Understanding the primary factors contributing to infertility in both men and women is crucial for couples struggling to conceive. Infertility, defined as the failure to conceive after one year of unprotected intercourse, affects around 10 to 15 percent of couples worldwide. While the numbers have remained relatively stable, there has been a noticeable shift in causes and age demographics associated with infertility.
In assessing infertility, it's important to recognise that both male and female factors can contribute, with each accounting for approximately 35 percent of cases, says Dr Monica Jani, Gynaecologist & Obstetrician, Bhailal Amin General Hospital, Vadodara.
Additionally, Jani says that about 20 percent of cases are attributed to issues involving both partners, while 10 percent remain idiopathic, lacking a clear identifiable cause.
Female factors
Cervical factors: Issues like cervical stenosis, abnormal mucus, or impaired sperm interaction hinder sperm transport to the uterus. These factors create a barrier that sperm must overcome to reach the egg, impacting fertility, says Jani.
Uterine factors: Conditions such as endometritis, fibroids, or structural abnormalities can affect implantation and embryo development. The uterus provides the environment for the embryo to implant and grow, so any abnormalities here can lead to infertility or miscarriages.
Ovarian causes: Ovulation disorders, hormonal imbalances, or ovarian cysts disrupt the release of eggs needed for fertilisation. Ovulation is a crucial step in conception, and any irregularities in this process can result in infertility.
Tubal factors: Blockages or adhesions in the fallopian tubes impede the journey of sperm to meet the egg. The fallopian tubes are where fertilisation typically occurs, so any obstruction here can prevent the sperm from reaching the egg, leading to infertility.
Male factors
Pretesticular factors: Hormonal imbalances or disorders involving the hypothalamus, pituitary gland, or adrenal glands can affect sperm production. Hormones play a crucial role in sperm production, so imbalances in these glands can impact fertility.
Testicular factors: Conditions like testicular failure, trauma, varicocele, or exposure to radiation/medications impair sperm production or quality. The testes are where sperm are produced, and any damage or abnormalities in this area can lead to issues with sperm quantity or quality.
Post-testicular factors: Obstructions in the vas deferens or ejaculatory ducts, infections, or surgical interventions may disrupt sperm transport or ejaculation. Even if sperm are produced normally, issues with transport or ejaculation can prevent them from reaching the egg.
Lifestyle and environmental influences on fertility
Impact of lifestyle: Factors such as obesity, poor diet, smoking, alcohol, drug use, and exposure to chemicals/radiation affect reproductive health. Unhealthy lifestyle choices can have a significant impact on fertility, affecting hormone levels and sperm quality.
Genetic factors: Inherited disorders, chromosomal abnormalities, or mutations can contribute to infertility in both men and women. Some individuals may inherit conditions that directly affect reproductive function, leading to infertility.
Advancing age: As couple delay childbearing, age-related declines in fertility become more pronounced, particularly in women due to decreased egg quantity and quality. Fertility naturally declines with age, especially after the age of 35 for women, making it more challenging to conceive.
Stress: Stress disrupts hormonal balance and interferes with reproductive processes in both men and women. High levels of stress can impact hormone production, ovulation, and sperm production, making conception more difficult.
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