I want to know if I am infertile! Explaining the causes of infertility [supervised by a doctor]

What causes infertility?

Many people may think that infertility is primarily a problem for women, but since men can also become infertile, it is not advisable for men to think of it as something that does not affect them.

Especially if you and your spouse are trying hard to conceive, it’s a good idea to think that you might have a chance.

People who are infertile are generally diagnosed with infertility.

Infertility is a term used to describe a situation where a man and woman are trying to conceive for a certain period of time without using contraception, but are not able to conceive.

If you continue trying to conceive under basically normal conditions, it is said that you will become pregnant with about 50% success rate after 3 months, about 70% to 80% success rate after 6 months, and about 90% success rate after 1 year.

In other words, if you have no signs of getting pregnant within a year, it is best to be suspicious.

The causes of infertility are as follows:

• Ovulation Factor
• Tubal factors
• Cervical Factor
• uterine factor
• Endocrine Factors
• Male Factor

Now, let’s explain each of the causes.

Ovulation Factor

In the first place, in order to become pregnant, the fertilized egg must be ovulated in order to implant, so if there is any problem with the ovulation factors, infertility is more likely to occur.

Problems with ovulation factors can be caused by irregular menstrual cycles, excessive dieting, excessive weight loss, and excessive stress.

These can cause hormonal imbalances, which can lead to abnormal ovulation.

One particular indicator is the menstrual cycle.

Generally, the menstrual cycle is around 25 to 28 days, but if your period comes earlier or later than this cycle, it may be that your menstrual cycle is irregular and you are infertile.

Tubal factors

The fallopian tube factor is a condition in which some abnormality occurs in the fallopian tube, preventing the egg and sperm from meeting. There are various causes for abnormalities in the fallopian tube, such as blockage due to adhesions or narrowing of the fallopian tube.

Abnormalities in the fallopian tubes may be caused by sexually transmitted diseases such as chlamydia and gonorrhea.

In particular, chlamydia is so asymptomatic that many people do not even realize they are infected, so by the time they realize they are infected, they are often already infertile.

In addition, severe endometriosis causing adhesions around the uterine adnexa or a history of lower abdominal surgery such as appendicitis can also cause tubal factors.

Cervical Factor

Cervical factors occur when there is a low amount of what is called cervical mucus, commonly known as vaginal discharge.

During ovulation, the body switches over to become capable of conceiving a baby, and the amount of vaginal discharge increases to make it easier for sperm to travel into the uterus.

However, if the amount of cervical mucus secreted is reduced, the sperm cannot be transported smoothly into the uterus, which causes infertility.

The causes of decreased cervical mucus secretion include having had a sexually transmitted disease in the past or having had some kind of inflammation in the cervix in the past.

Uterine factor

In the case of uterine factors, various causes are considered, the main ones being uterine malformations, uterine fibroids/adenomyosis, and endometriosis.

In the case of uterine malformations, problems with the shape of the uterus can easily cause blood flow problems, which can hinder the smooth implantation and development of a fertilized egg.

The main types are the double uterus, bicornuate uterus, septate uterus, arcuate uterus, and unicornuate uterus.

In the case of uterine fibroids or adenomyosis, even if fertilization occurs, the disease makes it difficult for the embryo to develop.

In the case of endometriosis, it affects not only the lining of the uterus but also the ovaries, making infertility more likely, as it can lead to ovulation disorders and reduced egg quality.

If the condition becomes severe, it may cause adhesions around the uterine adnexa.

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Endocrine Factors

Endocrine factors, also known as luteal phase deficiency, are a condition in which the secretion of hormones essential for maintaining early pregnancy is reduced.

The corpus luteum has the role of raising body temperature and thickening the uterine lining to make it suitable for implantation, but if the amount of secretion from the corpus luteum decreases, implantation may not be successful or miscarriage may occur.

Immune factors

Immune factors are phenomena that can occur when antibodies are produced that inhibit sperm implantation or stop sperm motility.

The reason why antibodies are produced is unknown, but if they are produced, the sperm cannot implant.

Male Factor

The causes of male factor infertility are:

• Spermatogenesis
• Jinglu
• Semen and sperm
• gene
• Ejaculation function
• Sexual function

First of all, if there is a problem with spermatogenesis, there will be a problem with the function of producing sperm, making implantation difficult.

If there is a problem with the spermatic duct, for example if the vas deferens is narrowed or blocked, the amount of semen ejaculated will be reduced.

If you have a low sperm count you may have obstructive azoospermia.

If there is a problem with semen or sperm, or if there is an abnormality in the seminal vesicles or prostate, the sperm will have low motility and will no longer actively try to fertilize.

Even if you ejaculate, if the sperm are no longer functioning or have an abnormal shape, it will be difficult for the egg to implant.

If there is a genetic problem, it is possible that there is a chromosomal abnormality in the sperm.

If a sperm causing a chromosomal abnormality implants, the fertilized egg will also develop a chromosomal abnormality and will not be able to develop.

If the fertilized egg does not develop, there is a high chance of repeated miscarriages.

If you have problems with ejaculatory function, it may be that the sphincter that should close when you ejaculate is not closing.

If the sphincter does not close, the sperm that should be released will flow back into the bladder, resulting in a low volume of semen and a reduced chance of implantation.

Sometimes the cause of the sphincter not closing is unknown, but it can also occur after prostate or pelvic surgery.

Problems with sexual function may be due to psychogenic or organic erectile dysfunction.

Erectile dysfunction is a condition in which a man is unable to achieve or maintain an erection during sexual intercourse, so it is necessary to identify the cause and take measures.

How do I know if I am infertile?

To find out if you are infertile, you need to get tested in the following ways:

• Transvaginal ultrasound
• Hysterosalpingography
• Hysteroscope

The test for men is as follows:

• Sperm analysis
• Examination of the Testes
• Blood tests

If you undergo the above tests and find out that you are infertile, you will need to undergo infertility treatment.

What are the methods of infertility treatment?

The treatment methods are as follows:

• Timing Therapy

Timing therapy involves predicting the day of ovulation and timing sexual intercourse around the day of ovulation.

When having sex, ovulation-inducing drugs may be used to increase the likelihood of fertilization.

• Artificial insemination

Artificial insemination is a method in which semen is collected from a man, washed, and carefully selected for high motility before being injected into the uterus.

Since artificial insemination is performed in accordance with the timing of ovulation and fertilization, it is necessary to accurately determine the day of ovulation.

• In vitro fertilization

In vitro fertilization is a method in which eggs collected during egg retrieval are fertilized outside the body with sperm that have been collected in advance, and then returned to the uterus.

IVF is a method used when other methods have failed, so in some sense it can be considered a last resort.

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Summary

The causes of infertility lie not only in women but also in men, so it is necessary to address both men and women.

It is recommended that you undergo infertility treatment to find out if you are infertile. If you are going to undergo infertility treatment, it is necessary to choose a clinic by comparing the ease of access, the atmosphere of the clinic, and the treatment policy.

If you choose a clinic that provides friendly service, you can feel at ease in consulting them.

【References】

• Medical Notes – Infertility
• Japan Society of Obstetrics and Gynecology – 5. Causes and Tests for Infertility