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Infertility

Introduction

It has become more common place 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 below, but essentially infertility occurs when fertilization process 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). Below I have listed the common causes of infertility in more detail. This is explained further in links under the various headings.

Common Causes of Infertility

Male causes of infertility

azoospermia (no sperm present) : due to genetic absence of sperm duct or from mumps, gonorrhea, alcoholism

– endocrine problems : hypogonadism, lack of testosterone

– 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

 

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.

25. Dr. John R. Lee and Virginia Hopkins: “Hormone Balance Made Simple – The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central, NY, 2006

26. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 29 – 38 (Chapter 2): Risk factors for breast cancer. Page 360 to 374 explains about xenohormones and how they cause estrogen dominance. Pages 221 to 234 (chapter 12) explains why Tamoxifen is not recommended and bio-identical progesterone is more powerful in preventing breast and uterine cancer.

Last modified: November 12, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.