What Are the Causes for Infertility?
Edited and published by Wellness Monster Mark
Infertility happens to ten to fifteen percent of American couples. The definition of infertility is not being able to get pregnant after having regular, unprotected sex for at least a year. One in every five couples in the Unites States goes for infertility care.
Causes of Male Infertility
The male reproductive system consists of the testicles, the duct system, which is made up of the epididymis and the vas deferens, the accessory glands, which include the seminal vesicles and prostate gland, and the penis. In a healthy conception of a child, the penis ejaculates healthy sperm into the female with no problems.
A cause of male infertility is poor sperm quality. Male sperm is needed to fertilize the woman’s egg to conceive a child. Poor sperm quality can happen for a variety of reasons. There are environmental chemical causes such as pesticides and radiation. Low or no sperm count can occur. The movement of sperm is a factor. Low sperm motility, or slow moving sperm, may not fertilize eggs fast enough. The shape of sperm is another factor.
Childhood cancer treatment can hurt sperm production. Chemotherapy, a treatment for cancer, may damage sperm. Some drugs used in chemotherapy are more harmful to fertility than other chemotherapy drugs. Targeted and immune therapies may affect fertility along with hormone therapy, bone marrow and stem cell transplants, radiation therapy, and certain surgeries. Medical conditions such as cystic fibrosis and hemochromatosis may affect fertility. Alcohol, smoking, and drugs may impact infertility. Being 40 and over also may impact fertility. Varicocele is another potential problem. This occurs when the veins on a man’s testicle are too big. The testicles are too warm, and the high temperature can influence the sperm’s numbers or shapes. Testicles may be abnormally formed or inflamed or have twisted, swollen veins. This can lead to sperm problems. Undescended testicles, exposure of the genitals to high temperatures, and early or late puberty may be factors. Scar tissue from surgeries may interfere with fertility.
Male reproductive cancers can interfere with having children. Testicular cancer starts in the testes. Penile cancer is in the penis. Prostate cancer is in the prostate, a gland inside the penis. Problems with erection and ejaculation will cause infertility. Erectile dysfunction is when a man can’t keep the penis firm enough for sex. Premature ejaculation is when a man ejaculates semen too soon and can’t impregnate the female. Retrograde ejaculation is when semen is forced back into the bladder. Injuries can lead to infertility. Spinal cord injuries, sports injuries, and combat-related injuries can lead to infertility. Men with spinal cord injuries may not ejaculate semen. Wearing tight underwear may lead to fertility problems because scrotal temperature is higher which means less sperm production.
Hypothalamic or pituitary disorders and gonadal disorders may cause infertility. Gonadal disorders include hypogonadism which is a result of low testosterone production. History of sexually transmitted diseases, hormone disorders, urinary tract infections, and certain medications for ulcers, psoriasis, depression, and high blood pressure may be a cause. Another medication is anabolic steroids which can shrink testicles. Hernia repairs and a severe mumps infection after puberty can lead to infertility. Men may have immune problems where they make antibodies against their own sperm. Not enough Vitamin C and Zinc in the diet may be a factor along with malnutrition and anemia. Too much exercise causes high levels of adrenal steroid hormones which cause a testosterone loss.
Hormone disorders that can interfere with fertility are Hyperprolactinemia, Hypothyroidism, Congenital Adrenal Hyperplasia, Hypogonadotropic Hypopituitarism, and Panhypopituitafism. Hyperprolactinemia is when the male has too much of the hormone prolactin which causes reduced sperm production, reduced libido, and impotence. Hypothyroidism is when low thyroid hormone levels cause poor sperm quality, poor testicular function, and disturbed libido. This can be caused by a diet too high in iodine. Congenital Adrenal Hyperplasia is when the pituitary is limited by high levels of adrenal androgens. This causes low sperm count, more immature sperm cells, and low sperm cell motility. Hypogonadotropic Hypopituitarism is when there is a low pituitary gland output of LH and FSH. Sperm development can be limited. Panhypopituitafism is total pituitary gland failure. This can cause impotence and undersized testicles.
Sperm ducts may be damaged. This may be genetic or caused by scarring by tuberculosis or STD’s. Torsion is when the testicles are twisted. Mumps, tuberculosis, brucellosis, gonorrhea, typhoid, influenza, smallpox, and syphilis may result in testicular atrophy. This means low sperm count and low sperm motility. Some STDs can cause infertility by blocking the epididimis or tubes. Klinefelter’s Syndrome is a genetic condition where there are chromosomal abnormalities, small testicles, and enlarged breasts. This condition entails testicular failure.
Causes of Female Infertility
Causes of female infertility can be numerous because the female reproductive system is complex and has many working parts: vagina, cervix, uterus, fallopian tubes, and ovaries. In a healthy conception, when the man ejaculates sperm into a female, the female’s parts have to be receptive to the sperm. The female has to produce a healthy egg in the ovaries. The egg has to travel freely from the ovaries to the fallopian tubes. Then the egg has to travel unimpeded through the fallopian tubes and land in the uterus. The uterus has to be healthy and a good environment to sustain the fertilization between the sperm and egg. The uterus has to be healthy enough to carry first the zygote, then the embryo, and then the fetus. The baby starts out as a zygote then becomes an embryo. The embryo becomes a fetus at the eleventh week of gestational age. Usually, after nine months, the baby is born. There can still be complications during the birth such as the death of the baby or a stillbirth. The loss of the baby is a miscarriage before twenty-eight weeks of gestation and a stillbirth afterwards. Miscarriage happens in ten to fifteen percent of pregnancies before the twelfth week of pregnancy. One to five percent of miscarriages happen between thirteen and nineteen weeks. One in one hundred women have repeat miscarriages. There are several causes for miscarriages such as poor fetal development, blighted ovum, and chromosomal problems.
Stillbirths happen in one percent of all pregnancies. They likely happen before labor but can happen after labor. Obesity, high blood pressure, and diabetes may cause stillbirth.
Ovulation problems are a major factor in female infertility. It’s the cause of thirty percent of women’s infertility. Ovulation is necessary for eggs to be fertilized. When anovulation takes place, there are no eggs released from the ovaries. Abnormal ovulation can lead to irregular or absent menstrual periods. Polycystic ovarian syndrome or PCOS involves hormone imbalance that can affect ovulation. It is the number one cause of female infertility. Primary ovarian insufficiency or POI also leads to ovulation problems. POI happens when a woman’s ovaries stop ovulating before she is forty. This is not early menopause. Early or premature menopause is another condition where a woman goes through menopause before age forty. A malfunctioning hypothalamus can cause ovulation problems because certain hormones aren’t triggered. A malfunctioning pituitary gland is when too many hormones or not enough hormones are released. This is caused by an injury, a tumor, or a chemical imbalance. Scarred ovaries that result from many surgeries or ovarian cysts may cause failed ovulation. The failure of an egg follicle to rupture can cause ovulation problems.
Tubal disease affects twenty-five percent of infertile couples. Fallopian tubes carry the egg from the ovaries to the uterus. Blocked fallopian tubes can result from Pelvic Inflammatory Disease, endometriosis, and surgery for an ectopic pregnancy. This can keep sperm from reaching an egg. Pelvic inflammatory disease is when sexually transmitted bacteria from chlamydia and gonorrhea spreads from the vagina to the uterus, fallopian tubes, or ovaries. Hydrosalpnix is a condition in which the fallopian tube is blocked at both ends and fluid gathers in the tube.
Endometriosis is when the lining of the uterus grows outside the uterus and affects ten percent of infertile couples. This happens to five million American women. Thirty to forty percent of endometriosis patients are infertile. This is two to three times the infertility rate of the overall population. Ectopic pregnancy happens when a fertilized egg grows outside the uterus. It usually grows in the fallopian tube. This tubal pregnancy can not be sustained, and the woman must receive immediate treatment for it. Appendicitis and colitis causes inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage. Pelvic or abdominal surgeries may cause adhesions that cause tubal blockage. Women may be born with tubal abnormalities.
Disruption in hormones can prevent pregnancy.
There can be various problems with the uterus. There are uterine fibroids and polyps which is non-cancerous tissue inside the uterus that can interfere with a woman getting pregnant. A septate uterus can lead to miscarriages or the inability to conceive. Another condition is adenomyosis where the uterine inner lining breaks through the uterine muscle wall.
Mullerian anomalies of the uterus can cause problems. This is when the female is born without a uterus or a misshapen uterus. Mayer Rokitansky Kuster Hauser syndrome is when a woman is born without a uterus or uterine remnants. Many women who have Turner’s syndrome are infertile.
Female reproductive cancers include cervical, ovarian, uterine, vaginal, and vulvar. It may also include breast cancer. Cancer treatment can hurt egg production. Chemotherapy, a treatment for cancer, may damage eggs. Some drugs used in chemotherapy are more harmful to fertility than other chemotherapy drugs. Targeted and immune therapies may affect fertility along with hormone therapy, bone marrow and stem cell transplants, radiation therapy, and certain surgeries. Surgeries may be a hysterectomy or oophorectomy. A hysterectomy involves removal of the uterus which means a woman can not carry a child. An oophorectomy is the removal of the ovaries. Pregnancy can’t occur because the woman has no eggs.
Smoking can be bad for a woman’s fertility. Being overweight or underweight can affect a woman’s fertility. The older a woman gets may impact her fertility. Fertility decreases with age especially after thirty-five. A woman getting pregnant after age forty-five is not likely.
Certain surgeries for women can result in pelvic adhesions or scar tissue that may limit fertility by blocking the fallopian tubes. Surgeries for endometriosis, ovarian cysts, fibroid removal, and ectopic pregnancy removal can cause adhesions. Surgeries to remove adhesions can cause new adhesions.
Cervical problems can cause infertility. It can prevent sperm from going through the cervical canal. Cervical mucus can hurt sperm or slow them down. Low levels of estrogen or high levels of progesterone can limit cervical mucus and interfere with the sperm flow.
Environmental causes can affect women’s fertility. Lead, Ethylene Oxide, and Dibromochloropropane (DBCP) are chemicals that can hurt women’s fertility. Lead may cause artificial abortion. Ethylene Oxide can cause early miscarriage. DBCP may cause early menopause.
Twenty percent of infertility cases are unexplained with no known causes.
Infertility can be treated in males and females in a variety of ways. Advances in medical technology have led to many successful births. Male infertility can be treated with surgery, medication, in-vitro fertilization, and other methods. Surrogacy allows a woman to carry and deliver a baby for another woman. The non-surrogate’s eggs may be used in the fertilization of the embryo transferred to the surrogate. This makes the non-surrogate the biological mother. Womb transplants where a healthy uterus is transplanted to a woman without a uterus have resulted in births. Scientists are working on an artificial womb where the pregnancy may be carried outside the female body. In the future, infertility cases will decrease as medical technology advances.
Costs of Infertility
In cases where infertility can’t be treated, adoption is an option. The financial costs of infertility treatments are high. The cost of an IVF treatment is $25,000. Insurance may cover it but only partially. There’s no guarantee the treatment will work. More than one treatment may be needed. The psychological effects of infertility that can’t be treated can be harsh as infertile men and women may have anxiety, stress, and depression. Whatever the causes of infertility, the effects of it can be deep.
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