What causes infertility?

Title:

Infertility-epidemiology, aetiology and effective management (1995).

Source:

Health Bulletin. 53(5):294-8, 1995 Sep.

Abstract:

Current epidemiological evidence suggests that 15% of couples will experience infertility and in half this number the problem will remain unresolved. Background prevalence rates now appear to be reasonably stable, but there is evidence of an increase in the rate of referrals for medical help. Rates of secondary infertility are higher in the population than represented by clinic referrals. The distribution of the main diagnostic groups is as follows: Male 25%; Ovulation 25%; Tubal 20%; Unexplained 25%; and Endometriosis 5%. Effective management in the male includes donor insemination and assisted reproduction (including intra-cytoplasmic sperm injection). Drugs are ineffective for idiopathic oligozoospermia, while the role of varicocele ligation is uncertain, but marginal at best. Ovulation problems can be treated with a high degree of success, except in cases of clomiphene resistant polycystic ovarian disease. However there are continuing concerns over multiple pregnancy rates and future research is needed to clarify the additional risks, if any, of ovarian carcinoma. Surgical correction of tubal abnormalities should be left to specialised units, where audit indicates that the results can match those achieved by assisted reproduction. There is no evidence that the medical (drug) management of endometriosis improves fertility, although surgery for moderate and severe disease can still be considered. However the results should be compared with those achieved by assisted reproduction. Superovulation and intra-uterine insemination appears to be an effective treatment for certain cases of mild male factor infertility, mild endometriosis and unexplained infertility and can be considered, where the duration of infertility is more than four years. A pregnancy rate of around 10% per cycle can be anticipated, but there is a significant risk of multiple pregnancy. The evidence is that IVF (and GIFT) has achieved significantly improved results in recent years, with fecundity rates of 20% per cycle being a reasonable target in women under 40 years.

Please click on the required question.

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• 1 What is infertility?
• 2 How prevalent are infertility problems?
• 3 What are the main causes of infertility?
• 4 What are the objectives of our infertility investigations?
• 5 Have there been any noticeable changes in fertility requirements in recent years?
• 6  What is the effect of our age on fertility?
• 7 I smoke cigarettes. Can this have an effect on my fertility?
• 8 Does my weight influence fertility?
• 8A Obesity! How can I lose weight?
• 9 I have fibroids. Could these reduce my fertility?
• 10 I have been told that my womb has an abnormal shape and that was the way that I was born. Could this reduce my fertility?
• 11 I have endometriosis. Could this reduce my fertility?
• 12 I have been told that I have cervicitis or a cervical ectopy (erosion). Could this impair my fertility?
• 13 My doctor tells me that my womb is retroverted (tilts backwards). Could this reduce my fertility?
• 14 I have had an ectopic pregnancy. Does this affect my future fertility?
• 15  We are worried that we may have a fertility problem. What should we do?
• 16 How will our doctor be able to identify the cause of our infertility?
• 17 How can we tell if I am releasing my eggs (ovulating)?
• 18 Investigations have shown that I have a problem releasing my eggs (anovulation). What could be the cause of this?
• 19 How important are my Fallopian tubes in fertility?
• 20 How can we tell if my Fallopian tubes are functioning?
• 21 How can we assess male fertility?
• 22  What is the purpose of a post-coital test (PCT)?
• 23 We have had our infertility investigations and our problem remains unexplained. How can this be?
• 24 What are our chances of achieving a pregnancy?
• 25 Where can I obtain more information?
• 26 Could we have some recommended infertility support groups?
  




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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.