What Causes Infertility?

Gain insight into the male and female 'barriers' to getting pregnant and the treatments available.

Male Factors

Failure to produce sperms in sufficient numbers and with the capacity to fertilize
a) Incomplete development of the testes
b) Late descent or non-descent of the testes
c) Infection of the testes (Orchitis) – complication of mumps
d) Damage of the testes from operation, accident, exposure to X-rays or radiation (in treatment of testicular cancer) or the result of chemotherapy
e) Exposure of testes to heat as in varicocele (varicose veins of the scrotum). This reduces the production of sperms.
f) Diseases of the testes, such as tumours, tuberculosis and syphilis
g) Depression of testicular activity by disease of other endocrine glands, by general ill health and by drugs or poisons
h) Age – male fertility tends to fall after the age of 40 years.

Bilateral obstruction of the epididymis, the vas or the ejaculatory ducts
a) Accident or operations, especially after Hernia operations
b) Infections, especially gonorrhoea
c) Congenital abscence or poor development of the vas

Failure to deposit sperms in the vagina
a) Impotence
b) Premature ejaculation
c) Abnormalities of the penis such as hypospadias and phimosis
d) Retrograde ejaculation into the bladder – usually after prostate operation.

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Female Factors

Failure to produce ova frequently or to produce ova capable of being fertilized.
May be congenital, result of disease (infection, endocrine diseases such as Hypothyroidism Addison’s disease)

Partial or complete bilateral tubal obstruction
Usually as a result of infection following STD (gonorrhoea, chlamydia), abortion, delivery

Cervical hostility
Usually due to antibodies produced by cervical mucus against sperms.

Vaginal hostility
From purulent discharge (Trichommas, gonorrhoea or chlamydia) or excessive vaginal acidity.

Tumours
Such as uterine fibroids

Endometrosis

Age
Female fertility declines sharply after 35 years

Coital errors
Non-consummation of marriage because of vaginismus or dyspareunia and very infrequent sexual intercourse.

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Medical Investigations

Male:
• Seminal Analysis
• Clinical examination to exclude varicocele, undescended testes
• Testicular Biopsy

Female:
• Tubal Patency tests: Laparoscopy or Hysterosalpingogram
• Dilatation and curettage
• Postcoital test

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Treatment

Male:
• Removal of varicose veins of testes
• Use of male hormones
• Storage of sperms before he undergoes chemotherapy/ radiotherapy/ surgery for testicular cancer

Female:
• Monitor ovulation using basal body temperature or ovulation kit
• Use of drugs to induce ovulation (eg. Clomiphene)
• Correction of any endocrine disorders, eg, treatment of thyroid disease, diabetes
• Surgery: tuboplasty, removal of fibroids (mycomectomy) or ablation of endometriotic tissues
• Treatment of endometriosis with Danazol or GnRH.
• IVF (In-Vitro Fertilization), commonly known as test-tube babies
• Artificial Insemination (Husband’s sperms – AIH or Donor’s sperms (AID)

I want to have a baby, but i cannot

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