In recent years, due to environmental and ecological influences, life stress and later childbearing age, there are a growing number of couples with infertility problems. Incidence of infertility in the United States is 8.4 percent, around the same as in Northern Europe, while in developing countries, it’s between 10 and 30 percent. In China, one out of 10 couples of childbearing age has fertility difficulties.
Main causes for infertility and sterility
While occasionally the reason for not being able to conceive may be unexplained, most of the time it comes down to several diagnosable complications: ovulation disorders, tubal disease, uterine and cervical factors, oligospermia and azoospermia, insufficient immune tolerance and reproductive tract or organ developmental abnormalities. Let’s look at the four most common:
1) Ovulation disorder: accounts for 25 to 35 percent of fertility problems. Anovulation is caused by ovulatory dysfunction, for which there are three main reasons. One is dysfunction of the hypothalamic-pituitary-ovarian axis. Another cause is ovarian lesions, such as congenital ovarian dysplasia, polycystic ovary syndrome, premature ovarian failure, functional ovarian tumors and ovarian insensitivity syndrome. The last one is adrenal and thyroid dysfunction.
2) Tubal diseases: blocked or partially obstructed tubes account for 50 percent of sterility cases. Distal tube obstruction or mucosal damage caused by chronic salpingitis (neisseria gonorrhoeae, mycobacterium tuberculosis, chlamydia trachomatis) could lead to complete blockage of fallopian tubes, which in turn causes infertility. In addition, tubal hypoplasia, pelvic inflammatory disease sequelae and endometriosis can also lead to tubal infertility.
3) Uterine factors: uterine malformations, uterine submucosal fibroids, endometriosis, endometrial tuberculosis, endometrial polyps and intrauterine adhesions can affect implantation.
4) Male semen abnormality or congenital maldevelopment: men with the former problem usually have normal sexual function but abnormal sperm with congenital or acquired issues, manifested by lack of sperm, weak sperm, low sperm count, sperm development stagnation, abnormal sperm or semen liquefaction insufficiency. The latter is related to genital hypoplasia or erectile dysfunction, premature ejaculation or even no ejaculation.
As the causes and pathogeneses of infertility and sterility are quite complex and tricky, patients may have to go through a series of exams and tests before reaching a diagnosis. In many cases, we find causes that have no cure and therefore have to resort to reproductive technology.
Thanks to the increased pregnancy rate facilitated by reproductive technology, however, many couples today are fortunate enough to be able to start a family.
// For more information or a consultation, visit Guangzhou Elizabeth International Medical Center, 484 Kangwang Zhong Lu, Liwan District, Guangzhou 广州市荔湾区康王中路484号 (400 886 9268, en.eliza.hk)
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