usually more difficult to diagnose.
As in females, the specific tests administered to males are determined based on findings during the medical history and physical examination. A semen analysis is the first test for males in most cases, and additional procedures may then be scheduled based on the findings.