The inability of a couple to conceive a pregnancy after one year of unprotected sexual intercourse
PRIMARY VS. SECONDARY INFERTILITY
In primary infertility, pregnancy has never occurred. In secondary infertility, one or both members of the couple
have previously conceived, but are unable to conceive again after a full year of trying
Medications - Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on
temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if
taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in
the body, impairing fertility.
Premature Menopause - Some women may experience premature menopause, when their ovaries stop
producing eggs. Often the cause is excessive exercise or anorexia.
Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the
ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by
weakening the cervix or by leaving scar tissue that obstructs the uterus.
Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm,
mistaking it for a toxic invader. Certain autoimmune diseases, in which the woman's immune cells attack
normal cells in her own body, may also contribute to ovarian problems.
Luteal Phase Defect - In a luteal phase defect, a woman's corpus luteum - the mound of yellow tissue produced
from the egg follicle - may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized
egg may be unable to implant.
Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result,
the sperm or fertilized egg cannot reach the uterus or implant there. Fibroids in the uterus are very common in
women over age 30.
Ovulation Disorders: A very fine balance of various hormones such as estrogen, progesterone, luteinizing
hormone, follicle-stimulating hormone is required to timely ovulate (release of egg from the ovary). The main
cause of ovulation disorders is hormone imbalance. Low levels of progesterone can cause interference in the
adhesion of the embryo to the uterine lining. It also increases the risk of a miscarriage. High levels of estrogen
are also associated with infertility in women.
Ovarian failure Ovarian failure can be a consequence of medical treatments (for ovarian tumours for instance),
or the complete failure of the ovaries to develop or contain eggs in the first place (for example, Turner's
Syndrome).The treatment for ovarian tumours may involve surgical removal of all or part of the ovary. Ovarian
failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in
other body areas. These therapies destroy eggs in the ovary.
Endometriosis: It refers to a condition where the uterine lining doesn't form normally. It grows outside the
reproductive tract causing fallopian tubes to become blocked. These blockages cause infertility in almost 10%
of infertile women. In advance cases of endometriosis, the forward movement of sperm are blocked due to
adhesion between fallopian tubes, ovaries and uterus. This results in infertility. Studies have indicated that the
eggs of women with endometriosis are more likely to have genetic abnormalities than those who do not have
the disease.
Uterine and Cervical Disorders: Benign growths such as fibroids on the uterine wall can interfere with the
attachment of embryo to the wall of the uterus and thereby cause problems in conception.
Abnormalities in cervix shape or change in the texture of cervical mucus can make the movement of sperm
from vagina to uterus extremely difficult.
Ageing :Age is a critical factor affecting a woman's fertility woman. In our society many women choose to delay
having children. Some of the common reasons for this include education and career demands, financial stability,
second marriages/relationships and waiting for a suitable partner.
Reproductive function declines as a woman ages, particularly after the age of 35. Women are born with a finite
number of eggs, unlike men who produce sperm most of their adult life. In the years approaching menopause,
there are fewer and fewer eggs left in the ovary. The quality of eggs also diminishes as a woman gets older.
When a woman is in her late thirties, there is an increase in chromosome abnormalities that can result in birth
defects like Down syndrome.
Ageing can also affect other reproductive organs and functions, such as the uterus, hormone production, and
ovulation. There is also a higher incidence of miscarriage in women in their late thirties.
Infertility treatments cannot reverse the ageing process and should not be thought of as a safeguard that will
ensure a pregnancy at some point in the future. The success rates of IVF for women over 35 are much lower
than for younger women.
Polycystic ovaries: Polycystic ovaries contain lots of small cysts, making the ovary larger than normal. The
condition, called polycystic ovarian disease (PSOD), is also associated with high levels of androgen and
estrogen. Women with PSOD have irregular periods and may not ovulate, resulting in infertility.
Immunological factors: The presence of antibodies to sperm in cervical mucus can cause infertility. In other
cases, the mother's immune system prevents the embryo from attaching to the wall of the uterus and so causes
a miscarriage.
Fallopian tube damage: It is in the fallopian tube that fertilization takes place, after the egg is released from
the ovary into the tube and is met by sperm. Full or partial blockage of the fallopian tubes will prevent
fertilization taking place.
Fallopian tubes can be damaged by inflammation that results from viral or bacterial infections, some types of
sexually transmitted diseases, or complications of surgery such as adhesions or scarring.
MALE INFERTILITY
Sperm defects
A low sperm count is the most common cause of male infertility. Abnormalities in sperm shape or their ability
to swim can also cause infertility problems. These can be due to hormonal imbalances, infection, or testicular
varicocele.
A total absence of sperm (known as ' azoospermia') in the ejaculate can be caused by testicular damage,
mumps, anatomical disorders, or lack of hormones.
Immunological factors
Some men produce antibodies to their own sperm, which prevent the sperm from penetrating the egg. The
exact cause is not known but may be due to infection or vasectomy.
Spermatic cord occlusion
The spermatic cord is the tube that transports the sperm from each testis to the penis and any blockages will
cause infertility. Common causes are vasectomy, infection and some sexually transmitted diseases.
Ejaculation disorders
Some ejaculation disorders such as retrograde ejaculation where the semen is ejaculated backwards into the
bladder can prevent proper transfer of sperm into the vagina without the man being aware of the problem.
Under-developed testes-usually arising after a mumps infection, a hernia surgery, an injury or birth defect.
Undescended testes-a problem often present from birth in which the testes remain in the body cavity.
Normally they descend into the scrotum before birth.
Infections, such as gonorrhea or tuberculosis, that block the ducts through which the sperm travel.