by Dr. Noah O. Olaomo
Having considered fertility, the male and female anatomy responsible for procreation, we would be considering the causes of infertility in today’s article-
There are many factors responsible for infertility which may be from the male, the female or both. It may also be unexplained. Approximately, the following are the different contributions of each sex to infertility; *female factor* (30%), *male factor* (30%), *combined*(30%) and *unexplained*(10%).
Herein below are some male factors that causes infertility:
a. Congenital problems: These include absence and malformation of the different parts of the male reproductive system. When a male child is born, it is particularly important to check that the testes are both present in the scrotum. Any undescended testes should be properly examined by a doctor and appropriate advice given. A testicle that is left for a long time in the abdomen, will eventually be damaged and may lead to cancer. If by 6 months of life, a boy’s testis(es) has/have not descended, urgent surgery for fixation is needed.
Also, the presence of fluid (hydrocele) surrounding the testicles should be attended to promptly.
b. Blockage from infections: Sexually Transmitted Diseases like gonorrhea, chlamydia etc can produce scarring which can eventually block the spermatic ducts.
c. Mumps: Mumps occurring especially in adolescent males may result in testicular atrophy thus compromising spermatogenesis.
d. Varicocele: This is an abnormal network of veins around the testis. It compromises sperm production probably by increasing the temperature around the testis.
e. Testicular failure: This is the inability of the testes to produce sperm and male hormones. It might be from problems of the testes or from problems of control from the brain. However, this is a rare condition.
What are the various causes of Testicular Failure:
i. Drugs such as e.g ketoconazole, opioids and steroids
ii. Untreated/ delayed treatment of testicular torsion: This is manifested by sudden onset of severe testicular pain.
iii. Chromosomal abnormalities
iv. Testicular cancer
f. Mumps: This is a viral disease that usually affects salivary glands (parotid glands) located just under the ears. It may also affect the testes and the ovaries.
g. Chemotherapy: Drug treatment for cancer
h. Radiation: Also used in treating cancers.
i. Testicular infections.
j. Injury to the testicles eg. from Road Traffic Accident
k. Lifestyle Behaviours such as Marijuana smoking.
Also, there are some female factors that contributes to infertility:
a. Ovarian factors: These are some of the factors that contribute to infertility.The causes include:
i. Galactorrhea (hyperprolactinaemia):* This is as a result of excess prolactin hormone. Prolactin is mainly involved in milk production. It usually results in a woman that is not breastfeeding or lactating producing water or milk from the breasts. This has a way of preventing ovulation thereby leading to infertility.
ii. Premature ovarian failure: This is sudden untimely stoppage of ovarian function. This usually results in premature menopause and infertility. It can be genetic.
iii. Surgical removal of ovaries: This might be due to some diseases like cancer or might be from patronizing quacks for surgeries
iv. Thyroid disorders: There may be presence of a goitre.
v. PCOS: (Polycystic Ovarian Syndrome): It is also a cause of anovulation. Affected women may have irregular menses, may be fat, may have multiple cysts on scan and may have man-like features.
b. Also, Tubal factors are also responsible for infertility; any disease or factor that blocks the tube or impair its motility will cause infertility. The causes include:
i. STDs and PIDs: STDs (Sexually Transmitted Diseases) like gonorrhea, chlamydia etc and PIDs (Pelvic Inflammatory Diseases) can cause intense inflammation of the tubes and surrounding structures and they can permanently damage and or block the tubes if not promptly and properly treated.
ii. Surgery: In surgeries like the one for ectopic pregnancy, the offending tube is usually removed. This may compromise fertility. Internal scars following abdominal surgeries (adhesions)* may distort the tubes and cause infertility.
ii. Post abortal Infections: Infections following abortions (whether natural or induced) are usually not properly treated. These infections just like STDs can permanently damage the tube when not properly treated.
iii. Tuberculosis of the tube can cause scarring and infertility
iv. Congenital problems with the tube: This is common in daughters of women who used a drug called DES (Diethyl Stilbesterol) during pregnancy.
c. There are also Uterine Factors that may lead to infertility; these are factors affecting the womb (uterus) of an expectant mother.
i. Adhesions inside the womb (Asherman’s syndrome). This mostly is from aggressive D & C resulting in removal of the internal layer of the womb. It may also follow surgeries on the womb. Infections could also lead to this. It is characterized by scanty or absent menses.
ii. Tuberculosis of the inside of the womb can also cause infertility.
ii. Congenital problems with the womb (absence, double uterus, single horn etc): This problem usually leads to recurrent mid trimester miscarriages.
iv. Uterine fibroids. We have all heard about Uterine fibroids, let’s conclude this edition by educating you more on fibroid. It does not actually cause infertility but it may occasionally contribute to infertility by-
•Preventing regular and adequate sexual intercourse because of prolonged menstrual bleeding, severe menstrual pain and frequent abdominal pain.
•Blocking the entry points of the fallopian tubes into the uterus.
•Preventing implantation of the embryo
•Causing frequent miscarriages
Watch out for another edition of the Doctor’s Room, we would still be discussing Infertility.
Dr Olaomo Noah Oluwafemi is a Consultant Obstetrician and Gynecologist with a love for writing. His desire is to enhance people’s lifestyle and effect positive change in their health through his writings