In general, the causes of infertility in women and men take time to diagnose. While it’s possible for couples to conceive without treatment after trying for two years, it’s important to discover the various causes and address them for timely treatment.
Common Causes of Infertility in Women
- Ovulation Disorder
Ovulation is when a mature egg moves down the fallopian tube after being released from the ovary, where it is fertilised.
At least 1 in 4 infertile couples endure the ovulation disorder, which means either that the ovulation is irregular or absent altogether.
Failure to ovulate can result from several conditions, such as:
- Ovarian conditions, such as primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS)
- Ageing, which causes diminished ovarian reserve, or a low number of eggs
- Problems with the hypothalamus or endocrine disorders, such as thyroid disease
- Lifestyle and environmental factors
- Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) causes hormone imbalance and affects ovulation.
With PCOS, the ovaries, and in some cases, the adrenal glands, produce more androgens than normal. High levels of these hormones impair the development of ovarian follicles and hamper the release of eggs during ovulation.
Common symptoms of PCOS are sacs or cysts that develop within the ovaries. Furthermore, insulin resistance, obesity, abnormal hair growth on the face or body, and acne can also be the result of PCOS.
In endometriosis, the tissue that normally grows in the uterine cavity, called the endometrium, grows outside the uterus instead. This extra tissue growth, and the surgical removal of it, causes scarring.
The scarring in the fallopian tube obstructs and affects the release of the egg after ovulation. Endometriosis further affects the lining of the uterus, thus disrupting the implantation of a fertilised egg.
- Uterine Fibroids and Polyps
Uterine fibroids are common noncancerous growths inside a woman’s uterus. Usually, those that are larger than 6 cm in diameter may impair fertility. Moreover, uterine fibroids located in the uterine cavity against those within the uterine wall also affect your chances of pregnancy.
Some women with fibroids are unable to get pregnant naturally or may suffer multiple miscarriages or preterm labour.
Uterine polyps are growths in the inner wall of the uterus that extend into the uterine cavity. Due to the overgrowth of such cells in the lining of the uterus (endometrium), they are also known as endometrial polyps. Although these polyps are usually benign, i.e. noncancerous, some can be cancerous. Surgical removal of the polyps increases the chances of pregnancy.
Several uterine or cervical issues are known to impact fertility. Benign polyps or fibroids in the uterus block fallopian tubes or interfere with implantation, thus impairing fertility. However, many women become pregnant in spite of fibroids or polyps.
- Menstrual Problems
The female menstrual cycle prepares the body for pregnancy and includes several stages. If issues occur at any one of these stages, it may lead to infertility or create difficulties in getting pregnant.
- Primary Ovary Insufficiency (POI)
Also known as POI, it is a condition in which a woman’s ovaries stop producing hormones and eggs at a young age. In such a condition, women ovulate irregularly, if at all. They may also have abnormal levels of ovarian and pituitary hormones.
- Hypothalamic Dysfunction
Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are produced by the pituitary gland to stimulate ovulation every month.
Irregular or absent periods are some common signs of ovulation disorder. High physical or emotional stress, fluctuations in body weight, or substantial weight gain or loss affects hormone production and, in turn, ovulation.
- Structural Problems With the Reproductive System
This usually involves the growth of abnormal tissue in the fallopian tubes or the uterus. If the fallopian tubes are blocked, the eggs cannot move from the ovaries to the uterus, and the sperm can’t reach the egg for fertilisation. Scarring due to injury or surgery increases the risk of miscarriage and interferes with implantation, thus leading to infertility.
- Excess Prolactin
In some cases, the pituitary gland may produce excess prolactin (hyperprolactinemia). This further results in lower estrogen production and may cause infertility. Although this is usually a problem related to the pituitary gland, it can also occur due to the intake of medications against a disease.
- Damage to Fallopian Tubes (Tubal Infertility)
Damaged or blocked fallopian tubes do not let sperms reach the egg or block the passage of the fertilised egg into the uterus.
Damage or blockage to the fallopian tube may be caused due to:
- Pelvic inflammatory disease
- Past surgery in the abdomen or pelvis
- Pelvic tuberculosis
- The Inability of Eggs to Mature and Implantation Failure
Ranging from PCOS to obesity and a lack of specific proteins, there are several reasons that the woman’s eggs may not mature.
Moreover, timing is crucial during ovulation: an immature egg may sometimes not be released at the correct time, may not reach the fallopian tubes, or may not be fertilised.
Implantation failure occurs when a fertilised egg does not implant in the uterine wall to stimulate pregnancy. Possibilities of implantation failure include:
- Genetic defects in the embryo
- Progesterone resistance
- Thin endometrium
- Scar tissue in the endometrial cavity
- Other Medical Conditions
Endometriosis scarring or inflammation within the uterus also affects implantation. Uterine abnormalities since birth, such as an abnormally shaped uterus, may also cause fertility problems.
Cervical stenosis, or the narrowing of the cervix, occurs due to an inherited malformation or damage to the cervix. In some cases, the cervix is unable to produce the best type of mucus, which does not allow the sperm to travel into the uterus.
- Unexplained Infertility
In some cases, the cause of infertility in women is never found. Unexplained infertility may be a combination of several minor factors present in both partners. Sometimes, such a problem also corrects itself with time. This shouldn’t, however, be the reason to delay unexplained infertility treatment..
Common Causes of Infertility in Men
- Sperm Deficiency
The disorder includes a range of problems related to the sperms, such as abnormal sperm, its production, shape, and quality.
Other crucial factors that determine infertility in men include:
- The sperm count, i.e. the number of sperms
- The motion of the sperm
- Transportation of the sperm through the tubes of the male reproductive system
A sperm deficiency may include a sperm that is not fully grown, is oddly shaped, is made in very low numbers (oligospermia), is not made at all (azoospermia), or does not move the right way.
Azoospermia causes and treatment:
Azoospermia may occur due to inborn traits, lifestyle choices such as smoking, drinking alcohol, and intake of certain medications. Health conditions and long-term illnesses such as kidney failure are also known to impact sperm count. Furthermore, damage to the reproductive system also causes low or no sperm. A male fertility test or a spermcheck are helpful ways to identify irregularities in sperm behaviour or sperm count in men.
Several treatments can help in azoospermia cure. Medicine for azoospermia come in many forms, the most common non obstructive azoospermia treatments include hormonal drugs such as Letrozole, Clomid, FSH injections, or hCG injections.
Varicoceles refer to swollen veins in the scrotum. They impair sperm growth by blocking normal blood drainage. The condition also causes blood to flow back into the scrotum from the belly, thus impacting sperm count.
- Retrograde Ejaculation
Retrograde ejaculation is the backward travelling of the semen into the body. It flows into the bladder instead of emerging from the penis. Although men experience sexual climax, they produce very little or no semen. This is why retrograde ejaculation is sometimes also called a dry orgasm.
Retrograde ejaculation isn’t harmful to a man’s health, but it can cause male infertility.
- Hormonal Imbalance
A sound balance of hormones in a man’s body is crucial for the successful functioning of the male reproductive system. Male infertility is a result of low testosterone or gonadotropins; these include follicle-stimulating hormone (FSH) and luteinising hormone (LH).
Hormones made by the pituitary gland enable the testicles to produce sperm. As a result, low hormonal levels cause poor sperm growth.
- Immunologic Infertility
In some cases of surgery, injury, and infection, a man’s body creates antibodies that impact sperm growth. Although an uncommon cause of male infertility, studies haven’t ruled out the possibility of antisperm antibodies resulting in lower infertility in males.
In some cases, sperm can be blocked due to repeated infections, surgery such as vasectomy, or swelling. Some developmental defects may also cause blockage in the male reproductive tract and keep the sperm from emerging during ejaculation.
- Other Problems
The causes of male infertility occur due to sexual problems such as premature ejaculation, genetic diseases like cystic fibrosis, structural problems like a blockage in the testicle, or injury to the reproductive organs.
Intake of certain medications may impact sperm production, function, and delivery. A regular dosage of medicines to treat health problems like arthritis, cancer, high blood pressure, infections, depression, and digestive problems may cause infertility in men.
- Environmental Factors
Overexposure to chemicals like pesticides and radiation are known to cause infertility in men. Frequent exposure to heat, such as in saunas or hot tubs, increases body temperature and affects sperm production.
Consumption of alcohol, marijuana, anabolic steroids, and smoking also leads to infertility in men. Taking medications to treat bacterial infections, high blood pressure, and depression may affect fertility. Plus, sperm production is severely impaired due to treatments such as radiation or chemotherapy.
– Some of the causes of female infertility include: PCOD, uterine fibroids, damage to fallopian tubes, and problems with the regular menstrual cycle.
– Some of the causes of male infertility include: sperm deficiencies, variocoeles, retrograde ejaculation, hormonal imbalances and blockages.
– Remember, just because you have these conditions does not mean you may never get pregnant or improve sperm motility or sperm count. Addressing these issues and getting timely treatment can resolve these issues and help you conceive.
Book an appointment with a fertility specialist to evaluate causes of your infertility