Fertility Infertility Issues

Infertility: It affects about 20-25% of all couples. It is generally defined as the inability to conceive after one year of unprotected intercourse. For that reason, most Doctors recommend waiting at least a year before seeking consultation. Of course if a couple starts trying to conceive in their mid to late thirties, most Ob/Gyns would not recommend that they wait a year before seeking help.

What are the causes: Well; it takes two to tango, so we can divide them in male and female factors.

In the male there might be a defect in sperm production. Not enough live sperm are produced in the testes. Or not enough normal sperm are produced. (There are too many abnormal forms). There could be a problem with sperm transport: The sperm must travel from the testes to the seminal vesicles, located at the base of the bladder. To get there they go through a series of tubes, first the epididimys, attached to the testes, and then through the vas deferens into the body and into the seminal vesicles. From there they go through the prostate gland and out into the urethra. At any time on this long trip, the course can be interrupted either artificially, as in a vasectomy (done for birth control) or pathologically, as for instance a result of an untreated or undetected STD like Chlamydia or Gonorrhea. At times the male may have developed anti-sperm antibodies that can kill the sperm as they move along the vas deferens. Inflammation of the prostate gland can also kill sperm as they pass through it.

Finally there may be inability to ejaculate, perhaps due to neurologic disease, diabetes, and such. Some men experience retrograde ejaculation, in which the ejaculate instead of being ejected out the penis is aspirated back into the bladder.

All of these causes may be treatable, and are the reason why the first thing we do in an infertility evaluation is to get a semen analysis. It doesn’t matter that the prospective father has fathered children before. Something may have happened since then, and anyway, a recent study showed that one in five children (20%) were not their “father’s”

On the female side, the ovaries might not release an egg regularly, or ever, this is called anovulation, and may also be seen in conditions such as PCOS (polycystic ovary syndrome) The ovary needs to be transported to the fallopian tube, where it will meet the sperm. If the tube is blocked or narrowed, as can happen from inflammation, caused by STD’s or other infections, either the sperm cannot get through, or what is worse, the sperm can get through, but the larger egg cannot, in which case it will implant in the tube and cause an ectopic pregnancy, which may be life threatening.

Finally, when the fertilized egg, now an embryo gets to the uterus (womb) it needs to implant, to anchor so to speak, in the wall of the uterus. At times the lining of the uterus may not be ready to receive the egg, due to a deficiency in the production of progesterone by the ovary (Luteal phase defect), and the very early pregnancy is lost.

In addition women too can develop antisperm antibodies so the sperm are killed as they swim through the cervix, into the uterus and up the tubes.

Essentially all of these conditions can be treated nowadays easily, or sometimes with assisted reproductive technologies.

Finally, in about 20% of the patients who experience infertility, no cause is found. Those are the most difficult to treat, because many do become pregnant spontaneously, but if not, it is hard to decide what to do.