The path to motherhood and fatherhood is different for everyone, a proper diagnosis can make a difference for those couples and individuals who are on their journey to create a family; that is why it is important to know the possible causes of infertility. At The Fertility Clinic Tijuana, our doctors will guide you every step of the way so that you can better understand your case and explore all the opportunities.
What is Infertility?
Infertility is defined as the inability to have a baby after a year (or longer) of unprotected sex – for women older than 35 years old, this period shortens to 6 months trying to conceive without success. Infertility can affect both women and men, and it may result from an issue with either you or your partner.
Infertility can be the result of a problem with the female reproductive system, the male reproductive system, or a combination of factors unrelated to the sexual organs but that significantly reduce pregnancy chances. Some of the infertility general causes that can affect men or women are:
Be over 35 years old
Family history of fertility problems
Having undergone cancer treatment, such as chemotherapy or radiation therapy
Systemic diseases such as diabetes
Excessive alcohol consumption
Problems with body weight, either obesity or underweight
Abuse of substances harmful to health such as drugs
Sexually Transmitted Diseases (STDs)
Eating disorders such as anorexia nervosa and bulimia
Constant exposure to toxic agents such as lead or pesticides
Emotional problems such as stress
How many types of infertility exist?
Primary. Primary infertility is defined women cases who have never been pregnant and who are unable to conceive after one year of intercourse without contraceptive protection.
Secondary. Secondary fertility refers to a woman who has already had at least one successful pregnancy, but who is unable to conceive again after having unprotected intercourse for more than a year.
What are risk factors for infertility?
Being over 35 years old and having unprotected intercourse and not being able to conceive for six months or more
Being over 40 years old
Very painful, irregular or absent menstrual periods
Have been diagnosed with pelvic inflammatory disease, polycystic ovary syndrome, primary ovarian insufficiency, or endometriosis
Having had miscarriages
Having had ectopic pregnancies
Pituitary gland disorders such as Cushing’s syndrome
Celiac disease or gluten intolerance
Uterine fibroids or polyps
Uncontrolled thyroid conditions such as hypothyroidism
Low sperm count
Defective or non-moving sperm
Testicular defects, such as testicles that are smaller than normal
Swelling in the scrotum
Having been diagnosed with prostate cancer and receiving hormonal treatment or chemotherapy
Improper use of anabolic steroids
Injuries to the scrotum or testicles
Low testosterone levels or hypogonadism
Varicocele, or dilated veins in the scrotum
Premature or retrograde ejaculation
Causes of Female Infertility
Blocked fallopian tubes
Due to chronic inflammation within the pelvis caused by endometriosis, infections, previous surgeries, or trauma.
A condition that consists of the growth of endometrial tissue outside and around the reproductive system such as fallopian tubes, ovaries, and uterus. It commonly manifests with symptoms such as cramps around the time of the menstrual period and is usually misdiagnosed as irritable bowel syndrome.
Which starts in the vaginal area and, if not treated, can extend and cause damage to other areas of the reproductive system (uterus and tubes). Some of the most harmful to fertility are chlamydia, gonorrhea, mycoplasma, and ureaplasma.
In 70% of cases, this disease does not present symptoms, which is why it often scapes early detection. Chlamydia can have serious consequences, causing health issues such as scarring in the reproductive tract (that can lead to infertility), as well as other problems like pelvic inflammatory disease (PID) or reactive arthritis in the long term.
Uterine Fibroids and Polyps
They are the most frequent benign pelvic tumors, occurring between 20%-40% of women of reproductive age. The most common symptoms are abnormal uterine bleeding, pelvic pain and/or pelvic pressure, constipation, and infertility (>15%).
Anovulation (Lack of Ovulation)
It occurs when the ovaries do not release eggs due to a hormonal imbalance caused by stress, eating problems, and excessive exercise, among other factors. This ovulation disorder is one of the most common reasons for infertility, representing 25% of cases.
Polycystic Ovary Syndrome (PCOS)
A condition that affects 10% of women, where a hormonal imbalance interferes with the growth and release of eggs from the ovaries; if there is no ovulation, pregnancy can’t take place. Fortunately, this condition is treatable.
The cervix is the canal that connects the vagina with the uterus; It is the spot where the spermatozoa enter on their way to the egg to fertilize it, and the duct through which the baby is born in a vaginal delivery at the end of gestation. Abnormalities in the cervix imply an infertility problem, such as alterations in the cervical mucus, in the cervix or at an anatomical level, such as defects in the shape of the uterus.Polyps and noncancerous growths in the uterine wall, or fibroids, can also make fertilization difficulty, or prevent the fertilized egg from implanting in the uterus.
Primary ovarian insufficiency
Primary ovarian insufficiency or premature ovarian failure occurs when the ovaries stop working normally before a woman is 40 years old, so that she begins to experience irregular periods and reduced fertility similar to menopause, but at ages that can begin in the adolescence. It differs from premature menopause because in ovarian failure you still have occasional menstrual periods, and some women can get pregnant.
Pelvic Inflammatory Disease
Pelvic inflammatory disease is an infection caused by bacteria or sexually transmitted diseases such as gonorrhea and chlamydia, which affect the female reproductive organs, such as the uterus and ovaries, causing scarring that can lead to obesity, ectopic pregnancy or infertility. Some women have no symptoms, while others have a fever, lower abdominal pain, foul-smelling vaginal discharge, burning with urination, pain with intercourse, or irregular bleeding.This disease is treatable with antibiotics, and it is essential to start treatment promptly, since waiting a long time increases infertility risk.
Uterine myomas or fibroids are benign tumors, which means, they are not cancerous. They grow around the uterus and cervix as abnormal masses of muscular tissue, originating from the cells of the myometrium or uterine wall. Due to their location, they can increase the difficulty to conceive, but it is not the only factor related to infertility.Myomas can be subserosal, intramural or submucosal, and it is the latter which are related to difficulty conceiving. Submucosal fibroids are found in the endometrium, so they block the fertilized egg entry into the fallopian tubes, or they make it difficult for the embryo to implant. Therefore, they are also related to spontaneous abortions in the first trimester.
For women, the recommendations are:
Maintain a balanced and healthy diet
Quit smoking if you plan to get pregnant.
Maintain a healthy weight, avoiding constant fluctuations
Do not drink or use recreational drugs
Limit caffeine intake
Is there any way to prevent female infertility?
Some types of infertility are not preventable, as they are determined by genetics, systemic or unknown causes. However, there are ways to increase your chances of getting pregnant:For couples, having sex regularly around your ovulation dates to increase your pregnancy chances. According to statistics, starting to increase the frequency of sexual intercourse five days before and one day after ovulation is the most likely frequency of pregnancy. It is also recommended for couples not to become obsessed with the subject, and to enjoy maintaining an active and pleasurable sexual life.
Male Factor Infertility
Azoospermia (No Sperm Count)
The absence of sperm in ejaculation can be classified in two ways: obstructive or secretory. The obstructive type is the result of the blockage of the conductor that transports the sperm, while the secretory is a problem due to the production of sperm from the testicles.
Oligospermia (Low Sperm Count)
This condition can be identified when there are less than 15 million sperms per milliliter of semen; the way it can be diagnosed is through a male fertility test.
Asthenozoospermia (Low Sperm Motility)
Sperms fail to swim efficiently through the reproductive tract to reach and fertilize an egg. It can be produced by testicular problems, smoking, alcoholism, antisperm antibodies, and factors such as age.
Teratozoospermia (Abnormal Sperm Shape)
Also defined as abnormal sperm morphology, where sperms show a defect in the head, midpiece, and/or tail. This malformation affects their chances of fertilizing eggs and can be caused by smoking, alcoholism, drug use, varicocele, diabetes, fever, chemotherapy, radiotherapy, and habits that increase the temperature on the testicles, like the constant use of hot tubs or saunas.
Testicular cancer and its treatment can have an impact on male hormone levels and the ability to fertilize an egg. In many cases, this type of cancer affects only one testicle, however, in adult men, sperm cryopreservation is recommended before starting treatment for later use in case of infertility.
Some alterations cannot be identified and it is classified as idiopathic infertility. In these, its origin is usually genetic. One of the causes of male infertility is DNA damage, specifically in the Y chromosome microdeletion, which means that there is a lack of information in the DNA structure, causing data disorder, producing from a very low number of sperm (olgospermia, or the complete lack of sperm (azoospermia).Another congenital anomaly is hypospadias, which consists of a defect in the urinary opening of the urethra, which is located on the underside of the penis instead of at the tip, causing sperm not to reach the cervix.
Varicocele is the most common cause of male infertility. This disease consists of the veins dilation which drain testicular blood, and a subsequent gradual deterioration of testicular function due to an increase in temperature in the testicles and epididymis. The testicles must be 2 to 3 degrees below the temperature of the abdominal cavity, so an increase can be critical for the sperm´s production and maturation.
Ejaculatory disorders can be premature and retrograde ejaculation. Premature ejaculation, which consists of reaching orgasm and emitting semen before starting sexual intercourse. Retrograde ejaculation, which occurs when semen goes into the bladder during orgasm instead of out through the penis, can be caused by bladder, prostate, or urethra surgery, some medications, and diabetes.Some men are born with blockages in the epididymis, which is the testicle´s part that contains sperm, or in the ejaculatory ducts, causing a lack of sperm or low sperm count.
Male hypogonadism is a condition in which the body does not produce enough testosterone for normal growth and development, as well as to produce enough sperm. Its causes are usually an intrinsic testicular problem (primary hypogonadism), a failure of the hypothalamus-hypophysis axis (secondary hypogonadism), or a diminished or absent response to androgens (androgen resistance). It manifests itself with body hair loss, decreased sexual function, gynecomastia, voice changes, among other signs.
Avoid very high temperatures in Jacuzzis or bathtubs.
Avoid exposure to environmental or industrial toxins
Avoid the use of electronic devices that give off heat in the legs
Even though there are numerous treatments for different infertility conditions, there are cases where no anomalies are shown after analysis; however they are still unable to conceive, this is known as unexplained infertility.
Infertility is commonly caused by hormonal and reproductive health-related issues, but in some occasions, it can be the result of other conditions, such as:
Previous surgeries or procedures.
Exposure to heat or carcinogenic toxins.
History of addictions such as alcohol, tobacco, and toxic substances.
Do you think you might have fertility issues? Identifying the symptoms through an infertility diagnosis is crucial if creating a family is your goal. Remember that it is never too late or too early to attend a consultation. Contact us today to schedule your appointment!.