CAUSES OF INFERTILITY

CAUSES OF INFERTILITY

Infertility: no conception after 12 months of unprotected heterosexual intercourse

  • in any given cycle, a "normal" couple has 20% chance of conception

    • How common is infertility?
  • 10%-15% of heterosexual couples experience infertility
  • 6.1 million hetersosexual couples in the U.S.
  • 33% of heterosexual couples in their late 30s

    • What are the causes of infertility?

  • 45% male
  • 30% female
  • 20% both
  • 5% idiopathic
    • (statistics vary according to source)

    Evaluation of infertility:

  • sperm problem?
    sperm analysis

  • ovulation problem?,
    BBT, urine LH, serum FSH/LH, serum progesterone, serum prolactin

  • egg and sperm uniting?
    ductal and tubal patency; mucus

  • implantation?
    serum progesterone

    • Common Causes of Male Infertility


    1. Low Sperm Count

  • most common cause
  • <20 million/ml semen defined as infertile
  • Rx depends on cause (some are lifestyle *)


    • 2. Varicoceles
  • abnormally dilated veins along spermatic cord
  • pooled venous blood effects sperm survival
  • most common cause is low sperm count
  • affects 30-40% infertile men


    • 3. Damaged/Blocked Sperm Ducts
  • 10-15% infertile men
  • vas deferens scarred from STD
  • vas deferens blocked by pressure from varicocele


    • 4. Hormonal Deficiency
  • insufficient or erratic release of FSH and LH
  • (clomiphene citrate/GnRH analogue


    • 5. Testicular Failure
  • adequate hormones but inadequate target tissue response
  • causes: some STDs, traumatic injury, surgery, tumors, drugs


    • 6. Sperm Antibodies
  • 10% infertile men have antibodies to own sperm
  • women may have antibodies to partner's sperm
  • sperm agglutinate, unable to penetrate cervical mucus
  • (Rx: washing, immune system suppression, IVF, AI, etc.)

    • Some Common Causes of Female Infertility


    1. Anovulation
  • often due to hormone insufficiency or imbalance
  • sometimes due to diet or body weight
  • check BBT, urine LH, serum FSH/LH/prolactin


    • 2. Fallopian tube blockage
  • often from STD (gonorrhea, chlamydia)
  • (hysterosalpingogram)


    • 3. Endometriosis

    4. Uterine abnormality
  • fibroid tumors
  • scarring due to surgery or trauma