Infertility

4.11 Infertility

Infertility is defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse. It can affect both men and women and may arise from a variety of factors, ranging from lifestyle choices to underlying medical conditions.

4.11.1 Causes of Infertility

1. Causes of Male Infertility

Low Sperm Count (Oligospermia): Fewer than normal sperm are produced.

Poor Sperm Motility: Sperm may not swim properly to reach the egg.

Abnormal Sperm Morphology: Sperm shape and structure may be abnormal.

Blockage of Vas Deferens or Epididymis: Prevents sperm from mixing with semen.

Hormonal Imbalance: Issues with testosterone or pituitary hormones can affect sperm production.

Varicocele: Enlarged veins in the scrotum can increase temperature and reduce sperm quality.

Infections: STDs like gonorrhea or mumps can damage the reproductive tract.

Lifestyle Factors: Smoking, alcohol, drug use, stress, obesity, and exposure to toxins.

Genetic Factors: Klinefelter’s syndrome, Y chromosome microdeletions.

1. Causes of Female Infertility

Ovulation Disorders: PCOS (Polycystic Ovary Syndrome)

Hypothalamic Dysfunction

Premature Ovarian Failure

Hyperprolactinemia

Fallopian Tube Damage or Blockage: Often caused by infections like pelvic inflammatory disease (PID), or ectopic pregnancy.

Endometriosis: Endometrial tissue grows outside the uterus, interfering with ovulation or fertilization.

Uterine Abnormalities: Fibroids, polyps, or congenital uterine malformations.

Cervical Problems: Abnormal cervical mucus or narrowing of the cervical canal.

Age Factor: Fertility declines significantly after the age of 35.

Hormonal Imbalance: Affects ovulation and menstrual cycles.

Lifestyle and Environmental Factors: Stress, malnutrition, smoking, excessive exercise, obesity, exposure to radiation or chemicals.

4.11.2 Risk Factors

Age: Women's fertility begins to decline after age 32. Men’s fertility declines after age 40.

Smoking: Increases the risk of infertility in both men and women. Smokers have a higher risk of miscarriages during pregnancy.

Body Weight: Being underweight due to excessive dieting may disrupt fertility in women. Nutritional Deficiencies: A vegetarian diet lacking in iron, folic acid, zinc, and vitamin B12 may affect fertility.

Exercise: Women who exercise more than seven hours a week may experience ovulation problems.

Sedentary Lifestyle: Linked to lower fertility in both men and women.

Chlamydia Infection: Can damage the fallopian tubes in women and affect men's scrotum, leading to infertility.

Environmental Exposures: Pesticides, herbicides, and heavy metals like lead can impair fertility.

Mental Stress: Can negatively affect ovulation and sperm production. Stress may also reduce the frequency of sexual intercourse.

4.11.3 Male Infertility

4.11.3.1 Causes

1. Cryptorchidism: The failure of testes to descend into the scrotum, leading to azoospermia (lack of sperm production).
2. Alcoholism: Alcohol disrupts spermatogenesis (sperm production).
3. Thyroid Dysfunction: Abnormal thyroid function may impair fertility.
4. Impotency: Inability to achieve an erection or penetration during intercourse.
5. Gonadotropin Deficiency: Deficiency of LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) affects sperm production.
6. Drug Use: Long-term use of anti-hypertensive and anti-psychotropic drugs can impair fertility.
7. Immotile Cilia Syndrome: Sperm immobility due to absent or defective tails.
8. Infections: Conditions like mumps and infections in seminal vesicles or prostate glands can cause oligospermia (low sperm count).
9. High Scrotal Temperature: Raised scrotal temperature from varicocele (enlarged veins in the testis) leads to poor sperm production.
10. Anti-Sperm Antibodies: The body’s immune system produces antibodies against its own sperm, leading to infertility.

4.11.3.2 Male Fertility Treatments:

Vitamin Supplements: Vitamins E, C, folic acid, and B12 improve sperm count and quality.

Clomiphene Citrate: Stimulates the production of gonadotropins and increases testosterone secretion.

Dexa Methasone: Corrects the presence of anti-sperm antibodies.

Surgical Interventions: Surgery for conditions like varicocele, vasectomy reversal, and undescended testes may restore fertility.

Lifestyle Changes: Avoid alcohol, maintain a healthy weight, and reduce stress.

4.11.4 Female Infertility

4.11.4.1 Causes

1. Anovulation: Failure of the ovaries to release an egg (no corpus luteum formation).
2. Luteal Phase Defect (LPD): Inadequate production of FSH and LH, impairing ovulation and implantation.
3. Chronic Cervicitis: Inflammation of the cervix causing ineffective sperm penetration.
4. Tubal Blockage: The fimbriae (finger-like projections) of the fallopian tube fail to pick up the egg, leading to fertilization problems.
5. Dyspareunia: Pain during sexual intercourse, making conception difficult.
6. Early Miscarriage: Spontaneous pregnancy loss in the first 20 weeks.
7. Ectopic Pregnancy: A fertilized egg implants outside the uterus, usually in the fallopian tube.
8. Endometritis: Chronic inflammation of the uterine lining (endometrium) can hinder implantation and cause infertility.
9. Fibroids: non-cancerous growths in the uterus (fibroids) may interfere with fertility.
10. Polycystic Ovary Syndrome (PCOS): A condition where the ovaries produce excessive androgens (male hormones), leading to irregular menstrual cycles and infertility.
11. Hyperprolactinemia: Elevated levels of prolactin, a hormone that interferes with ovulation.

4.11.4.2 Female Fertility Treatments:

1. Fertility Drugs: Clomiphene, Metformin, HMG (Human Menopausal Gonadotropin), and FSH are prescribed to stimulate ovulation.
2. Surgery: If the fallopian tubes are blocked, surgery may be performed to repair the blockage.
3. Laparoscopy: A minimally invasive surgery used to treat issues like endometriosis or tubal blockages.
4. Lifestyle Changes: Maintaining a healthy weight, regular exercise, and reducing stress can improve fertility.