Infertility – Causes, Symptoms, Diagnosis and Treatment

Infertility is the inability of an adult at reproductive age to reproduce offspring. This factor negatively affects the social and psychological adaptation of people, affects their health and quality of life.


Infertility – is it worth fighting?

If a married couple does not conceive during a year of regular sex life without using contraceptives, it is necessary to contact a specialist for examination. By itself, this fact does not mean that one of the spouses is infertile, doctors in this case speak of a temporary inability to conceive a child. In most cases, this problem is successfully resolved. For this purpose, modern reproductive clinics have been created, in which well-proven methods of infertility treatment are practiced.

Doctors distinguish between relative and absolute infertility. The first type includes cases in which it is possible to establish and eliminate the causes of disorders in the patient’s body.  Absolute infertility means irreversible physiological changes in the reproductive apparatus (anomalies in the development of the pelvic organs, traumatic injuries, surgical removal of the gonads).

Also, infertility is divided into primary and secondary. With primary infertility, there is no pregnancy in the anamnesis at all, although there is a regular sex life without any means and methods of contraception. Secondary is said if there was at least one pregnancy (regardless of how it ended: childbirth, abortion, miscarriage, ectopic pregnancy).

Contrary to popular belief, infertility affects both women and men equally.  That is, the quantitative ratio of infertile patients of each sex is approximately the same. The position when one partner places the blame on the other is absolutely wrong. First, it creates strong psychological pressure, which only exacerbates the situation.  Secondly, the solution to the problem is possible only on condition of full mutual support of the spouses.  Thirdly, there are frequent precedents when treatment is necessary for both partners.

Symptoms and causes of infertility

First you need to make a reservation that, due to physiological differences, infertility is divided into male and female. Accordingly, the causes, diagnosis and treatment methods differ.

Female infertility is more multifaceted than male. After all, a woman’s body must not only produce an egg, but also create conditions for conception and the normal course of pregnancy. Any, even a minor malfunction in the work of the female reproductive organs can significantly complicate conception. Among the main causes and signs of infertility in women are called:

  • ovulation problems;
  • hormonal problems;
  • ovarian dysfunction;
  • damage to the fallopian tubes, adhesions;
  • polycystic ovary disease;
  • hormonal imbalance;
  • scars on the ovarian membrane;
  • erosion of the cervix;
  • early menopause;
  • violations in the cervical canal;
  • defects in the development and structure of the uterus;
  • psychological reasons;
  • endometriosis;
  • unruptured follicle syndrome.

Do you have symptoms of infertility?Only a doctor can accurately diagnose the disease. Do not delay the consultation.

The most common reasons include the following violations.

Obstruction or absence of fallopian tubes

It is in them that the meeting of the egg and sperm takes place, their fusion and the formation of an embryo, which then enters the uterus.  Obstruction develops mainly due to the formation of adhesions (sticking of the walls) of the pipes as a result of their inflammation.  Occasionally, adhesions are caused by sterilization, in which the fallopian tubes are tied or crossed. The absence of a tube may be due to its prompt removal, performed for vital reasons (local purulent process, ectopic pregnancy).

Adhesions in the pelvic area

They occur after inflammatory processes, endometriosis, surgical interventions. The adhesion is able to envelop the ovary or be localized between it and the tube, which makes it impossible for the egg to pass.


This is the name of a disease in which the lining of the uterus (endometrium) grows beyond its limits. Foci of growth are formed, adhesions appear between them, which impede the process of fertilization.

Endocrine, it is also hormonal disorder

Endocrine failure is observed in diseases of the ovaries, thyroid gland, pituitary gland, hypothalamus, adrenal glands, kidneys, liver. It can be caused by metabolic disorders or severe mental stress, shock situation.

Psychogenic infertility

It arises as a psychological reaction to the unwillingness of pregnancy. A woman may consciously or unconsciously experience fear of childbirth or possible changes in appearance due to pregnancy. Sometimes the reason is the unwillingness to conceive with this particular partner.

Immunological infertility

It occurs when there are antibodies to sperm in the female body, which interferes with the fertilization process.  Under the influence of antibodies, sperm cells become inactive, and their passage in a woman’s body becomes difficult.

Causes and signs of infertility in men

In men, infertility is manifested by one single sign – the impossibility of conception. Unlike women, the symptoms of male infertility are practically not manifested. This fact gave rise to the myth that men suffer from infertility much less often than women. The key factors that trigger male infertility are:

  • inferiority of spermatozoa (violation of their mobility and vitality);
  • a sharp decrease in their number;
  • complicated movement of sperm through the vas deferens and their release outward.
  • Male infertility can be caused by:
  • varicocele;
  • congenital anomalies in the development of the reproductive apparatus (hypospadias, absence or obstruction of the vas deferens);
  • isolated disorders in the seminal fluid;
  • infectious and inflammatory diseases of the genitourinary system;
  • surgical intervention (groove hernia, hydrocele, bladder surgery, etc.);
  • systemic diseases (cirrhosis of the liver, tuberculosis, diabetes, mumps with complications of orchitis, chronic renal failure);
  • sexual and ejaculatory disorders;
  • psychogenic factors;
  • necrozoospermia;
  • obstructive azoospermia;
  • endocrine (hormonal) disorders.

Additional reasons are called: alcohol and nicotine abuse, the effects of radiation, trauma to the scrotum. Working in difficult and harmful occupational conditions, for example, at too high or low temperatures, or in a toxic environment, adversely affects the reproductive function.  Separately, there are factors that can provoke a decrease in sperm count: stress, malnutrition (lack of proteins and vitamins in the diet), chronic lack of sleep.

Classification of sperm pathologies

Regardless of what exactly caused infertility in a man, its mechanism can always be found out using a spermogram. There are such sperm pathologies:

  • Azoospermia – semen (ejaculate) does not contain sperm. It is divided into secretory and obstructive forms. With a secretory form, the testicles do not produce sperm, with obstructive due to obstruction of the vas deferens, ejaculation is disturbed.
  • Oligozoospermia – low sperm count in the ejaculate (normally at least 15 million / ml).
  • Oligospermia is a small semen volume (the norm is at least 1.5 ml).
  • Anejaculation is a complete absence of sperm.
  • Asthenozoospermia – sperm cells are not motile enough.
  • Necrospermia – the ejaculate does not contain live sperm.
  • Teratozoospermia is a violation of the structure of spermatozoa.

Infertility of unknown origin

Occurs in patients of both sexes. This is the name of the situation when, after a thorough diagnosis of the spouses, no causes of infertility are found.  According to the doctors, the couple is absolutely healthy, but conception does not occur. Such a diagnosis is explained by the fact that modern diagnostics are still not able to identify absolutely all the causes of the pathology of the human reproductive system. Often, instead of an unclear genesis, another reason is mistakenly determined, respectively, measures to eliminate it do not bring the desired result.

Sometimes the cause of infertility of unknown origin is due to the incompatibility of partners at the biological or immunological level. This is confirmed by situations when spouses have not been able to conceive for many years, and after a divorce, each of them soon has children in new families.

Infertility diagnostics, examinations and analyzes

As with any other disorder, high-quality diagnosis of male and female infertility is the key to successful treatment. It is imperative that the infertility diagnosis procedure is performed on both partners. First you need to do blood tests for hormones, tests to detect infections, ultrasound of the pelvic organs.

Infertility tests in women

The following methods are used to diagnose infertility in women:

  • A gynecological examination under the control of ultrasound is the first stage of a woman’s examination, which makes it possible to assess the size and establish the structural features of the uterus and ovaries, to identify ovarian cysts, fibroids and other pathologies of the pelvic organs.
  • Hysteroscopy – an examination used to more accurately study the uterine cavity, makes it possible to detect abnormalities that were not diagnosed during a routine examination and using ultrasound.
  • Hysterosalpingography – a method designed to determine the patency of the fallopian tubes, based on the introduction of a contrast agent into the uterus, after which a series of images is performed.
  • A blood test for hormones is carried out to determine the function of the ovaries and the endocrine system.
  • Laparoscopy is both a diagnostic and a therapeutic procedure.  During laparoscopy, the doctor can see on the screen an enlarged clear image of the pelvic organs.  If the causes of infertility are found, the specialist can eliminate them directly during the procedure: remove ovarian cysts, adhesions, foci of endometriosis.
  • Basal temperature chart – compiled by the patient independently for 2-3 menstrual cycles, is used to assess ovulation.
  • Ultrasound monitoring of the follicle maturation and ovulation process is prescribed at the discretion of the doctor as an additional examination.

Diagnosis of infertility in men

Just like a woman, a man must pass general clinical tests, make a blood test for hormones, and undergo examinations aimed at identifying an infection. An ultrasound of the scrotum and prostate gland is prescribed, during which they are examined visually.

In the process of diagnosing male infertility, the main point is to find out the fertility of the sperm, that is, the ability to fertilize. The spermogram will be the key analysis at this stage. This is a complete detailed analysis of sperm, in which its physical parameters, chemical and cellular composition are examined.  The survey allows you to find out the following characteristics:

  • sperm concentration (should be more than 15 million per 1 ml);
  • their mobility (over 40%);
  • the number of normal forms of sperm (at least 4%);
  • viability (more than 58%);
  • ejaculate volume (1.5 ml and more);
  • total sperm count (39 million or more).

In addition to these indicators, they certainly pay attention to the color of the sperm, color, smell, acidity, and the content of leukocytes.  Also, a spermogram establishes the presence or absence of antisperm antibodies produced in the immunological form of infertility – the MAR test.

To pass a spermogram, the patient must adhere to several medical requirements. For two weeks before the analysis, you should not drink alcohol and take antibiotics, visit a sauna or bath. You need to refrain from sexual intercourse for 4-7 days.

Often, along with the spermogram, a sperm maturity test (HBA test) is performed. The test determines the binding of sperm to hyaluronic acid, an important component of the environment surrounding the egg.  This parameter is extremely important for fertilization. A mature sperm usually combines with hyaluronic acid by special receptors, an immature one is not able to connect. Normally, the maturity of spermatozoa should be 60% or more, otherwise conception by natural means is impossible.

As an additional examination, the doctor may prescribe a testicular biopsy, which allows you to find out the presence of sperm and the condition of the tissues. Also, this procedure can be used for therapeutic purposes.

Which doctors treat infertility

The field of medicine that deals with the diagnosis and treatment of infertility is called reproductive medicine.  Treatment of men is carried out by andrologists, women – by gynecologists. Also involved in the treatment process:

  • embryologists – determine the method of fertilization
  • endocrinologists – examine the hormonal background;
  • hematologists – study blood counts;
  • immunologists – find out the immune factors;
  • doctors of ultrasound diagnostics;
  • geneticists – perform early diagnosis of chromosomal abnormalities.

One of the key factors in successful treatment will always be the qualifications of the attending physician. A true professional does not stop his education throughout the entire work experience, follows new methods, seeks to use new technologies.  Pregnancy and childbirth is a crucial step, so you shouldn’t skimp on the services of competent doctors. The specialists of JSC “Medicine” have devoted themselves to the fight against infertility and have already helped many families to find family happiness.

Male and female infertility treatment methods

The tactics of infertility treatment are determined by a reproductive physician based on the collection of patient anamnesis and the results of a comprehensive diagnosis. Treatment methods are divided into traditional (medication, surgical) and assisted reproductive technologies (ART). It should be understood that in the process of treating even one of the partners, the second partner is also directly involved. Therefore, the methods of treating male and female infertility described below are relevant for both spouses.

Treatment of female infertility

The method of treatment is determined by the cause of the pathology. Drug treatment is used:

  • with endocrine infertility, based on the intake of drugs containing hormones (urinary or recombinant gonadotropins, clomid);
  • infertility caused by infectious diseases (antibiotic therapy: metrogil, metronidazole, ofloxacin, ciprofloxacin and other drugs);
  • immunological infertility (antihistamines and corticosteroids are prescribed).

Surgical methods of treatment are effective for pathologies of the fallopian tubes and uterus. We are talking about low-invasive operations that cause minimal harm to the patient. They are carried out in a hospital setting, but the rehabilitation period is short – 3-5 days. Surgical methods include laparoscopy and hysteroscopy.

Do not forget about such an important factor as the psychological state. According to statistics, about 30% of problems with infertility are in the influence of psychological factors on the patient – stress, shock conditions and so on.  Psychologists and psychotherapists are successfully fighting this problem.

Assisted reproductive technologies in women

If traditional methods of treatment are ineffective, then they resort to ART. There are many reproductive technologies:

  • planned intercourse;
  • artificial intrauterine insemination;
  • in vitro fertilization (IVF);
  • oocyte donation;
  • egg sperm injection (ICSI);
  • surrogacy.

Intrauterine insemination is based on the introduction of sperm into the uterus artificially using a catheter.  Then everything happens in a natural way: the sperm move to the egg through the fallopian tubes and fertilization begins. A prerequisite is the integrity of the fallopian tubes.  Insemination is possible with both the partner’s sperm and the donor’s sperm. The method is effective in case of reduced fertility of the spouse (small or no sperm, their poor mobility), as well as if a single healthy woman wants to become pregnant.

In vitro fertilization (IVF) consists of fertilizing an egg in a laboratory, obtaining embryos and transferring them into the uterus – this is standard technology. It is possible to carry out IVF with the use of a donor egg or donor sperm. The IVF method consists of several stages, rather extended in time. This is a complex but effective technique performed by experienced reproductive specialists.

Male infertility treatment

When treating the secretory form of male infertility, if possible, they seek to eliminate the cause – varicocele, dropsy of the testicle, parotitis, elimination of an unfavorable factor.  After eliminating the cause, a course of therapy is carried out aimed at improving the spermatogenic function of the testicles – drug therapy comes into play. The course includes taking drugs that stimulate the blood supply to the scrotum, vitamin therapy, good nutrition and adherence to the regimen. Sometimes stimulating hormone therapy is required. Treatment of this form is a long and painstaking process, but not hopeless, so the patient should be patient.

Treatment of obstructive infertility in men is based on performing different types of biopsy – prompt extraction of mature spermatozoa from the testicle and its appendages.  For this, special testicular biopsy techniques have been developed: using puncture (testicular tissue – TESA, epididymis – PESA) and small incisions (TESE and MESE, respectively). The rehabilitation period after biopsy is 10-12 days, during which physical activity, sexual intercourse, increased physical activity are contraindicated.

Indications for the treatment of infertility

Indications for the treatment of infertility is the absence of pregnancy during a year of regular sexual activity, when partners want a child, but it is not possible to conceive. In such cases, a timely visit to a reproductive clinic significantly increases the chances of a successful childbirth.

Contraindications in the treatment of infertility

The main contraindications for the treatment of infertility include:

  • pathologies of a somatic and mental nature, in which pregnancy and childbirth are contraindicated;
  • oncological diseases;
  • acute infectious and inflammatory processes of any localization.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.