Infertility

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Common causes of infertility Introduction
Underlying condition: Comments:
Male causes of infertility
Azoospermia (no sperm present) due to genetic absence of sperm duct or from mumps, gonorrhea, alcoholism
Endocrine problems hypogonadism
Varicocele enlarged veins in scrotum lead to warming of sperm, which damages them
Genetic abnormality Hypogonadism (Klinefelter syndrome, Kallman syndrome, Turner syndrome etc.)
Impotence (=erectile dysfunction) due to physical cause, depression or as a side-effect from various medications
Female causes of infertility
Ovulation problems polycystic ovary syndrome; anovulatory periods; injection BCP
Blocked fallopian tube
 following pelvic inflammatory disease
Cervical mucous abnormality physical barrier, if mucous not penetrable; other cause can be antibodies against partner's sperm
Depression loss of sex drive is one of the cardinal signs and symptoms of depression
Endometriosis or adenomyosis invasion of tube and ovaries by abnormal lining from the uterine cavity
Treatment of infertility

Contents

[edit] Infertility

Introduction:

It has become more commonplace that infertility affects couples. About 15% to 20% couples in the U.S. have an infertility problem
(Ref. 3, p. 226). This means that they tried without birth control methods to get a child, but were not successful after 2 years.

There can be various causes of infertility as is explained in the table below, but essentially infertility occurs when fertilization of the egg by the sperm does not work. This can happen, because no sperm is there (azoospermia), no ovulation takes place to release an egg (anovulation) or because there is a fallopian tube blockage making it impossible for sperm to reach an egg. A review of several studies showed that in about 27% of infertile couples the reason for infertility was an ovulatory problem, in 22% there was a tubal blockage, in 5% there was endometriosis infertility, in 25% there was a male factor infertility, in 4% there were other factors and in 17% the cause was unknown (Ref. 3, p. 327). The table above lists the common causes of infertility in more detail. This is explained more thoroughly in the text (see also Ref. 4) under the links.

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[edit] Endocrine problems

Several endocrine problems can cause a man to have a low sperm count, even if sperm production is normal. For instance, in secondary hypogonadism there is an FSH and LH pituitary gland disorder
or a lack of production of hypothalamic releasing hormones, which leads to infertility both in the male and the female. However, other hormone dysbalances such as for instance thyroid problems and diabetes mellitus will often also lead to infertility. Hormone problems are less common in the most reproductive years (age 18 to 27), which is another reason why couples who wish to conceive should do so then and not beyond the age of 30.

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[edit] Varicocele

This is a condition where the male develops testicular varicose veins and there seems to be a tendency for this trait to run in a family. About 25% of males in an infertility practice will have this common condition, whereas in the general population this figure is more like 10%. Only the more severe cases where the veins have a worm-like appearance and where both testicles are affected will lead to infertility. A urologist can correct this with varicocele surgery.

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[edit] Genetic Abnormality

In Klinefelter syndrome there is a genetic abnormality (47,XXY) where due to the additional X chromosome testicles in the male appearing person do not produce sperm. In Turner syndrome there is a similar problem in that the female appearing person has no functioning ovarian tissue and therfore cannot produce eggs. Both of these conditions are medically termed "primary hypogonadism" and more detail about this can be found under the above links.

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[edit] Depression

As outlined in another chapter on depression one of the symptoms of depression is a low sex drive. When untreated this can be a powerful barrier. If there is no desire for sexual intercourse due to this condition, this will lead to secondary infertility, even though structurally everything is working.

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References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.

2. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

3. Ryan: Kistner's Gynecology & Women's Health, 7th ed.,1999 Mosby, Inc.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.

5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.

6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.

7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company

8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company

9. Rakel: Conn's Current Therapy 2001, 53rd ed., W. B. Saunders Co.

10. Ruddy: Kelley's Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company

11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.

12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company

13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.

14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.

15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.

16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins

17. St. Paul's Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC

18. Gabbe: Obstetrics - Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.

19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.

20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.

21. Ignaz P Semmelweiss: "Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers" ("Etiology, the Understanding and Prophylaxis of Childbed Fever"). Vienna (Austria), 1861.

22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.

23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.

24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.


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