In the past decades, medical science has shown great interest in researching the causes of infertility that is observed in couples. One reason is the demographic problem that more and more countries seem to be facing. A second reason is that having and raising children is an exceptionally important event in every person’s life.
According to the World Health Organization’s most recent studies, human fertility has decreased significantly during the past 50 years. It is estimated that approximately 8-10% of all couples have infertility issues. The frequency of infertility varies from country to country but especially in countries of Western Europe, it is considerably high reaching up to 12% in couples of reproductive age.
Infertility is defined as the inability to achieve pregnancy, after a 1-year or 6-month effort for women over 35, without any contraceptive measures and with regular sexual intercourse. You can read more about it in the article Infertility Definition & Causes.
In modern times, η Assisted Reproduction offers the solution to the huge problem of fertilization. It has to be taken into account that this can cause financial, social, and psychological problems.
Assisted Reproduction is defined as the methods used in order to achieve fertilization through various assisting techniques.
The first successful human egg fertilization in laboratory conditions took place in 1978. However, to this day, this issue triggers strong reactions and arguments, dividing public opinion worldwide. The reason is that it is associated with huge moral, psychosocial and legal concerns. According to research sources, infertility is a multifactorial problem with interacting dimensions. It can be the result of a variety of causes, such as acquired genetic disorders, modern way of living, eating habits and stress.
In order to select the most suitable treatment for this issue, it is necessary to investigate the causes of both male and female infertility.
The couple’s personality and personal beliefs should also be taken into consideration. Therefore, the issue of fertilization often requires dealing with the couple’s psychosocial and emotional needs. This is why, at this point, we recommend the assistance and support of the team’s psychologist.
In short, numerous factors could be responsible for the infertility observed in couples. The most important ones are the following:
- Inability to produce healthy gametes.
- Inability of healthy gametes to interact with each other, resulting in no fertilization.
- Failure to implant the fetus in the uterus.
- Inability to complete the pregnancy.
You can also read the useful article How do genes affect our fertility?
Female factor – Female infertility
The main causes of female infertility are health problems, usually associated with the hypothalamus, the pituitary gland and the ovaries. These problems also affect the fallopian tubes, the vagina, the body, and the cervix. To achieve a successful conception, it is essential that all the above are anatomically and functionally flawless. The fallopian tube is responsible for 25-30% of infertility cases. Anything that prevents the egg and the sperm cell from joining and conceiving and also affects the normal function and anatomy of the fallopian tubes, causes infertility. More specifically, such conditions are serious infections in the form of episodes of tuberculosis or generalized pelvic inflammation, dysplasia, blockages, tubal dysfunction, etc.
Another equally important cause are previous surgeries, as they can cause adhesions which result to serious problems in the fallopian tubes. In addition, the use of contraceptives is often a risk factor for infertility because it can lead to inflammation and cause damage to the fallopian tubes. It is worth noting that voluntary infertility is achieved by surgical ligation of both fallopian tubes. However, the chances of reversing this procedure are limited and depend on the method of surgery.
The main causes of female infertility that are related to the vagina are inflammation, shape abnormalities, neoplasms, dyspareunia and vaginal atresia. Causes related to the uterus are responsible for 5-10% of infertility cases. The main ones are the fibroids which are mainly located in the uterine cavity, the endometrial adhesions, the severe or recurrent inflammations of the uterus and finally the disorders of the cervical mucus such as its deficiency, its altered composition or the presence of antibodies that cause sperm inactivity.
Endometriosis
Ectopic development of the endometrial tissue is an important factor that, through various mechanisms, causes infertility. Endometriosis is observed in 20-50% of infertility cases. It mainly concerns women between the ages of 30 and 40, women who had children at an advanced age and those who have given birth many times. Due to its high rate of appearance in developed countries, it is often referred to as a “disease of the upper social class”. Check out the detailed video and article about this issue.
Other causes can be lack of ovulation, inflammation of the ovaries, neoplasms, as well as luteal phase insufficiency. More specifically, situations where there is a hormonal insufficiency after ovulation, resulting to improper conditions for the implantation of the fertilized egg in the uterus. Menstrual disorders are responsible for 20% of infertility cases.
Furthermore, it can be the result of metabolic diseases such as diabetes and thyroid disorders.
It is well known that if the thyroid gland is not functioning properly then the relation between the hypothalamic hormones, the pituitary gland and the ovaries is directly affected.
For example, an overactive thyroid gland (hyperthyroidism) can cause menstrual disorders, as well as an increase or decrease of the woman’s sexual activity. On the contrary, reduced thyroid gland activity is mainly associated with decreased sexual activity, menorrhagia or uterine bleeding and more rarely, secondary amenorrhea. The dysfunction or malfunction of the thyroid gland can also be caused by the presence of neoplasms.
Male factor – Male infertility
In the past, it was believed that it was the female factor that was mainly responsible for the couple’s inability to have children. However, recent research data has shown that the male factor is exclusively responsible in 20% of the cases of infertile couples and co-responsible in 40-50%.
The main causes of male infertility are disorders of the urogenital system, genital anomalies, effects from the neurological and endocrine system, as well as psychological causes. A review of the bibliography shows that 90% of male infertility cases are caused by spermatogenesis disorders and more specifically the inability of men to produce sufficient quantities of healthy and good quality sperm.
The main sperm related disorders are aspermia, azoospermia (absence of spermatozoa in the seminal fluid), oligospermia (sperm concentration less than 20 million / ml), as well as asthenozoospermia, and oligoasthenoteratospermia (cases where the quantity, motility and morphology of the patient’s sperm are below normal standards).
In addition, endocrine functions are responsible for 3 – 6% of male infertility. The glands involved are: the hypothalamus, the pituitary gland, the pancreas, the adrenal glands and the thyroid gland. Also, varicocele is another factor that is responsible for 10% of infertility cases and it is treated surgically because conservative treatment is often ineffective. Factors responsible for causing varicose veins may be an increase in testicular temperature (which creates bad conditions for spermatogenesis) and secondary Sertoli cell disorder.
Other infertility factors.
In addition to the above, there are a number of other factors that are common to both sexes, such as demographics or even factors related to habits
Having children at an advanced age is a risk factor for infertility.
Nowadays more and more couples are starting a family at an older age, where reproductive capacity is reduced. More specifically, in recent decades we have seen an increase in the average age of women that decide to have children. The main reasons are their entry into the professional arena and their effort to obtain financial security. However, research shows a high rate of infertility in younger men aged 15-44, which is mainly attributed to contemporary lifestyle. You can also read Fertility in Older Men: What Causes DNA Damage?
Apart from age, other demographic factors, such as socioeconomic status and educational level, could nurture the couple’s ability to reproduce.
For instance, people with a higher financial-educational level are more likely to detect the problem. They also have easier access to diagnostic and therapeutic methods of assisted reproduction. In contrast, people with lower incomes lose valuable time identifying the causes of infertility due to the high cost of the diagnosis.
Other factors affecting infertility could be the stress that today’s couples experience, as well as their views or beliefs about the difficulties of having children.
For example, infertile women can experience feelings of guilt, anger, loss of purpose in life, low self-esteem, and social isolation, while men on the other hand, experience feelings of guilt because they associate infertility with impotence. Sexual disorders, caused by problems either in the couple’s medical health or the couple’s relationship, could also be responsible for infertility. You can learn more by watching this relevant video.
Even the nature of the couple’s profession can affect its ability to have children. For example, in men, long hours of sedentary work, exposure to radiation and cytotoxic drugs are risk factors for infertility. Another factor is poor working conditions, like having to carry out increased physical activity in high temperatures. Similarly, professions with high stress, due to vast responsibilities and obligations, can also determine the success of reproduction. Other causes that are very likely to cause infertility are eating disorders that cause excessive weight gain or weight loss.
Also, the undesired effects of planetary pollution on nature’s food chains damages the endocrine system and thus affects the ability to reproduce.
Reproductive capacity is also determined by environmental factors, such as the place where we live. High rates of infertility are observed in people living in rural-industrial areas who engage in agricultural work or are exposed to harmful physical or chemical agents.
As far as habits are concerned, smoking is a common cause of infertility for both sexes as it has a negative effect on sperm quality and women’s reproductive ability. Similarly, the abuse of alcohol and anabolic steroids are also both highly associated infertility.
Infertility of unknown cause is defined as the failure to identify a clear cause of infertility after a complete diagnostic test of both partners.
After reviewing the available resources, two serious problems arise. The first one is the lack of counseling support for couples with fertility problems. It should be considered a matter of great importance because couples have the opportunity to discuss their fears, worries and problems in their marital relationship, which can generally help to reduce stress. The second problem is that there are insufficient insurance regulations and lack of public information in Greece, both of which make any effort to fight infertility, much more challenging.
SOURCE: Saridi, M. and Georgiadi, E. (2010) – from the quarterly scientific journal “Rostrum of Asclepius”.
Dimitris Papadopoulos, Clinical Embryologist, REA Maternity Hospital
