Infertility – Causes of
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Infertility can be caused by many different things. In 25-30% of cases, a cause cannot be identified.
Infertility in women
Infertility is most commonly caused by problems with ovulation (the monthly release of an egg). Some problems stop women releasing eggs at all, and some cause an egg to be released during some cycles, but not others.
Ovulation problems can occur as a result of a number of conditions, listed below.
- Polycystic ovary syndrome (PCOS), a condition that makes it more difficult for your ovaries to produce an egg.
- Thyroid problems, both an overactive thyroid gland (hyperthyroidism) and an underactive thyroid gland (hypothyroidism) can prevent ovulation.
- Premature ovarian failure, where a woman’s ovaries stop working before she is 40.
Womb and fallopian tubes
The fallopian tubes are the tubes along which an egg travels from the ovary to the womb. The egg is fertilised as it travels down the fallopian tubes. When it reaches the womb, it is implanted into the womb’s lining where it continues to grow.
If the womb or the fallopian tubes are damaged, or stop working, it may be difficult to conceive naturally. This can occur following a number of factors, outlined below.
Scarring from surgery
Pelvic surgery can sometimes cause damage and scarring to the fallopian tubes.
Cervical surgery can also sometimes cause scarring, or shorten the cervix (the neck of the womb).
Cervical mucus defect
When you are ovulating, mucus in your cervix becomes thinner so that sperm can swim through it more easily. If there is a problem with your mucus, it can make it harder to conceive.
Fibroids are benign (non-cancerous) tumours that grow in, or around, the womb. Submucosal fibroids develop in the muscle beneath the inner lining of the womb wall and grow into the middle of the womb.
Submucosal fibroids can reduce fertility, although exactly how they do this is not yet known. It is possible that a fibroid may prevent an embryo from implanting itself into your womb.
Endometriosis is a condition where small pieces of the womb lining, known as the endometrium, start growing in other places, such as the ovaries.
This can cause infertility because the new growths form adhesions (sticky areas of tissue) or cysts (fluid-filled sacs) that can block or distort the pelvis. These make it difficult for an egg to be released and become implanted into the womb.
Endometriosis can cause infertility because it can disturb the way that a follicle (fluid-filled space in which an egg develops) matures and releases an egg.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries. It is often the result of a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb.
Example: Infertility – Causes of
Some women choose to be sterilised if they do not wish to have any more children.
Sterilisation involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb. This process is rarely reversible, and if you do have a sterilisation reversed, it will not necessarily mean that you will become fertile again.
Medicines and drugs
The side effects of some types of medication and drugs can affect your fertility. These medicines are outlined below.
- Non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use, or a high dosage, of NSAIDs, such as ibuprofen or aspirin, can make it more difficult for you to conceive.
- Chemotherapy – Medicines used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly. Ovarian failure can be permanent.
- Neuroleptic medicines are antipsychotic medicines often used to treat psychosis. They can sometimes cause missed periods or infertility.
Illegal drugs such as marijuana and cocaine can seriously affect fertility, making ovulation (the monthly cycle where an egg is released from the ovaries) more difficult.
Infertility in women is also linked to age. The biggest decrease in fertility begins during the mid thirties. Among women who are 35, 95% will get pregnant after three years of having regular unprotected sex. For women who are 38, only 75% will get pregnant after three years of having regular unprotected sex.
Infertility in men
Male infertility is caused by abnormal semen (the fluid containing sperm that is ejaculated during sex). Some possible reasons for abnormal semen are listed below.
- Decreased number of sperm – You may have a very low sperm count, or no sperm at all.
- Decreased sperm mobility – If you have decreased sperm mobility, it will be harder for your sperm to swim to the egg.
- Abnormal sperm – Sometimes sperm can be an abnormal shape, making it harder for them to move and fertilise an egg.
- Many cases of abnormal semen are unexplained, but there are several factors that can affect semen and sperm.
The testicles are responsible for producing and storing sperm. If they are damaged it can seriously affect the quality of your semen. This may occur if you have, or have had in the past, any of the following:
- an infection of your testicles
- testicular cancer
- testicular surgery
- a congenital defect (a problem with your testicles that you were born with)
- undescended testicles (when one or both of your testicles has not descended into the scrotum)
- trauma (injury) to your testicles
Absence of sperm
Your testicles may produce sperm, but it may not reach your semen. The absence of sperm in your semen is known as obstructive azoospermia. This could be due to a blockage in one of the tiny tubes that make up your reproductive system, which may have been caused by an infection or surgery.
Example: During this session, Emily used a simple guided visualization exercise in which she explored and conversed with her ovaries, tubes and uterus. While communicating in this open-hearted manner with her body, Emily discovered and healed the block that had prevented her from having this little boy being who was hovering just above her shoulder. Below, Emily shares her experience.
“When I looked into my right tube I suddenly felt something dark stuffed there. Teresa asked me if I had ever experienced any sexual or reproductive trauma. I then shared with her that I had an abortion when I was nineteen. When I dialogued with this tube further I realized that this is where I had stored the trauma surrounding that abortion. My abortion experience had involved a great deal of heartache and pressure from my boyfriend at the time, who begged me to have the baby and marry him. I loved him deeply, but I was consumed with guilt resulting from a very religious upbringing that clearly defined premarital sex as both sinful and shameful. This, combined with the intense fear of my family’s reaction and taking on the responsibility of marriage and a family, played heavily as I made the heart-breaking decision to abort – an act that also was prohibited by my church.
“Teresa helped me to make this connection that my body simply made a decision to protect me from any future trauma of this nature by never getting pregnant again! Once I identified this phenomenon, I was able to empty this darkness out of my tube by simply connecting the tube to the center of the earth and asking for it to release. I also employed a wonderful visualization using colors that are healing for me, to wash my uterus and to reline it with warmth and welcoming energy for this little being. Once this area was clear and clean I was able to easily connect with the little boy spirit who wanted to come to me and Nicholas. Upon going home, Nicholas and I constructed a ‘Baby Altar,’ in order to welcome this baby boy spirit to come into our lives.”
A few days later, Emily conceived after making love with her husband, and nine months later joyfully gave birth to her son Adam.
A vasectomy is the surgical procedure for male sterilisation. It involves cutting and sealing off the vas deferens (the tubes that carry sperm out of your testicles), so that your semen will no longer contain any sperm. A vasectomy can be reversed, but reversals are not usually successful.
Some men experience ejaculation problems that can make it difficult for them to ejaculate. Other ejaculation problems include:
- retrograde ejaculation, where semen is ejaculated into your bladder
- premature ejaculation, where ejaculation occurs too quickly
Hypogonadism is an abnormally low level of testosterone, the male sex hormone that is involved in making sperm. This could be due to a tumour, taking illegal drugs or Kallman’s syndrome (a rare disorder caused by a faulty gene).
Medicines and drugs
Certain types of medicines can sometimes cause infertility problems. These medicines are listed below.
- Sulfasalazine, an anti-inflammatory medicine used to treat conditions such as Crohn’s disease (inflammation of the intestine) and rheumatoid arthritis (painful swelling of the joints). Sulfasalazine can decrease the number of sperm, but its effects are temporary and your sperm count should return to normal when you stop taking it.
- Anabolic steroids, often used illegally to build muscle and improve athletic performance. Long-term use or abuse of anabolic steroids can reduce sperm count and sperm mobility.
- Chemotherapy – Medicines used in chemotherapy can sometimes severely reduce sperm production.
- Herbal remedies – Some herbal remedies, such as root extracts of Tripterygium wilfordii (a Chinese herb), can affect the production of sperm or reduce the size of your testicles.
Drinking too much alcohol can damage the quality of your sperm. Guidelines published by the National Institute of Clinical Excellence (NICE) state that if men follow the Department of Health’s recommendations of drinking no more than three to four units of alcohol a day, it is unlikely their fertility will be affected. However, drinking more than this could make it difficult to conceive.
Infertility in both men and women
There are a number of factors that can affect fertility in both men and women. These are outlined below.
Being overweight, or obese, reduces both male and female fertility. In women, being overweight can affect ovulation. Being underweight can also have an impact on fertility, particularly for women, who will not ovulate if they are severely underweight.
Sexually transmitted infections (STIs)
There are several STIs that can cause infertility. For example, chlamydia can damage the fallopian tubes in women, and cause swelling and tenderness of the scrotum (the pouch containing the testes) in men.
As well as affecting your general and long-term health, smoking can also adversely affect fertility. Read more information about quitting smoking.
Occupational and environmental factors
Exposure to certain pesticides, metals, and solvents can affect fertility in both men and women.
If either you or your partner are stressed it may affect your relationship. Stress can contribute to a loss of libido (sex drive), which in turn can reduce the frequency of sexual intercourse. Severe stress may also affect female ovulation and limit sperm production.
The following is taken from http://www.truestarhealth.com/Notes/1039008.html#Diet-Options
Dietary changes that may be helpful
Consumption of one to one and a half cups of coffee per day in one study1 and about three2 or four3 cups per day in other studies has been associated with delayed conception in women trying to get pregnant. Caffeine consumption equivalent to more than two cups of coffee per day has been associated with an increased incidence of infertility due to tubal disease or endometriosis.4 In another study, women who consumed more than one cup of coffee per day had a 50% reduction in fertility, compared with women who drank less coffee.5
Caffeine is found in regular coffee, black tea, green tea, some soft drinks, chocolate, cocoa, and many over-the-counter pharmaceuticals. While not every study finds that caffeine reduces female fertility,6 many doctors recommend that women trying to get pregnant avoid caffeine.
In one study, consumption of three cups of decaffeinated coffee per day was associated with an increased risk of spontaneous abortion.7 In another study, caffeine consumption compounded the negative effects of alcohol consumption on female fertility.8 Some researchers suspect that the tannic acid found in any kind of coffee and black tea may contribute to infertility.9
Consumption of fish contaminated with polychlorinated biphenyls (PCBs) may reduce the ability of women to conceive. In one study, women who ate more than one fish meal per month of fish caught in Lake Ontario (known to be contaminated with PCBs) had reduced fecundity (meaning that it took longer for them to become pregnant) compared to women who ate less contaminated fish.10
Lifestyle changes that may be helpful
The more women smoke, the less likely they are to conceive.11 In fact, women whose mothers smoked during their pregnancy are less likely to conceive compared with those whose mothers were nonsmokers.12 Quitting smoking may enhance fertility.
Even moderate drinking of alcoholic beverages by women is linked to an increased risk of infertility in some,13 although not all, research.14 In a preliminary study, there was a greater than 50% reduction in the probability of conception in a menstrual cycle during which participants consumed alcohol. Caffeine appeared to enhance alcohol’s negative effect in this study. Women who abstained from alcohol and consumed less than one cup of coffee per day were more than twice as likely to conceive (26.9 pregnancies per 100 menstrual cycles) compared with those who consumed any amount of alcohol and more than one cup of coffee per day (10.5 pregnancies per 100 menstrual cycles).15 Based on this preliminary evidence, women who wish to improve their chances of conception should avoid alcohol and caffeine.
Being excessively overweight or underweight may also contribute to infertility in females.16 Infertile women who are overweight or underweight should consult a physician.
Some conventional medications can interfere with fertility. When in doubt, women taking prescription drugs should consult their physician or pharmacist.
Vitamins that may be helpful
In a preliminary study of women with infertility and mild endometriosis, supplementation with propolis (500 mg twice a day for six months) was associated with a pregnancy rate of 60%, compared with a rate of 20% in the placebo group (a statistically significant difference).17 Whether propolis would be beneficial for infertile women who do not have endometriosis is not known.
In some women, infertility is due to a hormonal abnormality known as luteal phase defect. In this condition, the uterine lining does not develop and mature properly, presumably because of a deficiency of the hormone progesterone. In a study of infertile women with luteal phase defect, supplementation with 750 mg of vitamin C per day for up to six months resulted in a pregnancy rate of 25%, compared with a rate of 11% in an untreated control group, a statistically significant difference.18
A double-blind trial found that taking a multivitamin-mineral supplement increased female fertility.19
Vitamin E deficiency in animals leads to infertility.20 In a preliminary human trial, infertile couples given vitamin E (200 IU per day for the female and 100 IU per day for the male) showed a significant increase in fertility.21
In preliminary research, even a subtle deficiency of iron has been tentatively linked to infertility.22 Women who are infertile should consult a doctor to rule out the possibility of iron deficiency.
Some previously infertile women have become pregnant after supplementing with PABA (para-aminobenzoic acid), 100 mg four times per day.23 PABA is believed to increase the ability of estrogen to facilitate fertility.
Supplementation with the amino acid, L-arginine (16 grams per day), has been shown to improve fertilization rates in women with a previous history of failed attempts at in vitro (test tube) fertilization.24
Herbs that may be helpful
Vitex is occasionally used as an herbal treatment for infertility—particularly in cases with established luteal phase defect (shortened second half of the menstrual cycle) and high levels of the hormone, prolactin. In one trial, 48 women (ages 23 to 39) who were diagnosed with infertility took vitex once daily for three months.25 Seven women became pregnant during the trial, and 25 women experienced normalized progesterone levels—which may increase the chances for pregnancy. In another double-blind trial, significantly more infertile women became pregnant after taking a product whose main ingredient is vitex (the other ingredients were homeopathic preparations) than did those who took a placebo.26 The amount used in this trial was 30 drops of fluid extract twice a day, for a total of 1.8 ml per day. This specific preparation is not available in the United States. Some doctors recommend taking 40 drops of a liquid extract of vitex each morning with water. Approximately 35–40 mg of encapsulated powdered vitex (one capsule taken in the morning) provides a similar amount. Vitex should be discontinued once a woman becomes pregnant.
Holistic approaches that may be helpful
Acupuncture may be helpful in the treatment of some cases of female infertility due to problems with ovarian function. In a preliminary trial, women who did not ovulate were treated with acupuncture 30 times over three months. Effectiveness was determined by a combination of measures indicating ovulation was returning to normal. Acupuncture treatment resulted in a marked improvement in 35% and slight improvement in 48% of trial participants.27 The beneficial results achieved with acupuncture may be due to alterations in the hormonal messages from the brain to the ovary.28
Auricular (ear) acupuncture has been studied in a preliminary trial and compared with standard hormone therapy for treatment of infertility. In both the acupuncture and hormone therapy groups, 15 out of 45 patients became pregnant. Although the pregnancy rates were similar with either treatment, side effects occurred only in women taking hormones.29 Still, double-blind trials are needed to conclusively determine whether acupuncture is a useful treatment for female infertility.