Inability to conceive after 12 months of having intercourse with average frequency (2 to 3 times per week), without the use of any form of birth control. Infertility may be a result of one or more male or female factors. Female and male factors are equally responsible for infertility (30% to 40% each) in 20% of cases there is a combination of both factors. So evaluating both partners is essential. Infertility can be stressful for both the partners. There is numerous Best Fertility Hospital in Chennai to cure infertility.
TYPES OF INFERTILITY:
Primary infertility: couple has never produced a pregnancy
Secondary infertility: women has previously been pregnant, regardless of outcome, and now is unable to conceive.
REQUIREMENTS FOR FEMALE FERTILITY:
- Ovulatory cycles
- Adequate hormonal status to maintain pregnancy
- Patent fallopian tubes
- Vagina capable of receiving sperm
- Normal cervical mucus to allow sperm passage
- Normal immunologic response to accommodate sperm and conceptus.
- Adequate nutritional and health status to maintain nutrition and oxygenation of placenta and fetus.
- Adequate sexual drive.
REQUIREMENTS FOR MALE FERTILITY:
- Normal spermatogenesis in order to fertilize egg:
- sperm count
- biological structure and function
- Normal ductal system to carry sperm from the testicles to the penis
- Ability to transmit sperm to vagina achieved through:
- -adequate sexual drive
- -ability to maintain erection
- ability to achieve normal ejaculation
- placement of ejaculate in vaginal vault
Male infertility is diagnosed:
The diagnostic process for men begins with a thorough physical examination, and a medical history, all of which may provide the contributing factors. The next step is usually a semen analysis, where a sperm sample is tested in the lab. The lab will perform a sperm count, check the health, shape, and movement of the sperm.
The most common infertility issues faced by men and causes?
Male infertility usually manifests as issues with the sperm or with the process of ejaculation, most common problems are:
You must produce healthy sperm. This involves the growth and formation of the male reproductive organs during puberty. At least one of the testicles must be functioning correctly, and the body must produce testosterone and other hormones to trigger and maintain sperm production.
Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate. Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.
Poor sperm motility or morphology: When a man is producing a good quantity of sperm, the sperm shape (morphology) or how they move (motility). These problems can mean that the sperm cannot reach or penetrate the egg.
Azoospermia: This condition is defined as the complete absence of sperm in the semen/ejaculate. Azoospermia affects around 5% of men who suffer from infertility. It is that the body is not producing any sperm, but more often it is a result of a blockage or obstruction in the ejaculatory ducts or vas deferens. This can prevent any sperm from leaving the testicles and reaching the ejaculate.
Oligospermia: “low sperm count.” Oligospermia means that there are very few sperm cells in the ejaculate. This is caused by low sperm production or by a partial ejaculatory ducts or vas deferens obstruction.
Congenital absence of the vas deferens: The tubes which transport sperm to the penis in the event of ejaculation do not develop before birth. A patient who has this condition may actually be producing viable sperm in the testes but without a way to travel to the ejaculate, pregnancy becomes impossible.
Ejaculatory duct obstruction (EDO) is a blockage in a man’s ejaculatory ducts may be caused by an injury or infection, or it may be a congenital issue which has been present since birth.
Varicocele: Some men develop enlarged varicose veins in the scrotum. This can affect the reproductive function which may impact sperm production, quality, and transport.
Previous vasectomy: This is a straight forward cause of infertility, where a man who underwent a vasectomy at an earlier point in his life now wishes to conceive.
Premature ejaculation: If a man consistently ejaculates before vaginal penetration (which can be caused by prostate health issues, mental health issues, and certain medications) the chances of a sperm meeting an egg are very low.
The common causes of male infertility:
The root cause of a man’s infertility is not easy to establish. Up to 50% of men diagnosed with male factor infertility, the specific cause remains unknown. Generally, male fertility problems have to do with the quantity or quality of the sperm, though there can also be issues with ejaculation. Some of the more common causes include:
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
Varicocele: Varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. The exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicocele result in reduced quality of the sperm. Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization.
Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. some infections can result in permanent testicular damage, sperms can still be retrieved.
Ejaculation issues: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. In these cases, sperm can be retrieved for use in assisted reproductive techniques.
Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
Tumors: Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In few cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
Undescended testicles: In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility occurs in men who have had this condition.
Hormone imbalances: Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a possible underlying causes.
Defects of tubules that transport sperm: Tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
Chromosome defects: Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
Problems with sexual intercourse: These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse this blockage or to retrieve sperm directly from the epididymis and testicles.
Over exposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:
Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
Radiation or X-rays: Exposure to radiation can reduce sperm production, it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
Overheating the testicles. Elevated temperatures impair sperm production and function. Frequent use of saunas or hot tubs may temporarily impair your sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.
Health, lifestyle and other causes
Some other causes of male infertility include:
Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke. Second hand smoke also may affect male fertility.
Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Certain occupations including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility
Risk factors linked to male infertility include:
- Smoking tobacco
- Using alcohol
- Using certain illicit drugs
- Being overweight
- Having certain past or present infections
- Being exposed to toxins
- Overheating the testicles
- Trauma to the testicles
- Prior vasectomy or major abdominal or pelvic surgery
- History of undescended testicles
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Having certain medical conditions, including tumors and chronic illnesses
- Taking medications or surgery or radiation used for treating cancer
Many types of male infertility aren’t preventable but can avoid some known causes of male infertility:
- Limit or abstain from alcohol.
- Illicit drugs.
- Body weight
- Avoiding things that lead to prolonged heat for the testicles.
- Reduce stress.
- Avoid exposure to pesticides, heavy metals and other toxins.
Causes of Female Infertility
Becoming pregnant is dependent on the release of a healthy egg that is capable of being fertilized by a healthy sperm, if your period is irregular or absent then your production and release of eggs may not take place. About 40% of women who are infertile will have ovulatory problems. Infrequent periods (oligomenorrhoea) or the absence of periods (amenorrhea) are most often caused by deficiency in one of the controlling hormones. These can be successfully treated with medications. Problems are also associated with extremely low body weight, being overweight, or a significant change in weight. In addition, ovulation problems can arise if the ovaries themselves are resistant to normal levels of hormones. Absent, damaged or diseased ovaries will also prevent ovulation.
Ovulation disorders:Ovulation disorder, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.
Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. It is a condition in which the ovaries are enlarged, with a smooth but thicker than normal outer cover many small cysts cover this surface, which are themselves harmless, but may cause infrequent or absent periods, resulting in infertility. polycystic ovaries are most easily seen by an ultrasound scan. It is also associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. This condition may be treated with medication or larger cysts may need to be surgically removed.
Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation every month — (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
Premature ovarian failure: Is called as primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.
Hyperprolactinemia: The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Related to a pituitary gland problem, this can also be caused by medications you’re taking for another disease.
Damage to fallopian tubes (tubal infertility):
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Pelvic inflammatory disease an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections, Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus
Pelvic tuberculosis, a major cause of tubal infertility.
Endometriosis is a condition in which the tissue that lines the uterus (endometrial tissue) grows in other parts of the body, usually in the pelvis. This endometrial tissue bleeds in the same way as the lining of the uterus, except the blood/tissue is trapped which causes irritation and inflammation. Scar tissue can form resulting in adhesions which can stick pelvic structures together. The most common symptoms of endometriosis are period pain and/or pelvic and abdominal pain. Endometriosis can affect fertility by damaging the ovaries so that ovulation cannot occur. Damaging or blockages to the inside of the fallopian tubes can impede the journey of the egg to uterus. Endometriosis also have an impact on the lining of the uterus, affecting the implantation of a fertilized egg. If women experience pain during sex from endometriosis they might also be reluctant to have sex, reducing their chances of getting pregnant.
Uterine and cervical causes:
Several uterine or cervical causes can impact fertility by interfering with implantation or increase the chances of miscarriage. Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. But many women who have fibroids or polyps do become pregnant. Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant. Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix. cervical problems are also related to the consistency of having enough cervical mucus. ‘mucus hostility’ may arise as a result of a vaginal infection or the presence of antisperm antibodies in the mucus. Mucus which allows the sperm to travel through the cervix into the uterus.
Sexually transmitted infections (STIs):
STI such as chlamydia or gonorrhea if untreated it can lead to pelvic inflammatory disease (PID). PID is the infection or inflammation of the organs and tissues in the pelvis. Unfortunately, women infected with a STI, particularly chlamydia, don’t always experience any symptoms or the symptoms are vague so they do not seek treatment. If PID is left untreated it can cause scarring in the fallopian tubes which can narrow them, blocking the path of the egg. If a fertilised egg becomes trapped in a blocked fallopian tube an ectopic pregnancy can occur (where the fetus develops outside the uterus). It is a serious, life-threatening health condition that requires immediate medical attention. One episode of PID decreases a woman’s chance of a successful pregnancy by 10%. After two or more episodes of PID a woman’s risk of becoming infertile is about 50%.
A woman’s weight is an important consideration in her fertility. Women who are underweight and/or have a low percentage of body fat (i.e., athletes) can experience irregular menstrual cycles and issues with ovulation. Being overweight or obese can also interfere with normal menstruation and ovulation. In addition, overweight and obese women also have a higher risk of miscarriage and other pregnancy complications and a lower success rate with infertility treatments such as IVF. Women who find it difficult to lose weight should be assessed for PCOS as this is a common symptom. Women can often improve their chances of pregnancy by relatively small changes to their weight. Women who are overweight or obese, a 5% weight loss can be enough to restore a regular menstrual cycle and ovulation.
- Some drugs can affect the fertility of a woman. These include:
- NSAIDs (non-steroidal anti-inflammatory drugs) – women who take aspirin or ibuprofen long-term may find it harder to conceive.
- Chemotherapy – Medications used in chemotherapy can result in ovarian failure. In some cases, this side effect of chemotherapy may be permanent.
- Radiotherapy- radiation therapy near the women’s reproductive organs there is a higher risk of fertility problems.
- Women who take marijuana or cocaine may have fertility problems.
- Age: The quality and quantity of a woman’s eggs begin to decline with increasing age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
- Smoking: Damage your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It’s also thought to age your ovaries and deplete your eggs prematurely.
- Weight: Being overweight or underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
- Sexual history: Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
- Alcohol: Stick to moderate alcohol consumption of no more than one alcoholic drink per day.
If you’re a woman thinking about getting pregnant soon you may improve your chances of having normal fertility if you:
- Maintain a normal weight
- Quit smoking
- Avoid alcohol
- Reduce stress
- Limit caffeine
Unexplained (idiopathic) infertility is not being able 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 15% of couples, a cause for infertility may not be found even after thorough investigation by Best Gynecologist in Chennai on both partners. 15 emotionally, this is the most frustrating and stressful diagnosis of all as there is no cause or management plan to focus on. Depending on a woman’s age, couples may continue to try to fall pregnant naturally, are to assisted reproductive technologies or consider other options, such as adoption or living child-free.