Possible causes of female and male infertility

 Many couples take a long time to see their desire to become parents come true. The causes of infertility can be multiple: from an infection to certain harmful lifestyle habits, but many have a solution.

The unsatisfied desire to have a child is a problem that affects both members of the couple. But there is not always an illness behind it. Lifestyle has a great influence on fertility, especially stress, excessive consumption of alcohol and coffee, and tobacco, you should review your lifestyle habits.

Investigate the causes

Before starting assisted reproduction treatment, the reasons why it is not possible to conceive a child must be investigated. The gynecologist studies the woman's menstrual cycle: using an ultrasound she observes the developing ovarian follicle. In addition, she orders a blood test to check for the presence of certain hormones, especially the hormone LH or luteinizing hormone, which stimulates ovarian cells and triggers ovulation. If the cycle is irregular, the doctor will recommend a urine analysis to more accurately determine the fertile days.

The man must also undergo a medical examination. The andrologist (usually a urologist) performs a monogram or spectrogram. It consists of a semen analysis in which the quantity, mobility, and shape of the sperm are assessed, above all. A figure of at least 20 million spermatozoa per milliliter of sperm is considered an acceptable value, of which half must have good motility.

If the semen analysis is not positive, it will be done again after a while. The spermogram reflects the characteristics of the sperm at a specific time. Some circumstances, such as a serious infection, can temporarily impair the ability to reproduce. Hence it must be repeated.

If the female cycle and spermiogram are normal, the following question arises: how are the fallopian tubes? This can be known through an abdominal laparoscopy. The doctor observes the uterine tubes with an optical tube inserted through the abdominal wall. An assistant injects a colored liquid into the tubes. If it flows without obstacles, everything is fine: the tubes are "passable" (they allow passage from the ovary to the uterus). With an ultrasound, fibroids, cysts, or malformations can be detected. Sometimes, the doctor may also examine the uterus with laparoscopy. A urine test or smear tells about possible infections.

The specialist assesses male hormone levels through a blood test. He also palpates the testicles and scrotum and notes the size and shape of the testicles. He may also examine the prostate and seminal bladder. A urinalysis can rule out possible infections.

Another test that is indicated is the postcoital test or Huhner-Sims test. It is done around the time of ovulation and up to 12 hours after having sex. A sample of sperm fluid is taken from the vagina after intercourse and analyzed under a microscope to see how many motile sperm there are. The test provides information about male infertility and possible vaginal disorders. It can also confirm a suspected sperm allergy.

After these analyses, most of the time it is possible to know the origin of the infertility. In approximately 40% of cases, the cause is male, and in another 40%, female. In the remaining 20%, either both men and women are involved, or the cause cannot be found.

Female fertility disorders

• Disorder of egg maturation (frequent cause: luteal or corpus luteum insufficiency).
• Absence of ovulation.
•  Infertility due to a problem in the fallopian tubes, for example as a result of a chlamydial infection.
•  Endometriosis  (growth of the uterine mucosa outside the uterus).
• Closure of the cervix by a mucous plug that, due to infections or hormonal disorders, does not dissolve during ovulation.
• Fibroids (benign tumors) in the uterus.
• Antibodies against eggs or sperm.
• Hormonal disorders (for example, an overproduction of the hormone prolactin or a malfunction of the thyroid).
• Early climacterium (premenopause): functional deficit of the ovaries.
• Congenital organic malformations of the ovaries, tubes or uterus.
• Tendency to suffer from repeated cyst formation.

Male fertility disorders

• The most frequent diagnosis: the number of sperm is low, their mobility is reduced and their appearance is abnormal.
• Closure of the sperm ducts, for example, due to a chlamydial infection.
• Varicose veins in the scrotum.
• Injuries to the testicles (for example, from an accident).
• Sperm antibodies.
• Having suffered mumps in childhood.
• A high testicle is not corrected in time in childhood.
• Having received chemotherapy.
• Chromosomal abnormalities (for example, Klinefelter syndrome, which consists of having an extra X chromosome).
• Circulatory disorders.
•  Diabetes.
• Abnormalities in the sperm ducts (often in men with cystic fibrosis).
• Rarely: impotence, erection, and/or ejaculation disorders.