أسباب العقم | Assisting Nature

Male Infertility and Contemporary Treatment

Male fertility has been declining in recent years, but this does not mean that it is not curable, since developments in assisted reproduction are rapid.

When does a man have to resort to a Fertility Specialist in AssistingNATURE?

Men although should be the first to examine their sperm, often they avoid undergoing a sperm evaluation if pregnancy does not occur within a year. They should realize that low or weak semen can not question their masculinity. Moreover, if they delay sperm analysis, they might achieve real subfertility, (due to the fact their wives become older and especially above 39). Therefore, andrological investigation is required when:

The semen is less than 15 million/ml, motility is below 35%, and/or sperm Morphology is less than 4% (new WHO criteria)
There is a history of cryptorchid, urological surgery, sexually transmitted Microbes, chemotherapy
They suffer from a systemic condition like hypertension or diabetes.

The main causes of infertility of a man are the following:

Infection: proper evaluation might reveal subclinical prostatitis or chronic urine infection
Hormone imbalances: hypogonadism due to low FSH production is a common cause for example in athletes
Varicocele: a varicocele is a swelling of the veins that drain the testicle.
Ejaculation issues: especially with age these problems arise and need special care and treatments
Antisperm Antibodies: are antibodies that attack sperm and decrease fecundity
Tumors: seminoma even in initial stages or Lymphomas. Sperm needs to be cryopreserved for future use!
Undescended testicles: is a congenital abnormality and needs surgical correction in early childhood
Defects of tubules that transport sperm: cystic fibrosis is the main cause or trauma in childhood
Genetic reasons: unfortunately the majority of male infertility. Up to 60% is due to genetic mutations which are known but still expensive to explore. However, there are also chromosomal anomalies like Klinefelter syndrome or balanced chromosomal translocations

Female Infertility

The main causes of infertility of a woman are the following:

Anovulation or ovulation disorders: PCO is the main example. In this case, when ovulation is not fixed and therefore the length of the cycle varies, then spontaneous conception becomes very difficult.
Blocked fallopian tubes: tubes are closed due to subclinical infections (ureoplasma, mycoplasma) operations of the past (appendicitis) and endometriosis
Defective endometrial cavity: in case of endometrial polyps, submucous myomas, uterine septum and when adhesions are present, implantation is impaired and even recurrent abortions might occur in case of pregnancy
Low egg reserves: AMH is low and premature ovarian failure might be already present
Decreased egg quality and Age: with age fertility is decreasing especially above 40, due to abnormal meiosis of the egg, which leads to aneuploid eggs (not having 23 chromosomes)
Endocrine causes: hypothyroidism & hyperprolactinaemia.
Defective myometrium: such as large intra-mural fibroids or in adenomyosis.
Endometriosis: infertility is due to impaired ovarian function on the one hand and problematic conception on the other. The fallopian tubes and ovaries are floating in bloody fluid with adhesions around them, which makes it impossible for the sperm and egg to move freely.
Closed cervix: is rare and occurs in 1-2% of patients.
Immunological reasons: autoimmunity rarely causes infertility, less than 5%! Your engagement in sophisticated examinations and/or expensive treatments should be cautious and only if other causes are ruled out.