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Infertility Facts


Fertility disorders are incredibly common. Falling pregnant actually involves a great deal of chance. The probability of a healthy fertile couple becoming pregnant is around 25% a month, but decreases, as a woman gets older. For couples with reduced fertility, the monthly probability is smaller. Reduced fertility is referred to as “subfertility” in medical jargon. (The term infertility is reserved for couples for whom there is no chance of a spontaneous pregnancy.) A distinction is drawn between couples who have never achieved a pregnancy together (so called “primary” subfertility), and couples who have previously conceived together but have not succeeded subsequently (“secondary” subfertility). Secondary subfertility includes couples with one or more children as well as couples who have experienced a past miscarriage.

01. Basic Facts
02. Male Infertility
03.Female Infertility

Basic Facts

  • For women younger than 35, subfertility is defined as the lack of conception over a period of 12 months or more during which unprotected intercourse has occurred. For women over the age of 35 years, the time period used to define subfertility is reduced to 6 months.
  • Women who experience irregular menstruation or periods - which may point to problems with ovulation (egg release) – are generally advised to consider evaluation and treatment earlier.
  • In India, 13-19 million couples of reproductive age are infertile as per WHO estimate. In general, reduced fertility occurs in approximately 1 in 10 couples.
  • Reduced fertility is not more common in people of a specific race or ethnic origin.

The term 'infertility' is actually reserved for couples for whom there is no chance of a spontaneous pregnancy.

Facts that Every Couple should know:

  • Couples with normal fertility have an 85% chance of becoming pregnant in the course of one year. For approximately 1 in 12 couples, becoming pregnant can take longer than 2 years.
  • Infertility occurs at about the same frequency in men and women. As a rule of thumb, in approximately 30% of cases, the problem can be traced back to the woman, while in 30% it can be traced back to the man. In another 30%, a combination of problems exists in both partners, while approximately 10% of couples fail to display any identifiable problems that could explain their reduced fertility.
  • The age of a woman is one of the most important predictors of fertility. While many women become pregant after their thirtieth birthday, a women is actually at her most fertile in her mid twenties. Thereafter, fertility diminishes gradually up to the age of thirty and then decreases rapidly throughout the thirties. The most common female fertility problem is a problem with ovulation (egg release).
  • The probability of a woman of 35 years becoming pregnant is approximately half that of a woman of 20 years, but drops to 10% for a woman of 40.
  • A 37 year-old woman has approximately a 25% chance of experiencing a fertility problem; a woman of 41 years, 50%, and a woman of 43 years, a 75% chance of having a fertility problem.
  • For men, fertility diminishes slowly until around the age of 40, after which it begins to decrease more rapidly. The most common causes of male infertility are reductions in the number or mobility of sperm cells and/or changes in their shape.

Infertility Today:

  • The procedures described as assisted reproductive technologies (ART) include in vitro fertilisation (IVF) and related  procedures.
  • Such procedures are absolutely essential for some couples in  whom conventional therapies have been unsuccessful.

Current Treatment Opportunities:

Treatment depends on identifying the underlying cause of the reduced fertility. Thereafter, a range of different options is available, which can be grouped under the following headings.

    • Natural (drug) treatments involve the use of drug treatments only, for example, ovulation induction.
    • Natural (drug) assisted treatments involve the use of drug treatments as well as a fertility stimulating treatment (such as intra-uterine insemination or IUI).
    • (Drug) assisted reproduction involve the use of drug treatments combined with one of the ART techniques through which “test tube” fertilisation occurs such as IVF or Intracytoplasmic Sperm Injection (ICSI).
    • In some cases, surgical intervention may be necessary to increase the chances of a potential pregnancy. One of the above treatments is often still necessary thereafter.
    • One  recent possibility that has become available for some couples, especially those affected by male infertility, is a technique called Intracytoplasmic Sperm Injection (ICSI). Instead of combining “normal” ova (egg) and sperm cells in a Petri dish for standard IVF, this fertilisation technique involves the injection of a single sperm cell into the ovum. The use of ICSI has spectacularly improved the fertilisation rate in cases of insufficient or insufficiently mobile sperm or poor sperm function. This method was first described in 1992.
    • In the rare instances when there is a complete absence of sperm cells in the semen (azoospermia) due to a blockage of the sperm ducts, attempts can be made to obtain sperm cells directly from the epididymis. This takes place through a puncture or tapping (withdrawing the material with a needle). The retrieved sperm cells can then be used for a standard ICSI procedure. This technique is known as PESA - ICSI.

Male Infertility

When it comes to reduced fertility, the cause lies with the man in approximately 30% of cases, and with the woman in another 30% of cases. Sometimes the problem is caused by a combination of medical problems in both you and your partner. Each of you may have a medical condition, which, in combination, can make it difficult for you to conceive as couple. Diagnostic tests are used to great success to identify underlying causes of reduced fertility, and treatments are available for many disorders. Unfortunately, in approximately 10% of cases, the underlying cause of the problem cannot be pinpointed.

The general causes of male infertility include reductions in the quality of the sperm and problems with ejaculation. Reduced sperm quality can be caused by a number of factors. But in contrast to women, hormonal problems are less frequently a cause of male subfertility. This section contains a broad overview including useful information regarding these and other disorders that might be contributing to your problems.

Reduced Sperm Quality:
Insufficient sperm cells and other seminal disorders might be caused by hormonal problems, anatomical problems, immunological problems or even environmental factors. The quality of the sperm cannot be ascertained with the naked eye. Only an analysis of a sperm sample in a laboratory (sperm analysis) will provide information about the quantity, the motility, the form and the vitality of the sperm cells in a man’s semen. In addition, the clotting, the inflammatory cells and the level of acidity can also be checked. As a result of this analysis, a man might be given one of the following diagnoses:
Azoospermia - There are no sperm cells in the semen. In some cases, sperm is still being produced in the testicles but there could be a blockage or defect that prevents the sperm entering the semen. This blockage may be congenital disorder in the development of the male reproductive system or caused by an infection.
Oligozoospermia - The semen contains only a small amount of sperm cells.
Asthenozoospermia - This diagnosis is used if sperm cells with insufficient or low motility are hindering other healthy sperm cells in their attempt to reach the ovum.
Teratozoospermia - The sperm cells are so malformed that the chance of fertilising an egg is very low.
Sometimes multiple abnormalities are identified in which case the classification becomes even more complicated.

There are many causes for reduced sperm quality. Below you can find a summary of the most common causes of sperm problems.

Any blockage in the sperm ducts (vas deferens) or urinary tract hinders the sperm from actually being ejaculated. Such blockages are a common cause of infertility. They can be caused by infections (including sexually transmitted diseases - STDs) and can sometimes be reversed with the use of antibiotics thereby restoring fertility. If the obstruction is structural (physical), surgery or another procedure might be necessary. If the structural blockage cannot be cleared, then a biopsy or testicular puncture can be carried out to extract the sperm from the testicles.

Heredity/Congenital Disorders:
Sometimes the sperm ducts may not have developed. In this instance, sperm production does occur, but due to the absence of sperm ducts, it is impossible for the sperm cells to be present in the seminal ejaculation. Without intervention, it would be impossible for such men to father a child. In addition, these men often have an increased chance of a genetic disorder, which may increase the chance of the child having cystic fibrosis.

Klinefelter’s syndrome is a hereditary disorder (congenital disorder of the sex chromosomes in the hereditary material) in men characterised by an absence of or insufficient sperm cells in the semen. It is caused by an extra X-chromosome (XXY instead of XY). In many cases, sperm is still produced in the testicles, which can be collected through a testicular biopsy or puncture. However because it is a hereditary disorder, affected men will be advised to consult a genetic specialist before trying to start a family. The reason for this is that some of the sperm will also pass on an extra X-chromosome, which means that the child could inherit the same disorder as the father. A chromosome test of the embryos - preimplantation diagnosis - is one of the options that can make it possible to have healthy children.

Another hereditary disorder is the so-called Y-deletion. If a man has very poor sperm quality, the cause might be a hereditary problem with the male Y chromosome. This can be identified by undergoing a blood test, and again, because this disorder is passed on to male offspring, genetic advice is essential.

Retrograde Ejaculation:
If a male suffers from retrograde ejaculation, the sperm cells travel in the wrong direction when an ejaculation occurs ending up in the bladder instead of in the urinary tract. From an anatomical perspective, the sperm ducts join the urinary tract normally but the valves that regulate the flow of urine and semen through the urinary tract are defective. (If the system functions as it should, the valve between the bladder and the urinary tract contracts during an ejaculation, while the valve between the sperm duct and the urinary tract closes during urination.) This rare disorder is sometimes associated with diabetes or removal of the prostrate gland. Infertility treatment is usually based on assisted reproductive technology with the use of sperm cells recovered from the bladder after ejaculation. A catheter is placed in the bladder first to introduce a buffered salt solution and secondly to retrieve the buffer semen mixture after ejaculation. The solution is needed, as urine can be poisonous to the sperm.  Alternatively, the man is asked to drink neutralizing fluid two hours before ejaculation. After ejaculation, the bladder is emptied normally and the urine semen mixture collected and processed in the laboratory.

Ectopic Testis (cryptorchidism):
The scrotum hangs on the exterior of the body because the sperm must be a few degrees cooler than normal body temperature. If the testicles do not drop into the scrotum within or around the first month after birth, fertility problems can arise. Ectopic testis can be surgically corrected, but permanent damage can arise if the testicles don’t drop during childhood. The corrective surgical intervention may in itself be damaging to future fertility.

Varicose veins can occur in the scrotum. It is not clear precisely how this affects fertility, but one general theory is that the veins increase the temperature in the testicles. This warmth weakens the sperm and hampers sperm production. Varicose veins can be surgically fused, but there is no general agreement regarding the value of this surgical intervention in relation to its impact on fertility.

Hormonal disorders:
The exact hormonal balance in the male body is critical for the normal functioning of the male reproductive system. Male infertility can develop if the body produces insufficient testosterone or gonadotropins, namely follicle stimulating hormone (FSH) and luteinizing hormone (LH). However, hormonal disorders affecting reduced sperm quality are not that common. Hormonal problems can either be traced back to the primary glands that produce the hormones or to the glands where the hormones exert their affects: hypothalamus, pituitary, thyroid, prostate and testicles. If one of these glands does not function properly, this can be problematic to either sperm production or to the milk-like nutritional fluids that make up the semen.

A common factor that leads to the absence of sperm in the ejaculate is previous male sterilization (vasectomy). Men who desire offspring (subsequently) can opt for restorative surgery, to reverse the effects of the vasectomy. The success of this procedure depends on how long ago the vasectomy was carried out. If the vasectomy was performed more than five years, there is a smaller chance that it can be reversed successfully. Moreover, the greater the intervening gap, the greater the chance that antibodies against the sperm cells will be produced, causing sperm clotting. Vasectomy reversal is an outpatient procedure consisting of rejoining the patient’s sperm ducts or directly attaching the sperm ducts to the epididymis. If the vasectomy has been carried out more than five years ago, or if the restorative surgery is unsuccessful, then there are methods for retrieving the sperm from the epididymis or testicles for use in in vitro fertilization (IVF) or ICSI.

Other factors:
Sperm can also be influenced by the immune system. As a result of trauma or an infection, the immune system may produce antibodies that envelop the sperm and cause clotting of the individual sperm cells.

Sexual problems:
To successfully become pregnant, regular sexual intercourse must take place during the days when a woman is fertile. If the man has problems achieving an erection and/or ejaculating, this will have a direct effect on the chance of becoming pregnant. Erection difficulties can become a problem, particularly in the later stages of life. In the case of sexual problems, help can be sought from a sexologist and sometimes medications are also prescribed. Making love “on command” due to the desire to have children often puts added pressure on both partners in their sexual relationship, adding to or creating sexual problems.

There are a number of general illnesses and diseases, which can interfere with the production of healthy sperm. Given that the process of sperm production takes approximately 3 months, the effect of diseases or illnesses is temporary in some cases in which case normal sperm function resumes in time. Untreated infections can cause structural damage or reduce the production of healthy sperm. Fever and the use of some medications can also negatively affect male fertility. Reduced fertility can also be an unfortunate side effect of many health conditions or diseases, including diabetes, cystic fibrosis and mumps. All diseases that are associated with an extended period of high fever can also lower sperm production. In general, however, the effects of fever are temporary in nature.

Urinary Tract Infection (UTI):
Urinary tract infections are generally characterised by a stabbing pain during urination. Their cause and treatment is the same as for epididymitis. These diseases can be treated with antibiotics but, in conjunction with possible fever, can also have a negative effect on the sperm. This effect is often temporary.

Sexually Transmitted Diseases (STD):
The risk of reduced fertility as a result of a STD is high, as appeared to be the case with epididymitis, but at least men in contrast to women more often have the “advantage” of being aware of symptoms so that treatment can be given. (Many STDs, such as gonorrhoea, frequently cause no symptoms at all in women.) Some infections can be resistant to drugs and treatment can take longer than expected. Many men can also have STDs with no noticeable symptoms (asymptomatic), such as chlamydia, ureaplasma or mycoplasma, which may or may not impact the fertility of the man. However treatment is essential as these diseases can obviously have a profound effect on the fertility of the female partner.

This is an infection that can interfere with the function of the epididymis (where the sperm are stored) and therefore with the production of healthy sperm. In the case of epididymitis, the testicles can swell up due to the infection, which often causes pain. Sexually transmitted diseases (STDs) are the most frequent causes of infections of the epididymis. A bacterial infection can usually be cured with antibiotics, yet sperm production may be permanently damaged. Mumps related orchitis occasionally occurs in young boys. This is an inflammation of the epididymis caused by the mumps virus. This can lead to fertility disturbances due to abnormal sperm later in life.

Serious illnesses:
Serious illnesses, such as cancer, can have an enormous effect on many aspects of life, including fertility:

  • Chemotherapy and radiation treatment can damage or destroy the cells in the reproductive system.
  • Sterility is a side effect of many drugs used to treat cancer.
  • To treat the cancer it may be necessary to remove some of the reproductive organs, which will result in a damaged reproductive system.

On a more positive note, doctors and the medical establishment as a whole increasingly are aware of cancer patients’ desire to preserve their fertility. Many cancer patients arrange for sperm collection ahead of treatment. The sample can then be frozen until needed (cryopreservation).

Although age has a greater impact on women’s fertility than men’s, men should not ignore age as a factor that contributes to reduced fertility. Various changes can occur in the man as a result of increasing age. These include:

    • Reduced function of the testicles
    • Lower hormone levels
    • Reduced sperm production
    • Increased chances of ejaculation problem

Female Infertility

In approximately 30% of cases of reduced fertility, the cause is found in the woman, and in 30% of cases the problem lies with the man. In another 30 % of cases the cause is a combination of factors in both partners. Diagnostic tests are used with great success to identify the cause of reduced fertility, and opportunities for treatments are available for many disorders. However, despite the astonishing medical advances in this field, no underlying cause for reduced fertility can be identified in approximately one in ten (10%) couples. In this section, we take a broad look at the general reproductive problems that affect women outlining the common features of a variety of different disorders including hormonal problems preventing ovulation and structural abnormalities such as defective fallopian tubes. Armed with this information, you will be better prepared for consultations with your doctor and your search for a solution.

The most common causes of female infertility are:

    • Menstrual disorders:
    • Fallopian tube / womb abnormalities
    • Endometriosis
    • Problems relating to the cervical mucus
    • Age
    • Lifestyle

Menstrual Disorders:
Abnormalities in the normal menstrual cycle can be a sign of reduced fertility. Menstruation - the monthly bleed - normally follows ovulation (egg release). If there are problems with the process of follicle maturation preventing ovulation, then as a general rule, menstruation does not occur. This means that the absence of menstruation (in women who are not pregnant) is an important indication that there may be a problem with ovulation. It is therefore advisable for women with an irregular or non-existent menstrual cycle to undergo initial investigations to identify the underlying cause. Problems relating to ovulation are often caused by hormonal imbalances. In many cases, a woman produces too little of one hormone or too much of another - this is the underlying cause of the disorders outlined below. Luckily, hormonal disruption is not difficult to identify and the treatment (ovulation induction) is simple and relatively effective.

  • Hormonal imbalances
  • Polycystic ovaries (PCO)
  • Premature menopause

Hormonal imbalances:
A disturbance in the balance between the different hormones involved in reproduction can lead to reduced fertility in women. Hormonal imbalances can sometimes be traced back to disruptions in the primary glands (hypothalamus, pituitary or ovaries) that produce sex hormones.

  • The hypothalamus, pituitary and ovaries send signals back and forth throughout the reproductive process triggering changes in hormone production. A shortage of stimulating hormones is one explanation for a disrupted cycle. The hypothalamus can, for example, be influenced by stress, sickness or some medicines.
  • Alternatively the pituitary gland may produce too much of the hormone prolactin (prolactinaemia). If the concentration of prolactin in the blood is too high, it disturbs ovulation (egg release). Prolactinaemia can be caused by benign lumps in the pituitary gland, so if it is diagnosed, tests will be undertaken to investigate this.
  • A mal-functioning thyroid gland can also disrupt the hormonal balance and, as a result, ovulation. An increased production of the so-called “male hormones” (androgens) is another cause of disturbed ovulation in women.

By ascertaining an individual woman’s hormone levels, doctors can identify at what level the cause of the ovulation problem lies. The underlying cause is the critical factor in determining the type of treatment that is appropriate. The World Health Organisation (WHO) classifies women with ovulation problems into three different categories. These classifications are based on the level at which the problem lies.

Polycystic ovaries (PCO):
Polycystic ovaries or PCO, also called Stein-Leventhal syndrome, is a disorder whereby the hormonal balance is disturbed, which in turn disrupts ovulation (egg release). Essentially, the adrenal gland and the ovaries produce excessive amounts of the so-called male hormones (androgens), which leads to an abnormally high production of luteinizing hormone (LH) and an abnormally low production of follicle-stimulating hormone (FSH). As a result, the ovary fills itself with cysts of immature follicles that cannot produce eggs. (Androgens, although viewed as male hormones are actually produced in women as well. Similarly men also normally produce estrogens - the so-called female hormones. In each sex, it is the balance of these hormones that determine their affects.)
Women who suffer PCO can display a range of symptoms including:

  • Irregular menstruation
  • Enlarged ovaries
  • Excessive facial and bodily hair
  • Oily skin
  • Acne
  • Overweight

A diagnosis of PCO can be made on the basis of the clinical symptoms mentioned above, determination of hormone levels and an ultrasound scan of the ovaries. If a woman with PCO displays the described physical symptoms, then the condition is termed Polycystic Ovarian Syndrome (PCOS).

Premature menopause:
The cause of disrupted cycles can also lie in the ovaries themselves. The menopause marks the end of reproductive life in women and occurs when the ovaries ‘run out’ of eggs. In the event that the ovaries’ egg reserves run out prematurely, a woman can become menopausal before her time. Normally, the average age for the menopause is 51. If the reserve of eggs runs out earlier, then ovulation does not occur and menopause - the cessation of menstruation - is experienced earlier. If this happens to a woman under the age of 40, it is termed premature menopause. A premature menopause, also known as premature ovarian failure (POF), occurs in about 1 to 4% of women. If your sister or mother has experienced premature menopause, then it is important to report this to your doctor, as this condition often runs in families.

Other physical disorders:
A variety of other physical disorders including structural disorders can also affect women’s fertility. The problems mentioned in this section are unlikely to be discernable to the average woman. Structural problems in a woman’s reproductive organs can be caused by a multitude of factors, including endometriosis, infections, congenital defects, inflammations, traumas, tumours and sicknesses.

Problems with The Fallopian Tubes:
The fallopian tubes play a crucial role in the female reproductive process, where they function by using their many fingers or fimbrae as the connecting path between the ovaries and the womb (uterus). In addition, they create a favourable environment for the sperm. Scarred or blocked fallopian tubes can prevent the egg (ovum) from reaching the womb and the sperm from reaching the ovum. Blockages in the fallopian tubes are mostly caused by infections resulting from sexually transmitted diseases (STDs); while scarring may occur as a result of pelvic surgery, pelvic inflammatory disease (PID) or endometriosis. If only one tube is blocked, it is still possible to become pregnant. However, a partially blocked fallopian tube can increase the chances of an ectopic pregnancy, because it can prevent the passage of the fertilised egg - the embryo - to the womb.

The lining of the womb (uterus) is called the endometrium or the uterine membrane. Endometriosis is a condition whereby endometrial tissue grows outside of the womb, for example in or on the ovaries, the fallopian tubes, the bladder or the kidneys. Although outside the womb, this tissue undergoes the same cyclical changes as the normal endometrium. However, it cannot be shed as the endometrium normally is via the vagina.

Endometriosis can therefore cause painful, heavy periods as well as pain during intercourse, although it can also be present without causing any symptoms. A mild case of endometriosis has a minimal effect upon fertility. In more severe cases, adhesions and scar tissue can develop, which undoubtedly have a negative impact on fertility. The most commonly accepted (but not proven) theory about the cause of endometriosis is that the menstrual blood flows up into the fallopian tubes instead of down through the vagina leading to the presence of endometrial tissue outside the womb.
Endometriosis can reduce the chance of pregnancy in a number of ways:

    • Tissue growth can occur on the fallopian tubes, the outside of the womb or the ovaries. This tissue can cause a blockage or deformation.
    • If endometriosis is present in the ovary itself, blood-filled cysts can form (so-called chocolate cysts). This may hinder the growth of the follicles.
    • The tissue can secrete substances that although will not necessarily exclude fertilisation may reduce its chance of occurring.
    • There is an unproven theory that an immune reaction (immuno-response) can occur. Cells released during an immune reaction (macrophages) due to the presence of endometrial tissue outside the womb can - according to this theory - destroy eggs, sperm or embryos.

    Adhesions and scar tissue are mostly caused by abdominal infections, although they can also result from endometriosis and surgery. Adhesion possibly plays a role in a quarter - 25% - of the cases of female infertility. The most common abdominal infections are appendicitis and colitis. These can cause an infection in the abdominal cavity, which may affect, for example, the Fallopian tubes and lead to scar tissue and blockages. Scarred ovaries can also be caused by pelvic inflammatory diseases - a condition characterised by infections of the pelvic organs. When, as a result of scar tissue, the ovaries’ position changes, the fimbria (the finger-like protuberances at the end of the fallopian tubes) may struggle to collect the egg after ovulation. Ovaries affected by PCO sometimes have a thickened exterior or topping, which can prevent the ovum from being released. Abdominal surgery can also cause scar tissue and adhesion.

Cervical Mucus Disorders:
Normal cervical mucus is an essential prerequisite for successful fertilization. Many women notice a change in the consistency of their cervical mucus during their menstrual cycle. Around ovulation (egg release), the cervical mucus is clear and thin easing the passage of the sperm into the womb. But outside of the fertile period, this mucus acts as a barrier and is tough and more acidic. Although it provides protection preventing infections entering the womb, the sperm cells cannot survive in an acidic environment.
Disorders of the cervical mucus impact fertility if:

  • The cervical mucus is too thick during ovulation, preventing sperm from swimming through it.
  • The cervical glands do not produce enough mucus.
  • The mucus is too acidic during ovulation, rendering the sperm cells unviable.

In some cases, the glands that produce the cervical secretions may be damaged by infection or surgical treatment, which could eventually lead to disturbances in the mucus. The use of some hormones (including the medicine clomiphene citrate) can also have a negative influence on the composition of the cervical mucus.

The Immune System:
Disorders of a woman’s immune system are sometimes also identified as a possible contributor to reduced fertility. There is however no firm evidence for this and it remains a theory. Under normal circumstances, sperm and embryos are the only two “foreign bodies” which are not attacked by the female immune system. The immune system regards the embryo as a part of the female’s body, whereby it is effectively placed into quarantine in the womb and protected from attack. According to an unsubstantiated theory, the immune system of some women functions abnormally and attacks the sperm or embryo as if it were an invading or foreign cell.

Uterine Disorders:
Disorders in or around the uterus (womb) are unlikely to interfere with the process of fertilization, but may prevent an embryo from implanting or thereafter bring about a miscarriage. Some women are incorrectly diagnosed as being infertile, that is unable to become pregnant, while the disorder actually lies within the uterus - after fertilization. Daughters of women who took the anti-miscarriage medication diethylstilbestrol (DES) have a higher chance of congenital disorders in their wombs (and cervixes). These women often have a greater chance of an ectopic pregnancy, a spontaneous miscarriage or a premature birth. Some examples of uterine disorders are:

  • Myoma - these are benign lumps that form on the walls of the uterus. They may be covered in tentacles (polyps). Polyps in the cavity of the uterus are particularly prone to preventing the implantation or healthy development of the embryo.
  • Adhesions - Adhesions of the interior of the uterus can occur after surgery on the uterus, cutterage or, more rarely, after an infection. The most serious of these is described as Asherman’s Syndrome.
  • Congenital deformities - A number of variations are known. The womb may for example have a double horn or partition. These deformities do not generally influence fertility, but increase the risk of premature births and breech presentations.
  • Presence in an abnormal place - The womb can slip into the vaginal canal (prolapsed).

Other factors:
A variety of other factors can also have a negative influence on female fertility. This includes a variety of infections, ‘stress’ and serious diseases, such as cancer. The influence of lifestyle on fertility will be discussed in a separate section.

Sexually Transmitted Diseases (STDs):
Sexually transmitted diseases (STDs) are one of the most common causes of infertility. For most people, AIDS, syphilis or gonorrhoea spring to mind when they hear of STDs. But there are a variety of other STDs about which people are less aware which can have an affect upon fertility. Aside from the very common chlamydia infections, this includes ureaplasma, mycoplasma and the human papilloma virus.

Many of the sexually transmitted diseases (STDs) that are most damaging to fertility also create the least amount of discomfort or symptoms. In these cases, women often don’t experience any problems that would normally alert them to the possibility of an STD. One particularly important symptom of a variety of STDs that should always be checked out medically is an abnormal secretion.

Gonorrhoea and chlamydia can cause permanent damage, especially if they are not treated and lead to infection in the pelvis (Pelvic Inflammatory Disease - PID). PID can result in abdominal pain, and is one of the largest causes of infertility in women of a sexually mature age. The more often a woman gets PID, the greater her risk of infertility. Moreover, serious, untreatable infections can cause uterine cancer and other types of cancer, as well as causing chronic hepatitis and cirrhosis of the liver. Luckily, many STDs are treatable with antibiotics.

Chlamydia trachomatis is the cause of chlamydia infections. This infection is spread via vaginal, oral or anal sex and is one of the most widespread STDs. In women, symptoms can include abdominal pains, pain while urinating, abnormal vaginal secretions and sometimes even abnormal vaginal blood loss. Chlamydia sufferers, however, often have no symptoms at all and as a result this infection can remain undetected and, consequently, untreated. If so, it can cause permanent damage to a woman and eventually lead to a pelvic infection (Pelvic Inflammatory Disease - PID), one of the most common causes of infertility in sexually-mature women.

Pelvic Inflammatory Disease (PID):
PID refers to all infections in the pelvic organs. Untreated PID can lead to infertility. PID can be caused by the presence of external bacteria, such as mounting gonorrhoea or chlamydia infections. STDs are thus an important cause of PID and in turn infertility.

Stress is interpreted and experienced differently by everyone. By definition, stress is any situation that is threatening or damaging. Acute chronic stress in women can lead to depression and changes in the immune system or sleeping patterns. While there is only minimal evidence that stress is directly related to reduced fertility, extremely high stress levels in women can cause changes in hormonal levels. These altered hormonal levels can lead to irregular ovulation or fallopian tube spasms - both potential contributors to infertility.

Sexual Problems:
Problems of a sexual nature can also influence fertility. Because of this, your doctor will routinely ask you about your sex life when investigating the cause of fertility problems. If sexual problems are an issue then depending on the origin of the problem, a sexologist may be able to provide help. Making love “on command” due to the desire to have children often puts added pressure on both partners in their sexual relationship, adding to or creating sexual problems.

Serious Diseases:
Serious diseases such as cancer can have an enormous influence upon many aspects of a woman’s life. Unfortunately, cancer can also affect the fertility of a woman directly if the reproductive organs are involved or indirectly through the side effects of cancer treatments.With cancer of the ovaries, uterus or endometrium (the lining of the womb), it may be necessary to surgically remove essential parts of a woman’s reproductive system. While this surgery may be necessary to save a woman’s life, the fact that she can no longer become pregnant or successfully complete a pregnancy can be devastating. The treatment used to destroy cancer can also influence female fertility. Chemotherapy and radiotherapy can damage or destroy cells in the ovaries or damage the lining of the womb and the fallopian tubes. On the positive side, such infertility is sometimes only a temporary problem, especially in younger patients. In addition, doctors and the medical world in general are increasingly taking into account the desire of cancer patients to retain their fertility. Fertilized embryos can be frozen and saved for future use.

While the freezing or cryopreservation of sperm and embryos is carried out regularly and successfully, there has unfortunately not been as much success in relation to eggs or ovarian tissue. Ongoing research is investigating ways to improve the success of freezing unfertilized egg cells or ovarian tissue prior to cancer treatment, so that cancer patients can retain their fertility. In the future, many cancer patients will be able to plan this before undergoing their treatment.

n the last decade, the decision to have children at a later age has become increasingly common. Many factors may contribute to a woman’s decision to postpone starting a family; considerations like career planning, economic factors and a lack of awareness about age-related changes in fertility. However, delaying pregnancy does mean that the chance of a successful pregnancy and/or a healthy baby decreases.

  • consequences of age on the fertility of women
  • consequences of age for pregnancy

Consequences of Age on The Fertility Of Women:
A woman’s age is one of the most critical factors when it comes to becoming pregnant. Female fertility peaks in the early twenties, and declines thereafter. After the age of 35, fertility decreases dramatically (such that a 35-year-old woman has only half the chance of a twenty-year-old of becoming pregnant); and when a woman approaches her forties the chance of falling pregnant is greatly diminished to approximately 10% of the chance of a 20-year-old. Put another way, a 37-year old woman has approximately a 25% chance of fertility problems; a woman of 41 years, 50%, and a woman of 43 years has a 75% chance of a fertility problem.

The reason age is so critical in relation to female fertility is explained by the fact that the quantity as well as the quality of the eggs (ova) decrease with time.

Before a woman is even born, her body produces a supply of egg cells - about seven million - that she draws on throughout her life. The ova are immediately enshrined by a special layer of supporting cells and enter a phase of dormancy, in which they remain until they resume their development - perhaps 40 years later. But from birth onwards, no new eggs are produced.

As the ova leave their state of rest and resume their development, there is a steady decrease in the number that is in reserve in the ovaries. By birth, the number of ova has already fallen dramatically to about one million. It falls to about 300,000 by the time a female reaches puberty, and then declines more gradually throughout a woman’s reproductive life. Eventually, there comes a time when the store of ova runs dry; and menstruation ceases. At this point, the woman has experienced the menopause. In the years immediately before the menopause, many changes arise; many women experience a change in the length of their menstrual cycles, or heavier periods.

Nor is it just the actual number of eggs present in an older woman that affects her fertility. There is also a greater chance that eggs from an older woman may either not contain all of the chromosomes, or may contain too many. Many of these abnormal eggs never become fertilized or do not implant and therefore don’t result in a pregnancy, or do but are not viable leading to miscarriage. Additionally, the foetus has a higher chance of congenital defects due to defective chromosomes. Due to this, prenatal examinations are warranted for pregnant woman of 36 years or older.

Consequences of Age for Pregnancy:
The age of a woman is also important for the smooth running of the pregnancy itself. It is a good idea to be aware of the risks associated with older pregnancy beforehand.


Acknowledgement: Organon India Ltd., a subsidiary of Schering-Plough Corp.For further information:


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Posted on : November 9, 2016   by:Dr. Alex Varghese

Dates 2015

4 - 6

Annual Meeting of the Middle East Fertility Society

Location: Liege, Belgium
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