Causes of infertility
Causes of infertility can occur in both men and women.
Male infertility causes
Restrictions on testicular function
The reduction in sperm quality can affect all three main factors (concentration, motility, and percentage of normal sperm morphology). Infection-related damage to the testicles (including mumps/mumps orchitis), testicular varicocele, or occupational-related pressure or temperature influences are also associated with this condition. A late-stage testicular tumor often leads to a reduction in sperm quality.
Improper functioning or blockage of the reproductive tract
Certain genetic disorders Or inflammation can also cause the ductless reproductive tracts to either not form at all or to become clogged. Here too, the potentially highly feverish mumps infection plays an important role.
Hormone disorders
Hormonal disorders that are relatively rare are responsible for impaired sperm production. An example of a self-induced hormonal shift that is not uncommon is the use of anabolic steroids.
Immunological factors
For example, due to prolonged sperm depletion, infection, or after vasectomy (surgical closure of the spermatic ducts), antibodies against the own sperm may form, which reduce their ability to fertilize.
State after vasectomy
The operative vas deferens closure as a method of male contraception (contraception) results in no sperm appearing in the ejaculate.
Neurological and psychological factors
In cases of transverse paralysis or after surgery for tumors in the genital area, erectile and ejaculatory disorders (disruption of the sexual response) may occur.
In the so-called Retrograde ejaculation Although there is a pooling of bile, it occurs in the „wrong“ direction, namely into the bladder.
Mental disorders can prevent the achievement of pregnancy through libido disorder (disorder of sexual desire) and associated erectile dysfunction, or even just ejaculation dysfunction.
Chromosomal disorders
In certain chromosomal disorders, sperm maturation in the testes is impaired, such that even by performing a testicular biopsy (removal of testicular tissue), no mature, fertile sperm can be found.
Malformations
There are developmental disorders of the penis where the urethra does not open at the glans penis (the glans), but in the area of the penis sheath, so that during ejaculation (semen release) the sperm cells cannot easily reach the area of the vaginal opening.
Female causes of infertility
Endometriosis and infertility
Endometriosis is one of the most common causes of unwanted childlessness in young women. In over 50 % of the women with fertility problems, an examination of the abdomen using ultrasound reveals endometriosis.
The exact mechanism by which endometriosis develops is not yet fully understood.
Through adhesions, adhesions (adhesions) and fallopian tube closures, „mechanical“ obstacles can occur. Endometriosis cysts in the ovaries can lead to the inhibition of egg cell maturation. Through the endometriosis lesions, a persistent inflammatory reaction occurs in the abdominal cavity. This can disrupt the maturation of the egg cells just as much as the sperm quality or the implantation of a fertilized egg cell.
Not always IVF immediate treatment is necessary. Your doctor will advise you in detail according to the stage of your disease. Spontaneous pregnancies are also possible with endometriosis. If severe pain during sexual intercourse is caused by endometriosis, many couples avoid sexual intercourse or don’t sleep together at all.
The causes of female infertility can be divided as follows:
Hormonal causes (Frequency approximately 30 % among the purely female causes of infertility)
The smooth functioning of the sensitive hormonal system between the hypothalamus, pituitary gland, and ovaries (so-called „hypothalamo-hypophysar-ovarian axis“) is important for the smooth ovarian cycle. Here, under optimal conditions, during the fertile phase of the woman’s cycle (between the ages of 15 and 40), and increasingly irregular thereafter (up to 45 years of age), a mature egg is formed in each cycle, which is basically fertile after ovulation. The hypothalamus (part of the midbrain) as the superior part of the brain controls the actual secretion of gonadotropins (sex hormones) such as FSH (follicle-stimulating hormone), which stimulates follicle maturation (egg follicle maturation), and LH (luteinizing hormone), which ultimately triggers ovulation.
The perfect interplay of these hormones is influenced by other hormones, such as prolactin, thyroid hormones, male hormones and insulin. The slightest deviations within this system can disrupt the very development of the follicles.
External factors that alter the hormonal structure, such as competitive sports and significant psychological stress, can also cause infertility.
Hormonal disorders can not only be a hindrance to achieving pregnancy, but they can also have a negative effect on the child's development or lead to a miscarriage.
Tubal infertility (frequency approx. 30 %)
As a result of inflammation of the fallopian tube, the transport of the egg from the ovary to the uterus can be disrupted. In extreme, but not very rare cases, one or both fallopian tubes can be completely blocked. These changes are often caused by bacteria such as chlamydia.
Inflammatory processes (ovarian inflammation or also a renal artery inflammation) often lead to local inflammatory reactions that affect the formation of adhesions. This can restrict the mobility of the fallopian tubes, which hinders the function of the fallopian end membranes (fimbriae). During ovulation, the egg cell must be taken up by the fallopian end membrane in order to be transported further to the fallopian tube where fertilization finally takes place. If the passage of the egg cell or the early embryo is more severely compromised, premature implantation in the fallopian tube can occur, resulting in a life-threatening condition (fallopian tube pregnancy).
Endometriosis, which has been discussed in more detail elsewhere, can also cause this and other consequences, especially if it is not treated properly.
Uterine infertility (frequency approx. 5 %)
There are various abnormalities of the uterus, such as the uterus septum, uterus subseptus, and uterus arcuatus, which can interfere with implantation or the undisturbed development of an embryo. They can also cause bleeding during pregnancy. Myomas (benign muscle growths) depending on their size, growth location (uterus, uterine wall, uterine surface) can restrict fertility. So-called endometrial polyps (local overproduction of mucus) or adhesions after inflammation or as a result of discharge (including abortion) can restrict fertility.
Another problem is the poorly developed uterine lining without any identifiable cause.
Cervical infertility (frequency approx. 5 %)
Vaginal bleeding or inflammation are detrimental to the viability of the sperm. In particular, the properties of the cervical mucus during a woman’s fertile period can be altered by a lack of estrogen, preventing the sperm from ascending further from the vagina (the cervix) towards the uterus (the uterus).
Vaginal-induced infertility (frequency approximately 5 %)
Malformations or stenosis can prevent sexual intercourse from taking place. Inflammatory processes can favor a miscarriage or premature birth.
Immunological sterility (frequency approximately 5 %)
Much speculation continues to surround the importance of sperm antibodies and the possible „rejection reaction“ between sperm and egg cells. The speculation stems from suspected Immunological causes Therapies resulting from them are questionable in their effectiveness and are subject to controversy.
Disruption of blood clotting (frequency approximately 5 %)
Various congenital disorders of the so-called „cascade of blood coagulation“ can, without having any discernible impact on daily life, negatively affect the likelihood of becoming or remaining pregnant. These disorders, collectively referred to as „thrombophilia,“ are partially successfully treatable with blood-clotting inhibitors.
Chromosomal disorders (frequency approx. 5 %)
Congenital disorders, such as numerical chromosome aberration (deviation from the normal number of chromosomes) in all cells or in a part of the cells of the body (mosaicism), can also prevent pregnancy from occurring. On the other hand, they can increase the probability of miscarriage (birth defects).
