Infertility: Overview, Causes

Definition

Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).

Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.

Overview, Causes, & Risk Factors

Causes of infertility include a wide range of both physical and emotional factors. A couple’s infertility may be due to female factors, male factors, or both:

FEMALE INFERTILITY:

Female infertility may be due to:

  • Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
  • Problems with the eggs being able to attach to the lining of the uterus
  • Problems with the eggs being able to move from the ovary to the uterus
  • Problems with the ovaries producing eggs

Female infertility may be caused by:

  • Autoimmune disorders, such as antiphospholipid syndrome (APS)
  • Clotting disorders
  • Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
  • Excessive exercising, eating disorders, or poor nutrition
  • Exposure to certain medications or toxins
  • Heavy use of alcohol
  • Hormone imbalance or deficiencies
  • Long-term (chronic) disease, such as diabetes
  • Obesity
  • Ovarian cysts and polycystic ovary syndrome (PCOS)
  • Pelvic infection or pelvic inflammatory disease (PID)
  • Scarring from sexually transmitted disease or endometriosis
  • Tumor

MALE INFERTILITY:

Male infertility may be due to:

  • A decrease in the number of sperm
  • Sperm being blocked from being released
  • Sperm that do not work properly

Male infertility can be caused by:

  • Environmental pollutants
  • Exposure to high heat for prolonged periods
  • Genetic abnormalities
  • Heavy use of alcohol, marijuana, or cocaine
  • Hormone deficiency or taking too much of a hormone
  • Impotence
  • Infections of the testes or epididymis
  • Older age
  • Previous chemotherapy
  • Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery
  • Radiation exposure
  • Retrograde ejaculation
  • Smoking
  • Surgery or trauma
  • Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 – 30% per month. A woman’s peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month.

When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.

Pictures & Images

Pelvic laparoscopy

Laparoscopy is performed when less-invasive surgery is desired. It is also called “band-aid” surgery because only small incisions need to be made to accomodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

Female reproductive anatomy

Female reproductive anatomy

External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

Male reproductive anatomy

Male reproductive anatomy

The male reproductive structures include the penis, the scrotum, the seminal vesicles and the prostate.

Primary infertility

Primary infertility

Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy after a minimum of 1 year of attempting to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well as emotional factors.

Sperm

Sperm

The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the egg’s DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The midpiece contains the mitochondria which supplies the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm have to reach the uterus and the fallopian tube in order to fertilize a woman’s egg.


Review Date : 3/17/2009
Reviewed By : Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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