Causes of infertility

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Causes of infertility 2016-11-10T12:49:27+00:00

Causes of infertility

According to the World Health Organisation (WHO), infertility is a social disease. Based on the estimate data, on average every tenth couple in the world has problems with conceiving a child. In Poland, no detailed population studies have been carried out so far to determine the scope of infertility. Nevertheless, taking into account the above indicators, we can assume indirectly that the problems with conceiving affect approximately 1.2 – 1.3 million couples.

With regular sexual intercourses, 84% women get pregnant in the first year, and 92% in total after 2 years. At present, a couple’s infertility is defined as the couple’s inability to conceive after 12 months of regular, unprotected sexual intercourse.

The most common causes of infertility

Regular menstruation – in the case of every woman – depends on the proper ovulation. It is considered that the proper menstruation cycle should last from 21-35 days. In such cycles, menstruation occurs at acceptably regular intervals. If the cycle is once longer, and another time shorter, and a woman cannot determine the approximate date of menstruation – we can already speak about the irregularity the background of which should be examined.

Irregular menstrual cycles can often indicate a hormone imbalance and resulting ovulation disorders. They can be associated with thyroid diseases, polycystic ovary syndrome (PCOS) or luteal phase disorders. If ovulation does not process properly, problems with getting pregnant emerge.

In the case of bleeding / spotting which occurs irregularly or between periods, a specialist in gynaecology should be consulted. Typically the doctor will recommend a panel of tests and determining the levels of hormones participating in the regulation of the menstrual cycle in order to diagnose the cause of the problem. The gynaecologist will also perform an ultrasonography and suggest the path of proceeding optimal for the patient’s medical situation.

Pain during menstruation and also during a sexual intercourse may indicate an inflammatory condition within the pelvis or be the symptom of endometriosis. Inflammatory conditions may result from bacterial or viral infection within reproductive organs and their vicinity (appendix, intestines) and lead to lesions hindering or preventing pregnancy.
Endometriosis is a hormonal and immune condition occurring in girls and women in reproductive age. It is associated with the growth of the mucosal tissue of the uterus (endometrium) and its presence within the abdominal cavity. The endometrial cells produce mediators (chemical substances), which to significant extent affect negatively the process of ovulation, fertilisation and, later on, embryo implantation in the uterine cavity.

The cause of the problem is diagnosed on the basis of performed laboratory tests, examination of the bottom of the uterus and/or laparoscopy. When endometriosis is diagnosed, the therapy increasing the patient’s fertility is selected by the doctor – depending on the stage of the disease’s development and its severity.

Sometimes – where the course of the disease is mild or mild to moderate – the treatment consists in limiting the symptoms of the disease; in more problematic cases it may, however, require in vitro fertilisation.

The surgical treatments to which the patient was subjected, especially within the abdominal cavity, may lead to adhesions which cause tubal occlusion, a physical obstacle for a spermatozoon joining an oocyte.

The examination allowing the diagnosis is fallopian tube patency evaluation by laparoscopy or ultrasound examination with a contrast agent administered to the reproductive tract. If serious abnormalities are confirmed, the doctor may suggest in vitro fertilization.

Recurrent, untreated or improperly treated infections within small pelvis, like adnexitis or cystitis may result in adhesions. These in turn are the cause of tubal occlusion and resulting difficulties with fertilisation.
Women planning pregnancy should visit a gynaecologist before they start trying to get pregnant. The doctor will assess the condition of reproductive organs during an ultrasound examination. Problems with conceiving a child can occur in connection with, for example, underdeveloped uterus or uterine septum, retroverted uterus or congenital tubal anomalies.
Both underweight and obesity may influence the problems with getting pregnant. The most popular method of determining the proper body mass is the calculation of BMI based on body weight in relation to height of a given person. It is assumed that the permissible BMI value ranges between 18.5 and 24.5. Higher indices indicate overweight or obesity and lower ones indicate too small body mass. In both cases, improper body mass correlates with difficulties with conceiving a child.

It is worth taking care of the health condition and proper body mass already at the stage of planning a pregnancy. Consultation with a dietician or paying more attention to nutritional choices may be advisable. Sometimes the situation requires a visit to a specialist who will verify whether the improper body mass is not related to other diseases, e.g. thyroid dysfunction.

In case of diabetes or other metabolic diseases in the future mother, she should also consult the physician before starting trying to get pregnant. In some cases the consequences of disorders may have impact on the ability to get pregnant. Enhanced diagnostics and taking additional medical measures may be necessary.
In the case of certain couples the woman’s body produces antibodies to her partner’s spermatozoa which damage and destroy them. Typically such situation is defined as the “hostile cervical mucus syndrome”. By performing the test after an intercourse in the Fertility Clinic, partners may check whether they will have problems causes by such situation. The immune system disorders may also be the cause of miscarriages; however in such cases the detailed diagnostics is necessary.
Hyperprolactinaemia, the presence of abnormally high levels of prolactin in the blood, also can cause problems with conceiving a child. Prolactin is a hormone produced by the anterior pituitary gland, and its physiological function is the stimulation of mammary glands during pregnancy and lactation. Its abnormally increased level disrupts the proper functioning of the hormones taking part in the menstrual cycle. The symptoms of hyperprolactinaemia may include irregular menstruation, spotting, abdominal pain, dizziness or visual disturbance.

Hyperprolactinaemia is diagnosed on the basis of tests determining the blood prolactin levels and in some cases on the results of supplementary MR imaging of the head and ophthalmic examination.

The studies show that the problem of infertility affects ca 15-20% of couples in Poland. Despite the common access to information, there is still a common belief lingering on in the society, and in particular in its male part, that infertility is primarily the women’s problem.

Meanwhile the studies indicate that in 50% the causes of difficulties with conceiving can be attributable to the male partner. Based on the observations of the medical clinics in the world, in couples facing infertility the treatment is commenced most often only by the woman. Her partner does not want to acknowledge that he also can be infertile. Men affected by the disease have more difficulties in coping with the information about their infertility and tend to blame others for their imperfections. The news about the problem more often results in the decrease of their self-esteem, apathy, alienation, sometimes even aggression towards their family.