This page is profiding basic information about infertility. It should be used to obtain information and not for diagnostic or treatment purposes. A couple is infertile, if in spite of regular sexual intercourse without any contraceptive, no pregnancy occurs within twelve months. About 80% of women planning a pregnancy, will conceive within six months and about 90 % within twelfve months.(these figures are just approximations, it differs in diferent parts of the world and between different researchers)
There are many causes for infertility. There are male and female causes. Therefore it is important that both partners should be examined!
We will explain the causes of infertility, the investigations necessary to try and diagnose the cause and posible treatment options. Remember we are not there to replace your doctor and can never replace him. We are just helping you to understand your problem better and also to show the doctor's dilemma in treating infertility. Unfornately there is no magic formula to clear infertility.
Like in all fields of medicine your doctor will first try to diagnose the exact cause of infertilty ( not alwyas easy) and than try to treat it. As science advances more and more treatment options are becoming available.
Causes of Infertility
We will first discuss female causes. Please refer to fertilization and implatation for additional background information.
The next drawing will give a basic understanding of the causes.
The sperms are colored blue and the egg cell pink. There is only one egg cell .The seven small little balls represent one egg cell. The seven balls just show how it is sucked from the ovary to tube. It is one egg cell at different stages of its journey.
For a pregnancy to accur there must be:
Enough normal sperm cells. ( Male infertility to be discussed a bit later).
An egg cell. ( ovulation must occur)Abcence of an egg cell is known as anovulation.
Open tubes. If the tubes are blocked, the egg and sperms cannot meet each other.
A properly prepared endometrium (lining of the womb). The endometrium must be properbly prepared for implantation to occur. See Implantation.
Changes in the mucous at the the entrance to the cervical canal (See Cervix). The mucous must allow the sperms to pass.
Growths and abnormalities that disturbed the form and cavity of the womb.
The rest of the body must be relatively healthy.Other diseases must be excluded.
Infertility in a female should always be properly investigated. It could be the symptom of a more serious underlyning disease like endometriosis , polycystic ovaries, etc.
When Ovulation does not occur (Anovulation)
It is posible to determine if somebody ovulated. The progeterone levels increases after ovulationand is at the highest level about seven days before the next menstruation occurs. This is why doctors test for progesterone , usually 21 days after the onset of a period. See The Normal Ovary and Fertilization
The underlying problem can be anywhere in the system that regulates ovarian function , from the pituitary and its connections to the brain ( hypothalamus ), up to the ovary.
It is posible for a women to menstruate and not to ovualate. The egg cell starts developing in a follicle but is not released. The follicle than dies without relasing an egg cell. The ovary stops producing estrogen and menstruation occur. Anovulatory cycles are usually less regular than ovulatory ones. Refer to the page Abnormal menstruations
The polycystic ovarian syndrome (see Polycystic Ovaries ). is another imprtant cause of anovulation.
The pituitary gland also prosuces a hormone called prolactin. One of the functions of prolactin is to stimulate the breasts to produce milk. High prolactin levels in somebody that is not breast feeding, is associated with anovulation and infertility. High levels of prolactin can also be associated with pituitary tumors. This is another reason way infertility in a female patient should always be fully investigated.
Before any treatment is given the diagnosis must be confirmed.
There are different treatment options available to induce ovulation. A detailed discription is beyond the scope of this site. Every option has its place and the managing phycian is in the best position to give advise. Therefor discuss it with your doctor.
The most commonly used drugs are clomiphene citrate (tablets) and injections containing FSH(follicle stimulating hormone) and LH ( luteiinising hormone). All these drugs stimulate the ovaries to release egg cells. We stress it again that these drgs shoud only be used under close medical supervision. One of there side effects are over stimulation of ovaries with the development of large painful cysts. Another complication is multiple pregnancies with the increased risk of babies be born severely premature before they are viable. These drugs should always be used for the proper indications and not blindly for the sake of treating infertility.
Tubes are blocked when there is an occlusion or blockage of the lumen. We will discuss and illustrate the more common causes.
Bacterial infections effecting the tubes are one of the very common causes of blocked tubes. Bacteria are tiny living organismes. Certain kinds of bacteria attack and damage our cells. See Bacterial Infections The next drawings will illustrate the destructive effect of bacterial infections. Another conditon namely endometriosis causes similar effects on the tubes.Endometriosis usually only effects the tubes during the later stages of the disease. ( Endometriosis ).
First a drawing of a crossection of a normal healthy tube.
Now a crossection of an infected tube during the early stages of an infection. The walls are thickened and red due to an increased blood flow and swelling.
The next drawing illustrates a bend tube with part of the tube adherent to the womb. The lumen is kinked. Due to the swelling and inflammation a sticcky fluid if the ability to clot leaks from surface of the tube. In this case part of the tube got stucked on the wall of the womb adn tube got bend.
The next two drawings illustrate how inflammation can cause blockage at the entrance of the tube by damaging and effecting the fimbriae.The fimriae stuck together and close the opening of the tube.
All the abnormal tubes illustrated above are not functional and if both tubes are effected pregnancy is highly unlikely.
Endomtriosis in its later stages can also cause similar tubal damage.
Ectopic pregnancies are another cause of blocked tubes. click Blocked tubes are diagnosed by either doing a special kind of X- ray examination or by doing a laparoscopy. The X ray method is called a histero salpingo gram(HSG).
A special dye is injected into the womb through the cervix and a series of x-rays taken . The dye is visible on X - film and it is possible to see if the dye is flowing through the tubes or if the tubes are blocked. The laparoscopic method is the perferred modern way if it is available in your community. (See laparoscopy for more deatail.
While the laparoscopy is done , a dye is injected through the the womb and if the tubes are open , this dye will spill through the tubal openings. The presence of absence of spilling will be visible through the laparoscope.
The laparoscopy method is the prefered method because all the organs are visualized and other conditions like endometriosis can also be diagnosed or excluded.
Here is video clip showing how the tubes are tested during a laparoscopy. A harmless solution ( a mulivitamine injection) is
injected into the womb.