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Causes of Infertility

In vitro fertilization
21 Sep, 2015
A – Ovulatory Dysfunction

Hormonal problems: Ovulatory Dysfunction can occur when the secretion of FSH and LH hormones are not in the normal range. These hormones are secreted from pituitary gland in the brain, and they are necessary for ovulation. Abnormal secretion of these hormones may occur due to congenital causes or causes appeared later, or when there is no secretion of these hormones at all. In addition, the excessive secretion of prolactin hormone can cause ovulation problems.
The problems related to ovary:

  • Polycystic ovary syndrome
  • Decreased ovarian reserve
  • Endometriosis
  • Previous surgeries
B – Functional disorders of fallopian tubes resulting from adhesion or blockage of the tubes
C – The problems related to the uterus:
  • Myoma
  • Structural abnormality of the uterus
  • Endometrial polyp
  • Problems of the uterine cervix
  • Disorders of uterine lining (endometrium) like endometrial adhesion.

Upon determination of the cause of infertility, the studies on the solution of the cause start, and following these studies, the next step is planning the treatment.

  • Hormonal Disorders: Insufficient production of FSH and LH hormones secreted by the male’s pituitary gland do not stimulate testis and therefore sperm cannot be produced.
  • Disorders related to testis: Sperm production problems related to structural anomalies of the testis. These structural problems may be congenital or related to acquired infections.
  • Problems related to ejaculatory ducts: Conditions in which the sperm production is normal, but sperm cells produced cannot ejaculate as a result of the structural problems like congenital absence of the ducts or obstruction related to the infections.
  • Chromosomal abnormalities: Insufficiency in sperm production or no sperm production as a result of numerical and structural anomalies of the male chromosome which is normally 46 XY. However, in some of these patients sperm can be found in their testicular biopsies.
  • Varicocele: Varicocele is the dilation of the veins surrounding the testis. This causes the local temperature to increase and therefore sperm quality to decrease. However, varicocele is not always a cause of infertility by itself.
  • Azoospermia: Azoospermia is the condition when there are no sperms in the semen sample of the male partner. In these patients, sperm is tried to be collected from the testicle by an urologist with the surgical methods such as TESE, TESA, MESA and PESA. Urologist will either take small tissue biopsies from the testicle for microscopic examination, or aspirate fluid rich in sperm from the epididymis where sperms are stored.
  • Systemic diseases: Liver diseases, kidney deaseses and problems of pituitary gland that disrupt the hormonal balance. They affect the sperm production. Diseases with high fever decrease the sperm quality. Diseases of the nervous system can cause sexual dysfunctions.
According to the World Health Organization (WHO 2010) data, normal sperm values in the semen are as follows:
  • Semen volume (mL) – 1.5 (1.4-1.7)
  • Total sperm number (106 per ejaculate) – 39 (33-46)
  • Sperm concentration ( 106 per mL) – 15 (12-16)
  • Total motility (PR+NP, %) – 40 (38-42)
  • Progressive motility (PR, %) – 32 (31-34)
  • Vitality (live spermatozoa, %) – 58 (55-63)
  • Sperm morphology (normal forms, %) – 4 (3.0-4.0)

Most men will initially be diagnosed with the potential male factor problem based on the result of an ejaculated sperm specimen.

By examining the three sperm tests taken at different times from the male partner, deviations from the normal ranges are determined, if there are any. This plays an important role in the planning of the treatment.

Tobacco, alcohol, heat, a lot of factors such as drugs and infections affect the analysis of sperm tests and its production. In this case, the analysis should be repeated 2-3 times after a month.

If the semen analysis detected a fertility problem, the hormonal examination is done later.
Sperm production cycle is repeated every 2-3 months. So, after 2-3 months, the sperm will be released. The results of some treatments for improvement of spermogram’s quality or bad actions of harmful factors can be seen only after 3 months. Semen analysis findings should be kept in mind when the results of the treatments are evaluated.