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Identifying the Causes of Male & Female Infertility

In a conservative society like India, not many couples are open to approaching or discussing fertility issues with a doctor or a specialist. Given that infertility is often perceived as a social taboo, couples often keep the problems to themselves and in this process delay the diagnosis of their infertility. This delay can potentially disrupt fertility treatment – advancing age for woman is a major determinant for fertility – and too much of delay could cause irreversible damage. In recent times however, this attitude is changing and several couples are opting to voice their infertility concerns. The young generation is also embracing the reality that infertility is both a male & female phenomenon. It is therefore important to understand fertility problems in both females and males and make collaborative efforts to treat infertility. Causes of Infertility in Females The primarily causes for infertility in females are related to ovulation. Majority of women with ovulatory problems will experience irregular menstrual cycles - once in 2 months to 6 months - or there may be complete lack of them. Some women also have abnormally shorter cycles of just 15-25 days. Each of these problems is caused by hormonal imbalances, which result in inadequate growth of the egg and subsequent failure to ovulate. Some of the common hormonal problems are – polycystic ovarian syndrome, thyroid and prolactin hormone dysfunction, hypothalamus/pituitary dysfunction, amongst others. The decreased number of eggs in women is the result of advanced age, premature menopause, previous ovarian surgeries, cancer therapy or genetic problems which are potential precipitators of infertility. Endometriosis is another factor that is detrimental to as it affects the quality of the egg, alters the tubal functions and impairs implantation. This condition effects close to 10% of women; it can be identified with symptoms of heavy, painful and long menstrual periods; urinary urgency; rectal bleeding and premenstrual spotting. Uterine problems also contribute to female infertility. Presence of fibroids; and polyps or adenomyosis is some of the common uterine problems which cause painful and heavy menstrual bleeding or inter-menstrual bleeding. Congenital abnormalities of the uterus can result in difficulty in conception and recurrent miscarriages. Blockage of fallopian tubes, tuberculosis, sexually transmitted diseases, previous abdominal or tubal surgeries and congenital tubal defects are some of the other gynecological factors that affect a women’s ability to conceive a child. Aside from the gynecology factors, a women could face infertility challenges due to lifestyle factors such as - being underweight or overweight; excessive stress; and general health issues such as - uncontrolled diabetes and epilepsy. Causes of Infertility in Males In the last decade, infertility problems in males have increased from 20% of all reported infertility cases to almost 50% now. The most common reason for male infertility is low sperm count or absence of sperm or poor sperm quality. There are a variety of factors that may affect sperm production and as a result cause male infertility. Some of the common causes can be enumerated as - hormonal problems; history of testicular infection (mumps); trauma to testis, past genital surgeries (varicocele repair, hernia repair); exposure to high temperatures; use of certain medications; general illnesses such as diabetes, hypertension, high cholesterol; and genetic problems. Erectile dysfunction and ejaculatory dysfunctions are also factors contribute to male infertility and these are precipitated by psychological stress, hormonal problems, diabetes, neurological factors. Anatomical problems like abnormal urethral orifice (hypospadiasis), undescended testis or absence of vas deferens are also causes for infertility in males. Unexplained Infertility As stated above in about 30% of the cases of reported infertility it is difficult to ascertain any contrite causes - the precise cause for infertility may not be thus ever identified or attributed. This is the so-called broad category of unexplained infertility. Couples in this category simply have no obvious reason preventing their conception and therefore can be frustrating for the want-to-be-parents. Gynecologists and anthologists, however, can still work with such couples and there are fertility therapies that can work for couples with unexplained infertility as well as it works for those with specific causes of infertility.


MBBS, DGO, Fellowship in Reproductive Medicine

Rainbow Children's Hospital, Banjara Hills, Hyderabad