CAUSES OF INFERTILITY
Before getting into the causes of infertility it’s only appropriate to begin by explaining the natural process of conception.
Ovulation: At the beginning of the female cycle hormones stimulate the follicles (small fluid-filled sacs) within the ovaries to grow into eggs. Eventually, one of the eggs erupts from the follicle and enters the Fallopian tube. This is called ovulation and usually happens about 2 weeks before your next period.Note that ovulation day varies from one cycle to the other. The mature egg moves along the Fallopian and enters tube and towards the womb, it can live for up to 24 hours. Sperm survival is more variable, but typically 3-5 days.
Fertilization: Hundreds of sperms make their way into the fallopian tube surround and penetrate the cells surrounding the egg. If one sperm makes its way and burrows into the egg, it fertilizes it resulting in a fertilized egg, a potential pregnancy.
1. Unexplained Infertility:
Planning for a baby is an important event in the life of a couple and involves many emotions. Any obstruction to the above process can prohibit pregnancy evoking feelings of frustration. The fact is that approximately 10% of the couples are unable to conceive naturally after one year of unprotected intercourse.
Unfortunately, the cause of this is no straightforward matter. Cases of infertility show approximately 30% male factors, 30% female causes and 30% combined factors. Through examination and investigation we can usually get some answers to the specific cause or causes of infertility.However, in some cases, tests and examinations render no answer. Such cases are referred to as “unexplained infertility”. This group makes up approximately 10% of the cases.
2. Male Infertility:
During sexual intercourse, sperms produced by the male travel through the vagina to the uterus and then to the fallopian tubes and finally one fertilizes the female egg. For the sperms to successfully fertilize an egg, they have to be within a certain range of numbers, shapes and movements.
Infertility in males may be caused by low sperm count, increase in the abnormal forms of the sperms, or the absence of sperms in the semen. Number, shape, and movement of the sperm can be revealed by a simple semen analysis (analysis of the sperm produced by the male). The average of these numbers is determined by the World Health Organisation (WHO). The range of male infertility can be from only having a slightly lower numbers of the different parameters of the WHO to not having any sperm at all.
The cases with zero sperm count are advised to go directly to a specialized clinic where they will perform a testicular biopsy. The biopsy will show whether there are sperms produced or not. If the biopsy sample is positive and there are sperm found, a number of sperm are used in the intracytoplasmic sperm injection (ICSI) process in which the sperm is injected directly in an egg. Excess sperm, may be frozen for later use.
There are multiple factors that can cause male infertility; some of these factors are clearly seen by examination while others need further investigations. Please find below a list of some of the factors that might cause male infertility:
- Undescended testicles at birth
- Industrial chemical, metal and/or heat exposure
- Illegal drugs and some medications
- Damaged testicles
- Genetic disorder
- Congenital problem
- Infection, specially infections caused by sexually transmitted diseases
- Ejaculation issues
- Hormone imbalances
- Sexual intercourse problems
3. Female Infertility:
In general, a female with a normal menstrual cycle produces one mature egg per month. With right timed intercourse, this egg should be at the fallopian tube waiting to be fertilized by a normal sperm, produced by the male partner, creating an embryo.
The embryo will travel through the fallopian tube and implant in the uterus causing a pregnancy that will hopefully lead to a delivery. Women who experience some difficulties in conceiving naturally are likely to have an underlying problem that prohibits the normal process. There is a wide range of factors causing female infertility:
a. Ovulation factor: this can be caused by any hormonal release disturbance. One of the most common disturbances is called polycystic ovary syndrome (PCOS).
b. Tubal factor: this is the case when the female has blocked or damaged fallopian tubes which will prevent the mature egg and the sperm to meet or prevent the fertilized egg from migrating to the uterus to get implanted
c. Uterine or cervical factor: defects in the uterine cavity can be a cause of infertility because it does not allow the embryo to implant in the uterus or it might block the fallopian tubes. Also cervical factors can be a cause of infertility.
4. Sexual problems:
a) Problems with erection and ejaculation
b) Severe vaginismus (female difficulty in normal intercourse due to involuntary spasm of the vaginal and pelvic muscles)
c) Infrequent intercourse due to travelling of one of the partners