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Causes of Infertility

Definition of Infertility : Infertility is defined as a failure to conceive within one or more years of regular unprotected coitus.

Primary infertility denotes those patients who have never conceived.

Secondary infertility indicates previous pregnancy but failure to conceive subsequently.

Incidence : 80 % of the couples achieve conception if they so desire, within one year of having regular intercourse with adequate frequency (4-5 times a week).

Another 10 % will achieve the objective by the end of 2 nd year.

As such, 10 % remain infertile by the end of 2 nd year.

Factors responsible for fertility are:

• Healthy sperms should be deposited high in the vagina.

• The sperms should undergo changes and acquire motility.

• The motile sperms should ascend through the cervix into the uterine cavity and the fallopian tubes.

• There should be ovulation in females.

• The fallopian tubes should be patent.

If any of these events do not occur properly, then infertility can occur.

Causes of Infertility

Conception depends on the fertility potential of both the male and female partner.

The male is directly responsible in about 30 – 40 %, the female in about 40 – 50 % and both are responsible in about 10 % cases.

Common causes of Male infertility :

Fig : Anatomy of Male genital tract

Defective spermatogenesis :

1. Undescended testis

2. Orchitis (mumps usually)

3. Genetic factors (47 XXY)

4. Testicular toxins (drugs, radiation)

5. Endocrinal (thyroid dysfunction, gonadotropin deficiency)

6. Varicocele

7. Primary testicular failure

Obstruction of efferent duct :

1. Congenital

   1. Absence of vas deferens

   2. Young's syndrome

1. Acquired

   1. Infective (tuberculosis, gonorrhea)

   2. Surgical trauma (hernioraphy)

Failure to deposit sperm high in vagina:

1. Impotency

2. Ejaculatory failure

3. Retrograde ejaculation

4. Hypospadius

5. Bladder neck surgery

6. Psychosexual

7. Drug related

Defect in sperm and seminal fluid:

1. Immotile sperm (kartagener syndrome

2. Oligo-astheno-tertozoospermia

3. Low fructose content

4. Sperm antibodies

Common causes of Female infertility:

Fig: Anatomy of female genital tract

Ovarian factors :

1. Anovulation or oligo-ovulation

2. Luteal phase defect (LPD)

3. Luteinised unruptured follicle (LUF)

Tubal factors

1. Defective ovum pick up

2. Impaired tubal motility

3. Loss of cilia

4. Partial to complete obstruction of tubal lumen

Peritoneal factors

1. Peritoneal adhesions

2. Endometriosis

Uterine factors

1. Uterine hypoplasia

2. Inadequate secretory endometrium

3. Fibroid uterus

4. Endometritis (tubercular in particular)

5. Uterine synechiae

6. Congenital malformation of uterus

Cervical factors

1. Congenital elongation of cervix

2. Uterine prolapse

3. Acute retroverted uterus

4. Fault in the cervical mucus

Vaginal factors

1. Atresia vagina (partial or complete)

2. Transverse vaginal septum

3. Septate vagina

4. Narrow introitus causing dyspareunia (pain)

Combined factors – factors both in male and female partners causing infertility:

1. General factors – advanced age of wife beyond 35 yrs, ageing reduces the fertility of male but spermatogenesis continues through out life

1. Infrequent intercourse, lack of knowledge of coital technique and timing of coitus to utilize the fertile period (are very much common even amongst literate couples)

2. Apareunia and dyspareunia

3. Anxiety and apprehension

4. Use of lubricants during intercourse – may be spermicidal

5. Immunological factors

Over the next few weeks fertility-treatment.org is going to examine and explain each of these causes of infertility. Watch this space, and check back often. Please let us know if there are any causes we have missed as we would be happy to include any such topic.

The materials contained here are not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional.

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