What Causes Infertility

What causes infertility?

To understand the causes of infertility, it helps to understand how normal pregnancies happen. There are many steps that need to happen correctly, from the time the sperm is released until the point when a baby is growing inside the womb. A problem can happen at any part along this path.

How do I find out why I am not getting pregnant?
If you are worried about your fertility and concerned that you may have a problem then come to the clinic for some advice. The first step is to have some basic tests. Many couples will contact our fertility clinics directly and speak with one of the nurses. We offer free appointments with the fertility nurses to discuss your situation and they can organise some basic tests for you both. There are tests for men as well as for women.
Testosterone, androgens and low sperm levels
Long term use of Anabolic Steroids and androgens will reduce the number of sperm produced and affect their motility (swimming). This is why men on testosterone replacement therapy (gel, patches & injections) often have a low sperm count and infertility. Stopping these treatments will often lead to a higher sperm level and a return to normal fertility levels. Other drugs, such as Proviron, are weak androgen drugs and are known to have the same effect on generally lowering fertility levels for men. Sadly they are sometimes prescribed with the opposite intentions, to boost fertility, when doctors or pharmacists are out-of-date with international medical best practice.
Cancer treatments and preserving fertility
The drugs involved with Chemotherapy can severely reduce sperm production, however advances in sperm freezing of course now mean that if you have to undertake a course of chemotherapy you should be offered the option the of freezing sperm in advance of your treatment.
Smoking
New evidence shows that the sperm DNA (genetic material) is damaged by the chemicals in tobacco smoke – this may lower the chance of a healthy pregnancy and may affect your child’s future health.
Alcohol
Drinking alcohol is a part of daily life for some people and drinking in small amounts is not harmful to fertility. However, binge drinking and regular heavy drinking can harm your health. Drinking heavily may cause liver problems, and affect a range of body functions including sexual and reproductive function. Also, drinking heavily, even if there is no damage to the liver, may damage the function of the testicles.
Your work environment
Pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm you produce. Men should try to avoid exposure to these harmful chemicals. For men who must work with such agents, sticking to occupational health and safety guidelines is crucial. If in doubt – ask!
Medical Treatments
‘Think before you get the snip’. Men planning a vasectomy should think about storing sperm before having the surgery.
Laptops and WiFi

Can laptop computers and WiFi damage male fertility?

This is a good question. Sperm counts have been dropping worldwide for the last 100 years and scientists remain baffled as to all the reasons. In a recent study from Argentina scientists have shown that ejaculated sperm from 15 men showed damage to both the swimming ability and genetic integrity after exposure to a laptop computer connected to WiFi. The study was small and experts have warned that other factors could explain the damage seen in the sperm. At present we advise men to avoid having laptop computers on their lap. Apart from potential damage to sperm the heat generated underneath the laptops caused significant heating in testicles which is thought to reduce sperm quality.

Drugs and Medical Treatments

Although fertility is often the last thing you think about when diagnosed with cancer, radiation therapy and chemotherapy can cause long-term problems with sperm production. Often sperm can be stored before starting treatments. With low doses of radiation and some types of chemotherapy, sperm production can return to normal after  a period of time. Ask your doctor about sperm storage before having these treatments, and find out when it is safe to try to become pregnant naturally after the treatments have stopped.

Fertility or sexual performance problems can also happen with other prescribed drugs such as some drugs used to treat inflammatory conditions, depression, epilepsy, high blood pressure and diabetes. Well known to cause low sperm counts are the drugs Proviron and testosterone injections, which are sometimes mistakenly given to increase sperm counts.

Taking anabolic steroids for body building or competitive sports damages your body. Besides causing acne, weight gain and changes in mood, your testicles shrink in size and sperm production stops. In other words, “steroids = sterile”. Once the drugs are stopped, sperm production may take one to two years to return to normal.

Fertility can also be affected by using other illegal drugs, such as marijuana, cocaine and heroin because they lower testosterone levels and sex drive. Not having regular sex can make it more difficult to become pregnant. There are many other illegal drugs that affect sexual performance and may reduce sperm production or even damage the sperm themselves. We simply don’t know all the risks – so don’t take the chance!

Heat
Avoid spas, saunas and hot baths if trying to father a child. Wearing boxer shorts may also help keep things cool down there.
Infections

Sexually transmitted infections (STIs) such as Gonorrhoea, chlamydia, syphilis, warts… these little nasty’s can not only be painful, but some of them can affect your fertility. STIs, especially untreated gonorrhoea and chlamydia, can cause blockages in the sperm tubes so that sperm can’t move on from the testicles (where they are produced) and into the semen and ejaculated. Surgery to fix the blocked tubes isn’t always possible. STIs can cause fertility problems in women so getting treatment can also stop the spread of disease to a female sexual partner.

The prostate sits underneath the bladder and adds fluid to protect sperm on their journey through the reproductive system. Infections of the prostate, known as prostatitis, can cause pain in the abdomen and fever. As the sperm move through the prostate into the urethra, swelling of the prostate may stop sperm from passing through the reproductive system.

Mumps is a viral infection that can be caught by anyone at any age, but it’s much more dangerous for adult men. The mumps virus can totally destroy the tubes that make sperm and permanently stop sperm production.

Age and fertility for women

For women one of the most important factors is age. In normal conditions, when a woman and man are healthy and younger than 35 years the chance of a pregnancy occurring each month is between 5-25%. As a woman gets older the chance of a pregnancy each month becomes lower because she has less eggs and these eggs are not such good quality.

By the age of 40 years pregnancy is becoming less common and it is almost impossible to achieve a pregnancy from the age of 45 years without using someone else’s eggs (donor egg IVF).

A woman is born with all the eggs she will ever have and as she goes through life, these eggs naturally reduce in numbers. By forty a woman has only 1-2% of the eggs she was born with. Also the good eggs tend to be used first and as she gets older the eggs being released are not such good quality. This causes higher rates of both miscarriage and abnormal babies in women 40 and over.

This reducing fertility as a woman ages is illustrated in a study that looked at pregnancy rates in women receiving sperm donation. In these cases the infertility problem was due to the male partner (male factor) and the women were all without infertility problems, so there was a need for sperm donation. The study showed that among healthy women who are 25 years old, 40 per cent (40/100) will not be pregnant after six months of trying, and 15 per cent (15/100) will not be pregnant after one year. For women who are 35 years old, 65 per cent (65/100) will not be pregnant after six months of trying and 40 per cent (40/100) will not be pregnant after one year. The study also showed that 15 per cent (15/100) of women over 35 will still not be pregnant after two years. The fertility rate of these women has been halved because of age alone.

By the age of 40 years pregnancy is becoming less common and it is almost impossible to achieve a pregnancy from the age of 45 years without using someone else’s eggs (donor egg IVF).

How does conception occur?

Women have two ovaries, which are located in the pelvis on each side of the womb. The main function of the ovary is to grow and release eggs and produce hormones.

For a pregnancy to happen an egg needs to be fertilised by a sperm. The fertilised egg (embryo) then needs to implant itself into the lining of the womb so that it can obtain nutrients to aid its growth.

A number of steps need to take place for this process to occur successfully:

  • The egg needs to grow and mature in the ovary.
  • The egg needs to be released from the ovary (ovulation). Eggs are tiny and have to be magnified hundreds of times with a microscope to be seen by the human eye.
  • The egg needs to be collected into the end of the fallopian tube. The tube achieves this by it’s end moving down to the ovary to the area where the egg is releasing. The inside of the tube is wet (like the inside of our mouths) and has delicate hairs and muscles that gently create a current of fluid moving towards the womb, just like a gentle vacuum. There are finger-like structures (fimbriae) at the end of the tube that catch the egg and it is sucked up into the tube.
  • The egg and sperm need to meet. Therefore sexual intercourse needs to occur around the same time as an egg has been released from the ovary.
  • The egg needs to be good quality
  • The sperm need to be present in good numbers with the ability to swim forwards. They swim through the cervix (neck of the womb), through the womb and into both tubes, to look for an egg.
  • At the same time, the lining of the womb should be thickening up and preparing itself for the fertilised egg to implant.
  • When the sperms find the egg they need to bind to the egg. One sperm will then get inside the egg and fertilisation occurs.
  • Once successful fertilisation has occurred, the egg changes to grow into an embryo. As the embryo divides from two to four cells and then more, it starts it’s journey down the fallopian tube towards the womb. The embryo will eventually become the billions of cells that we are made up of.
  • Once the embryo reaches the womb it begins to burrow into the lining (implantation) and a week or so later there will be pregnancy hormone detectable in the woman’s system and a pregnancy test will be positive.
  • Anything that interferes with this process can affect a couple’s fertility. For example:
  • An egg is not produced. This is due to either very low or absent egg levels or the eggs not releasing (anovulation)
  • The egg is poor quality
  • Sexual problems meaning no sperm are delivered into the vagina
  • Blockage in the tubes allowing the sperm to move from the testicle to the tip of the penis, so no sperm reach the vagina
  • The end of the tube cannot move to collect the egg due to scar tissue inside the pelvis
  • The sperm cannot reach the egg because of tubal blockage or tubal damage, e.g. from infection or pelvic disease, or because the sperm cannot swim well or are present only in low numbers
  • The sperm cannot reach the egg because the sperm cannot swim well or are present only in low numbers
  • The sperm cannot fertilise the egg, due to a problem with being unable to bind to the egg or due to a genetic problem with the egg or sperm when they meet.
  • The tube cannot catch the egg due to the absence of the finger-like ends (fimbriae) or damage to the hairs or muscle in the tube
  • The embryo cannot implant due to problems in the womb
  • The embryo does not implant due to a failure of the cells to grow
  • If the egg is not fertilised the lining of the womb is shed and the blood released in a period or menstruation. This usually occurs 14 days after ovulation.

The causes of infertility can be due to something that affects the man or the woman, or both. If the problems are related to the woman this is called female factor infertility.

In our clinics in Trinidad, in over half the couples we see both the man and the woman have a fertility problem.

Things that might be a problem causing infertility for women are

  • problems with the womb eg fibroids, polyps or a problem with implantation of the embryo
  • problems with eggs eg poor quality eggs, absence of eggs or failure of the eggs to ovulate each month
  • blockage or damage to the fallopian tubes
  • medical conditions in the woman’s pelvic area that cause scar tissue or inflammation (example, infections or endometriosis)
  • a general health problem for the woman that reduces fertility, eg diabetes, immune conditions and thyroid problems
  • Older age, which causes a lower number of good quality eggs
Age and fertility for women

For women one of the most important factors is age. In normal conditions, when a woman and man are healthy and younger than 35 years the chance of a pregnancy occurring each month is between 5-25%. As a woman gets older the chance of a pregnancy each month becomes lower because she has less eggs and these eggs are not such good quality.

By the age of 40 years pregnancy is becoming less common and it is almost impossible to achieve a pregnancy from the age of 45 years without using someone else’s eggs (donor egg IVF).

A woman is born with all the eggs she will ever have and as she goes through life, these eggs naturally reduce in numbers. By forty a woman has only 1-2% of the eggs she was born with. Also the good eggs tend to be used first and as she gets older the eggs being released are not such good quality. This causes higher rates of both miscarriage and abnormal babies in women 40 and over.

This reducing fertility as a woman ages is illustrated in a study that looked at pregnancy rates in women receiving sperm donation. In these cases the infertility problem was due to the male partner (male factor) and the women were all without infertility problems, so there was a need for sperm donation. The study showed that among healthy women who are 25 years old, 40 per cent (40/100) will not be pregnant after six months of trying, and 15 per cent (15/100) will not be pregnant after one year. For women who are 35 years old, 65 per cent (65/100) will not be pregnant after six months of trying and 40 per cent (40/100) will not be pregnant after one year. The study also showed that 15 per cent (15/100) of women over 35 will still not be pregnant after two years. The fertility rate of these women has been halved because of age alone.

By the age of 40 years pregnancy is becoming less common and it is almost impossible to achieve a pregnancy from the age of 45 years without using someone else’s eggs (donor egg IVF).

The cause of a couple’s infertility can be due to problems that affect the man or the woman, or both. If the problems are related to the man they are called male factor infertility.

Male factor infertility is related to problems that affect a man’s ability to achieve a pregnancy with his partner. These problems might be a problem with sperm, a problem with sexual intercourse, or a general health problem for the man that reduces fertility.

The most common cause of infertility in men is relating to sperm. Fertility problems occur when either not enough sperm is being produced, or the sperm is of poor quality. Often the sperm’s swimming ability is low and a lack of swimming means that the sperm will be unable to reach the egg. Sperms that are abnormally shaped will also be a lot less likely to make a baby.

A simple sperm test performed in a fertility clinic will often show up a sperm problem. Problems with sperm will require some tests to see whether any underlying cause might be found. Both medications and illnesses can cause sperm problems and these will be evaluated when you attend for a sperm test. For many men, the cause cannot be found with the tests currently available worldwide. In these situations medications and drugs will rarely achieve a pregnancy. Treatments often used are IUI and IVF with sperm injection (ICSI).

For men with very low sperm counts (less than 5 million sperm per ml) or no sperms at all (azoospermia) a genetic blood test might reveal the problem. The latest figures suggest that one of every 20 men with these severe problems will have a genetic reason causing the sperm problem.

Sometimes the cause of sperm problems is due to a blockage or absence of the tubes which carry sperm from where they are produced in the testicles. If tests show that hormone levels are normal then a simple surgical procedure can be used to find sperm that are being made in the testicles, but cannot get out naturally. A range of surgical sperm retrieval procedures are available (MESA, TESA TESE).

Testosterone, androgens and low sperm levels
Long term use of Anabolic Steroids and androgens will reduce the number of sperm produced and affect their motility (swimming). This is why men on testosterone replacement therapy (gel, patches & injections) often have a low sperm count and infertility. Stopping these treatments will often lead to a higher sperm level and a return to normal fertility levels. Other drugs, such as Proviron, are weak androgen drugs and are known to have the same effect on generally lowering fertility levels for men. Sadly they are sometimes prescribed with the opposite intentions, to boost fertility, when doctors or pharmacists are out-of-date with international medical best practice.
Cancer treatments and preserving fertility
The drugs involved with Chemotherapy can severely reduce sperm production, however advances in sperm freezing of course now mean that if you have to undertake a course of chemotherapy you should be offered the option the of freezing sperm in advance of your treatment.

Most men do not think much about fertility or the health of their sperm until it comes time to start a family. For the best chances of starting a healthy pregnancy you need to make large numbers of sperm that are good swimmers, and that ‘know’ how to fertilise the egg when they arrive. Sperm also has to contain genetic information (DNA) in good condition.

Whether young or old, with a current partner or not, you should be looking to protect your fertility so that natural conception can happen when you’re ready to have children. In about half of couples having trouble getting pregnant naturally, the problem lies with men.

Sperm problems can be many things and are often more than one thing. Sperm can be:

  1. Low in numbers
  2. Abnormal in shape
  3. Poor swimmers (so they have difficulty getting to the egg)
  4. Unable to bind to the egg or get inside the egg
  5. Unable to fertilise the egg
  6. Genetically abnormal so that they do not make normal embryos so that pregnancy does not happen
  7. Unable to get into the right place due to sexual problems (erectile dysfunction, impotence, or other sexual problems)

In many cases, there are no treatments to correct poor sperm problems, which means that assisted reproductive technologies such as insemination (IUI) or in vitro fertilization (IVF) treatments may be needed.

The Sperm’s Journey

Testicles are important for fertility because this is where sperm and the male sex hormone testosterone are made. After sperm are made in the testicles, they travel with a few drops of fluid through the male reproductive system. As they move through the system, the sperm mix with more fluid made by the prostate and seminal vesicles, until the sperm are released (ejaculated) at the time of sexual climax (orgasm).

How to help yourself

There are certain things that you can do to protect your fertility,  Your chances of fathering a child may be better if you pay attention to your overall health, which means:

  • Exercising regularly
  • Having a healthy diet
  • Watching your weight
  • Not smoking

Other things that can affect your fertility are:

Smoking
New evidence shows that the sperm DNA (genetic material) is damaged by the chemicals in tobacco smoke – this may lower the chance of a healthy pregnancy and may affect your child’s future health.
Alcohol
Drinking alcohol is a part of daily life for some people and drinking in small amounts is not harmful to fertility. However, binge drinking and regular heavy drinking can harm your health. Drinking heavily may cause liver problems, and affect a range of body functions including sexual and reproductive function. Also, drinking heavily, even if there is no damage to the liver, may damage the function of the testicles.
Your work environment
Pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm you produce. Men should try to avoid exposure to these harmful chemicals. For men who must work with such agents, sticking to occupational health and safety guidelines is crucial. If in doubt – ask!
Medical Treatments
‘Think before you get the snip’. Men planning a vasectomy should think about storing sperm before having the surgery.
Laptops and WiFi

Can laptop computers and WiFi damage male fertility?

This is a good question. Sperm counts have been dropping worldwide for the last 100 years and scientists remain baffled as to all the reasons. In a recent study from Argentina scientists have shown that ejaculated sperm from 15 men showed damage to both the swimming ability and genetic integrity after exposure to a laptop computer connected to WiFi. The study was small and experts have warned that other factors could explain the damage seen in the sperm. At present we advise men to avoid having laptop computers on their lap. Apart from potential damage to sperm the heat generated underneath the laptops caused significant heating in testicles which is thought to reduce sperm quality.

Drugs and Medical Treatments

Although fertility is often the last thing you think about when diagnosed with cancer, radiation therapy and chemotherapy can cause long-term problems with sperm production. Often sperm can be stored before starting treatments. With low doses of radiation and some types of chemotherapy, sperm production can return to normal after  a period of time. Ask your doctor about sperm storage before having these treatments, and find out when it is safe to try to become pregnant naturally after the treatments have stopped.

Fertility or sexual performance problems can also happen with other prescribed drugs such as some drugs used to treat inflammatory conditions, depression, epilepsy, high blood pressure and diabetes. Well known to cause low sperm counts are the drugs Proviron and testosterone injections, which are sometimes mistakenly given to increase sperm counts.

Taking anabolic steroids for body building or competitive sports damages your body. Besides causing acne, weight gain and changes in mood, your testicles shrink in size and sperm production stops. In other words, “steroids = sterile”. Once the drugs are stopped, sperm production may take one to two years to return to normal.

Fertility can also be affected by using other illegal drugs, such as marijuana, cocaine and heroin because they lower testosterone levels and sex drive. Not having regular sex can make it more difficult to become pregnant. There are many other illegal drugs that affect sexual performance and may reduce sperm production or even damage the sperm themselves. We simply don’t know all the risks – so don’t take the chance!

Heat
Avoid spas, saunas and hot baths if trying to father a child. Wearing boxer shorts may also help keep things cool down there.
Infections

Sexually transmitted infections (STIs) such as Gonorrhoea, chlamydia, syphilis, warts… these little nasty’s can not only be painful, but some of them can affect your fertility. STIs, especially untreated gonorrhoea and chlamydia, can cause blockages in the sperm tubes so that sperm can’t move on from the testicles (where they are produced) and into the semen and ejaculated. Surgery to fix the blocked tubes isn’t always possible. STIs can cause fertility problems in women so getting treatment can also stop the spread of disease to a female sexual partner.

The prostate sits underneath the bladder and adds fluid to protect sperm on their journey through the reproductive system. Infections of the prostate, known as prostatitis, can cause pain in the abdomen and fever. As the sperm move through the prostate into the urethra, swelling of the prostate may stop sperm from passing through the reproductive system.

Mumps is a viral infection that can be caught by anyone at any age, but it’s much more dangerous for adult men. The mumps virus can totally destroy the tubes that make sperm and permanently stop sperm production.

The causes of infertility can be due to problems that affect the man or the woman, or both. Sometimes no cause is found, despite thorough and up-to-date testing of both partners and this is known as unexplained infertility.

In unexplained infertility abnormalities are likely to be present but not detected by current test available world wide.

By understanding the many steps that go into making a baby it is easy to see that there are many possible problem areas that will not show up on currently available tests.

Possible problems could be that the egg is poor quality, that the egg is not getting into the fallopian tube, sperm may not be able to bind to the egg or get inside correctly (in which case fertilization will not occur), transport of the fertilized egg from the tube to the womb lining may not occur normally or at the right speed, or implantation of a healthy embryo might fail for a variety of reasons.

The quality of the egg quality is critically important and this is the main problem for women as they get older, especially from 40 years and over. These women have eggs a reduced ability to undergo normal and successful fertilization.

Other theories accounting for unexplained infertility are genetic defects in both the man and woman, pelvic abnormalities such as endometriosis that are invisible to the naked eye during surgery, variations in folate pathway genes, dysfunctional immune systems and abnormalities of fallopian tube function.

Treatments for unexplained fertility are recommended based on the length of time a couple have been trying along with the woman’s age. For young couples that have not been trying for over four years, drugs for ovulation are often tried first followed by IUI treatment. Older couples or those who have been trying for over four years will often move to IVF as their first treatment option.

Laptops and WiFi

Can laptop computers and WiFi damage male fertility?

This is a good question. Sperm counts have been dropping worldwide for the last 100 years and scientists remain baffled as to all the reasons. In a recent study from Argentina scientists have shown that ejaculated sperm from 15 men showed damage to both the swimming ability and genetic integrity after exposure to a laptop computer connected to WiFi. The study was small and experts have warned that other factors could explain the damage seen in the sperm. At present we advise men to avoid having laptop computers on their lap. Apart from potential damage to sperm the heat generated underneath the laptops caused significant heating in testicles which is thought to reduce sperm quality.