Causes of Infertility

Infertility Causes are unexplained (No male or female cause found)

Occurs in about 25% of couples presenting for fertility treatment. Occasionally factors not previously identified come to light during In Vitro Fertilization (IVF) treatment.

Ovulation (infrequent or absent)

Normally pregnancy results from a sequence of hormonally regulated events which act to ensure maturation and release of an egg from the ovary, a process called Ovulation. Any abnormality affecting these events may interfere with ovulation.

A common ovulation disorder, polycystic ovarian syndrome (PCOS), occurs in about 7% of women. Symptoms associated with PCOS include abnormal hair distribution (hirsutism), irregular or no menses, acne and being overweight.

Patients with PCOS can have an excessive response to fertility treatment known as Hyperstimulation Syndrome. This condition results in fluid accumulation around the entire body and places one at risk for developing blood clots in the vessels. Patients with PCOS should be given specific treatment protocols to prevent them from becoming hyperstimulated.

The normal aging process can affect the function of the ovary, in some cases ovulation may be apparent however the poor quality of the egg produced precludes the ability to get pregnant.

Tests for ovulation include hormonal and ultrasound imaging.

Tubal factors

The fallopian tubes need to be patent, as well as function normally for fertilization to take place. If the tube is blocked or damaged the movement of the egg through the tube is prevented. During IVF the tubes are not required as the eggs are fertilized outside of the body.

The tubes can be damaged by infections such as Pelvic Inflammatory Disease (secondary to organisms such as chlamydia or gonorrhea) and ruptured appendix, previous surgery or previous tubal ligation.

A hydrosalpinx is a fallopian tube blocked at the distal end and filled with inflammatory fluid. This fluid can flow into the uterus and provide a hostile environment for embryo implantation.

A common test used to determine if the tubes are blocked is the Hysterosalpingogram (HSG).

Uterine factors

After fertilization has occurred the uterus is responsible for the attachment and development of the embryo. Factors such as polyps, fibroids (occupying the innermost region of the uterus) and uterine scarring can prevent this implantation process. Very large fibroids occupying the uterine wall and external to the uterus, distort the uterus and may disrupt blood flow to the endometrium preventing implantation. In this setting surgery may be recommended, and may be of significant value in fertility treatment.

An ultrasound is commonly used to identify uterine factors. Examining the uterine cavity with a telescope can also be done.

Endometriosis

Endometriosis is a common cause of infertility. Approximately 5-10% of women in the reproductive age group have endometriosis. In this condition cells lining the uterine cavity attach to and penetrate areas in the pelvis such as the ovaries, tubes and the uterus in an abnormal manner.

Patients with endometriosis commonly present with pelvic pain.

This condition is diagnosed by using a telescope to examine the pelvic cavity.

Male factor

Almost 50% of couples presenting with infertility have some degree of male infertility. In about 25-40% of men the cause of their infertility is unknown.

Hormonal causes of infertility are usually at the hypothalamus-pituitary level or at the testicular level. Abnormal follicular stimulating hormone (FSH) and luteinizing hormone (LH) levels can affect normal sperm production.

Testicular causes of infertility include tumours, chromosomal abnormalities, absence of germ cells, drugs, radiation, orchitis, chronic diseases, undescended testis and varicoceles.

The semen analysis is the test to measure the quantity and quality of sperm

PRECYCLE/IVF TESTING

Blood tests include tests for viruses such as Human Immunodefiency Virus (HIV), venereal disease research laboratory test (VDRL), Hepatitis B and C.

Complete blood count, sickle cell testing and fasting glucose.

Hormonal tests such as thyroid function tests, prolactin levels, FSH/Anti mullerian hormone (AMH), LH and Estradiol levels.

Ultrasound to exclude uterine abnormalities (such as fibroids, polyps and ovarian cysts) as well as to determine the treatment protocol and to determine the prognosis.

Tubal testing such as HSG unless both ovaries have been removed surgically.

Semen analysis

Psychological testing