According to the World Health Organisation, one in six people in the world faces fertility problems. To find the most effective infertility treatment, it is necessary to determine its cause, which becomes a difficult task due to the many factors affecting reproductive health.
Hormonal failures, anatomical abnormalities, infections, genetic issues and many other factors can become an obstacle to conception. Identifying the true source of the problem requires a comprehensive diagnosis and a thorough analysis of all possible causes.
In this article, we will look in detail at what causes infertility, and what questions it is important to get answers from a fertility specialist before starting treatment.
What are the different types of fertility problems in women and men?
Fertility problems affect millions of people around the world. According to the World Health Organisation, about 17,5% of adults cannot conceive naturally. The reasons for this can be related to male or female health, and sometimes remain unclear.
Idiopathic infertility is a condition where doctors cannot identify a specific cause that is preventing pregnancy from occurring. According to a SingleCare study, 25% of couples have no way of knowing what caused their inability to conceive naturally. In such a case, treatment can be difficult.
To help couples conceive, doctors use ovulation stimulation, insemination (injecting sperm directly into the cervical canal or uterine cavity), and in vitro fertilisation (fertilisation of the egg is carried out outside the woman’s body in a laboratory, after which the embryo is transferred to the uterus for further development of the pregnancy).
Infertility is divided into 2 main types – primary and secondary infertility:
Primary infertility is diagnosed if a couple has never had a pregnancy despite regular attempts to conceive.
Secondary infertility is seen if a couple has previously had at least one pregnancy (including successful births or miscarriages), but have difficulty conceiving again.
A condition in which a woman or man is unable to conceive under any conditions, including medical interventions, is called absolute infertility.
In the case of women, this may be due to the absence of or damage to the ovaries, uterus or other reproductive organs.
In the case of men, it may be due to the absence of sperm or the inability to produce sperm normally.
What doctors should I see if I have trouble conceiving?
If a couple has trouble trying to conceive, the first step is to see a gynaecologist (for women) and urologist (for men). These specialists will help identify possible problems such as menstrual irregularities, hormonal disorders, diseases of the reproductive organs or problems with sperm quality in men. If the initial diagnosis does not give a clear answer to the causes of infertility, or the problem cannot be solved by traditional methods, you should make an appointment for a consultation with a fertility specialist – a doctor who works in the field of diagnosis and treatment of infertility.
When should I see a fertility doctor?
If a couple cannot get pregnant within a year of regular sexual intercourse without contraception, it is already a reason to see a fertility doctor. However, there are situations when a visit to the doctor should be planned earlier:
If the woman’s age is over 35, it is recommended to see a specialist after 6 months of unsuccessful attempts to conceive, as fertility decreases with age.
If one of the partners has diseases that may affect fertility (e.g. endometriosis, polycystic ovaries, genital tract diseases or hormonal disorders, sperm quality problems or erectile dysfunction).
If the woman has had miscarriages or unsuccessful attempts to become pregnant, this may also be a signal to consult a reproductive specialist.
Irregular menstrual cycle and severe pain can be a sign of hormonal disorders or other pathologies that may make it difficult to conceive.
If the couple has tried to improve their fertility, for example by eating healthily, avoiding unhealthy habits or reducing stress, but pregnancy has not yet occurred, this is also a reason to get a check-up.
Contact a MediGlobus medical expert to find out more about where you can undergo fertility diagnostics. We will provide a free consultation and tell you which clinics are the most successful in infertility treatment, help you make an appointment with a fertility doctor and organise travel.
Read: What are the main causes of infertility in women?
- ‘Ovulatory dysfunction is a common cause of infertility in women, especially given the difficulties we face in society due to weight gain. In addition, today’s women are starting their families at an average or older age (many wait until their 30s, while previous generations typically started families between the ages of 20-25). Starting a family at an older age can lead to egg quality factors and ovarian dysfunction playing a larger role in infertility. Anatomical problems such as endometriosis and fallopian tube blockage are also common, occurring in at least 15-20% of patients.’ – Dr Jessica Scotchie, Reproductive Endocrinologist and Infertility Specialist, USA.
Infertility in women can be caused by many different factors. One of the most common causes is problems with ovulation (the process of an egg leaving the ovaries each month). Some disorders and gynaecological diseases can stop ovulation completely, while others make it irregular.
The main causes of ovulatory disorders:
- Polycystic ovarian syndrome is a hormonal disorder characterised by multiple small cysts on the ovaries, menstrual irregularities and increased levels of male sex hormones.
- Thyroid problems – hyperthyroidism (increased thyroid activity) and hypothyroidism (decreased activity) can disrupt the regularity of ovulation.
- Premature ovarian failure – when the ovaries stop functioning before the age of 40, causing ovulation to stop.
Other factors that affect women’s fertility:
| Scarring after surgery | Pelvic surgery, such as myoma removal or fallopian tube surgery, can lead to scarring and interfere with tubal patency. |
| Problems with cervical mucus | During ovulation, cervical mucus becomes more fluid, which helps sperm travel to the oocyte. Abnormalities in the composition or amount of mucus can make it difficult to conceive. |
| Fibromas | Benign tumours in the uterus can prevent a fertilised egg from attaching to the uterus or block the fallopian tubes. |
| Endometriosis | This is a gynaecological condition in which tissue similar to the inner lining of the uterus (endometrium) grows outside the uterus, causing pain, inflammation and, in some cases, infertility. |
| Inflammatory diseases of the pelvic organs | Infections of the upper reproductive organs, especially those caused by sexually transmitted diseases, can damage the fallopian tubes and interfere with the egg’s ability to enter the uterus. |
| Sterilisation | Some women decide to undergo sterilisation as a way of contraception. In this case, the fallopian tubes become blocked, making it impossible to conceive. This process is rarely reversible, and even after surgical restoration of fertility, the likelihood of getting pregnant may be low. |
| Medications and drugs | The side effects of certain medications such as non-steroidal anti-inflammatory drugs, chemotherapy drugs, neuroleptics and oedema medications can affect fertility. Drug use can also make it difficult to ovulate. |
Uterine myoma and infertility
Uterine myoma is a benign uterine neoplasm consisting of smooth muscle cells. It is one of the most common tumours in women of reproductive age. Often myomas do not cause symptoms, but in some cases, they lead to painful menstruation and pain in the lower abdomen, heavy bleeding. Myomas can cause infertility in 2-3% of women, as well as lead to miscarriages. The effect of pathology on fertility depends on its location: submucosal myomas, distorting the uterine cavity, significantly reduce the chances of a successful pregnancy, while subserosal myomas, as a rule, do not affect fertility. The disease is treated with drug therapy to control symptoms or surgically (myomectomy).
Adenomyosis and infertility in women
Adenomyosis is a condition where the tissue that normally lines the uterus from the inside begins to grow inside the muscle layer of the organ. The disease increases the risk of infertility, increases the likelihood of miscarriage and reduces success with assisted reproductive technologies (such as IVF). About 20% of women under the age of 40 have adenomyosis, and 80% are diagnosed at the age of 40-50. Treatment includes hormone therapy or surgery.
Genetic infertility in women
Infertility can be caused by various inherited disorders that affect a woman’s fertility. Some of the most common disorders that affect fertility are: Turner syndrome, broken X chromosome syndrome and Cullman syndrome. They can lead to early menopause or impaired hormone production, making it difficult to conceive. Treatment depends on the specific condition and its severity. In some cases, hormone therapy or surgery can be used to correct structural changes. In complex cases, assisted reproductive technology such as IVF or ICSI is used, with the option of prior genetic testing of the embryos. However, in some genetic diseases, the chances of a natural pregnancy may be low. In such cases, alternative methods such as the use of donor cells or surrogacy may be used. Genetic counselling helps to understand the risks of transmitting the disease to children and to choose the best way to start a family.
What is tubal infertility?
Tubal infertility is very likely to occur when one or both fallopian tubes are partially or completely blocked. This type of infertility accounts for about 30-40% of all cases and is often caused by infections (such as chlamydia or gonorrhoea), as well as pelvic inflammatory disease, endometriosis and scarring from surgery. Symptoms of tubal infertility include pain in the lower abdomen as well as problems conceiving, especially if there is a complete tubal obstruction. Treatment may include surgery to restore tubal patency (tuboplasty), IVF in cases where tubal damage cannot be repaired, or tubal cannulation under laparoscopy, which restores patency in 75 per cent of cases.
If you have not been able to get pregnant for a long time, modern diagnostic methods used in foreign clinics can help you find out the causes of the problem. MediGlobus specialists will help you choose a clinic and a doctor to solve your problem. We work with leading medical centres of the world, which offer effective methods of infertility treatment and individual approaches to each patient.
What are the main causes of infertility in men?
- Infertility in men can be caused by a variety of factors affecting sperm quality, testicular function or other aspects of reproductive health.
One common cause is poor sperm quality, which can manifest as low sperm count, impaired sperm motility or abnormal shape. This hinders their ability to reach the egg and fertilise it. In some cases, the causes of sperm abnormalities remain unclear. Some scientists suggest a link between increased scrotal temperature and decreased sperm quality.
Damage to the testicles can also significantly affect spermatogenesis. This can occur due to infections, testicular cancer, trauma, surgery, or birth defects such as undescended testicles.
A vasectomy is a surgical procedure in which the seminal ducts are blocked or ligated, which blocks sperm from entering the semen. This surgery is used as a method of contraception as the man becomes unable to conceive after it. Vasectomy is considered irreversible, although in some cases it is possible to attempt to restore fertility surgically (vasectomy reversal).
Some ejaculation disorders, such as problems with the ejection of semen, can also lead to infertility.
Hypogonadism, a condition in which testosterone levels are lower than normal, can be a cause of male infertility. Causes of the pathology include tumours, drug use or genetic abnormalities such as Klinefelter’s syndrome.
Certain medications, such as sulfasalazine (used to treat inflammatory diseases), anabolic steroids (if used for long periods), chemotherapy drugs and even some herbal remedies can negatively affect reproductive health by reducing sperm count or sperm motility. Drugs also harm fertility.
What is aspermia – is this disorder treatable or not?
Aspermia, or ‘dry orgasm’, is a condition in which a man reaches orgasm without releasing seminal fluid. It is also possible to develop retrograde ejaculation when semen is directed not forward from the penis but into the bladder. These phenomena are infrequent and can be caused by various reasons: surgical interventions, trauma and nerve damage, taking certain medications, the effects of radiation therapy or other factors. Treatment of aspermia depends on the cause and may include drug therapy, surgery, vibrostimulation, extraction of sperm from urine or testicular tissue and the use of assisted reproductive technologies such as in vitro fertilisation.
Can infertility be caused by varicocele?
Varicocele is a condition in which there is a dilation of veins in the scrotum. It occurs in 10-15% of men and is often asymptomatic. Most men with varicocele have no problems conceiving. In rare cases, fertility problems occur when vein enlargement increases the temperature in the testicles, which impairs sperm production and quality. Varicocele treatment is performed when there are symptoms, sperm problems or when a couple is infertile. The main therapies include surgery (varicocelectomy) and embolisation. The prognosis is favourable in most cases, with many men experiencing improved spermatogenesis after treatment.
Smoking and infertility in men – is there a link?
According to numerous studies published between 1980 and 2014, smoking has a significant negative impact on male fertility. It reduces sperm quality, sperm concentration, sperm motility and viability. In addition, toxic components of tobacco smoke, such as nicotine, cadmium and lead, disrupt the structure of sperm DNA, which can lead to genetic disorders in offspring. Men who smoke also often experience a decrease in testosterone levels, which further impairs fertility. Another serious consequence of smoking is impaired blood circulation, which can contribute to erectile dysfunction. Smoking increases the risk of inflammatory processes in the organs of the reproductive system and can lead to cell and tissue damage. All these factors significantly reduce the likelihood of conception, making smoking one of the key causes of male infertility.
Can obesity lead to infertility?
According to numerous studies, obesity and infertility in men are closely related. Being overweight leads to lower testosterone levels, poor sperm quality, impaired spermatogenesis and sexual dysfunction. Obesity also contributes to increased aromatase activity, which converts testosterone into estrogen, further depressing reproductive functions. The thermal effects caused by increased temperature in the testicular area due to fat deposits also impair sperm performance. It is believed that the chance of infertility increases by 10% for every 9kg of excess weight gain. However, research shows that many of the negative effects of obesity on fertility are reversible and reducing body weight can significantly improve reproductive performance.
What is secretory infertility in men?
Secretory infertility in men (azoospermia) is a condition in which there are no sperm in the ejaculate. This type of azoospermia occurs due to primary dysfunction of the hypothalamic-pituitary-testicular system, which disrupts the process of spermatogenesis. Secretory azoospermia occurs in 10-15% of men and has a significant impact on reproductive function, as it deprives the possibility of natural conception. Treatment depends on the cause: hormonal therapy is used for endocrine disorders, and surgery may be required for structural abnormalities. Testicular biopsy (TESE) or microscopic sperm extraction (micro-TESE), allows one to obtain sperm directly from the testicular tissue. In cases of irreversible damage, assisted reproductive technologies such as IVF using surgically retrieved sperm are used. The prognosis depends on the degree of damage and the cause of the disorder, but modern treatment methods give a chance for paternity in most cases.
Genetic infertility in men
Infertility in men can be caused by a variety of inherited disorders, including Klinefelter syndrome, microdeletion of the Y chromosome, changes in the CFTR gene and Cullman syndrome. Klinefelter syndrome, for example, causes the presence of an extra X chromosome, which disrupts spermatogenesis and results in missing sperm. Microdeletion of the Y chromosome can cause poor sperm quality, irregularly shaped sperm or lack of sperm motility. Cullman syndrome results in a deficiency of the hormone GnRH, which reduces testosterone production and impairs spermatogenesis.
Treatment for genetic infertility includes the use of hormone therapy to stimulate sperm production or assisted reproductive technologies such as IVF and ICSI. In some cases, such as the complete absence of sperm, alternative methods such as the use of donor sperm or surrogacy are possible.
Is male infertility after mumps treatable?
Mumps can harm male fertility, especially if the disease occurs in adolescence or adulthood. One of the main complications is orchitis, an inflammation of the testicles that occurs in 20-30% of men who contract mumps after puberty. In rare cases, orchitis affects both testicles, which can lead to reduced or complete loss of spermatogenesis, causing infertility. If azoospermia (absence of sperm in the ejaculate) occurs, assisted reproductive treatments may be used. According to research data, live spermatozoa are successfully extracted from the testes in 67% of men with azoospermia after mumps, and the fertilisation rate of eggs using IVM-ICSI is 71,2%.
There can be a large number of causes of infertility in men. Complex diagnostics can help discover what exactly prevents normal conception. Foreign clinics have all the possibilities to find out the true cause and prescribe a suitable treatment. Click on the button below to find out more.
Is infertility caused by autoimmune diseases treatable?
Autoimmune infertility occurs when the body’s immune system mistakenly attacks its own reproductive cells or tissues, disrupting their function.
In women, these conditions can manifest as antiphospholipid syndrome, which leads to thrombosis and pregnancy complications, including miscarriages and problems with placental development. Autoimmune diseases can also damage ovarian tissue, causing premature menopause and reduced egg reserves.
In men, autoimmune infertility is often associated with anti-sperm antibodies, which attack sperm cells, reducing their motility and ability to fertilise. This condition can develop after testicular trauma, infections, or surgical procedures such as vasectomy.
Treatment of autoimmune infertility requires a comprehensive approach. In women with antiphospholipid syndrome, therapy with low-dose aspirin and anticoagulants is used to prevent thrombosis. In men with anti-sperm antibodies, intrauterine insemination or in vitro fertilisation (IVF) may be used to circumvent the effects of the antibodies. In some cases, treatment of comorbidities such as rheumatoid arthritis or systemic lupus erythematosus can also improve the chances of successful conception. Thanks to modern reproductive technologies, many couples with autoimmune infertility can achieve a successful pregnancy.
What examinations should I undergo in case of infertility?
Fertility diagnostics include a set of tests aimed at identifying the causes and assessing the reproductive potential.
In women, the examination begins with hormone analysis at the beginning of the menstrual cycle (on days 2-5) – the levels of follicle-stimulating, luteinising and anti-müllerian hormones are measured to assess the ovarian reserve. Transvaginal ultrasound is used to count antral follicles in the ovaries, which helps determine how much of the ovarian reserve is preserved. Additionally, tests for thyroid hormones and prolactin can be carried out, since their violations affect fertility. To assess the patency of the fallopian tubes and the state of the uterus, hysterosalpingography (X-ray with the introduction of a contrast agent) or sonohysterography (ultrasound with saline solution) are used. These methods detect abnormalities such as polyps, myomas, scars or septa that prevent embryo implantation.
To find out the cause of infertility in men, first of all, semen analysis is carried out to assess its volume, mobility, number and shape of sperm. Genetic and infectious screenings are also performed to rule out transmissible diseases and hereditary pathologies.
Clinics for diagnosis and treatment of infertility
Medicana hospital
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IVI Fertility Clinic
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SoonChunHyang Hospital
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North Cyprus IVF
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Summary
Infertility is a condition in which a couple is unable to conceive after a year of regular sexual activity without the use of contraception. Fertility problems affect approximately 17,5% of the world’s adult population, according to the World Health Organisation. The causes of infertility can be linked to reproductive health problems in both women and men, and in some cases, the causes remain unclear.
The main causes of infertility in women include ovulatory disorders such as polycystic ovaries, thyroid problems and premature ovarian failure. Reproductive anatomy disorders such as endometriosis, fibromas, pelvic inflammatory disease and scarring from surgery can also affect fertility. Infertility with endometriosis and ovulation problems are some of the common causes of difficulty conceiving.
The most common causes of infertility in men are impaired sperm quality (low or absent sperm count, poor sperm motility or abnormal sperm shape). Damage to the testicles caused by infection, injury or disease can also significantly reduce fertility. Other important factors are hormonal disorders such as hypogonadism, as well as external influences including smoking, obesity and certain medications.
For infertility, women undergo a comprehensive evaluation including hormone tests, ultrasound to assess ovarian reserve, and tests for fallopian tube patency and uterine health such as hysterosalpingography. Men with infertility begin their diagnosis with a semen analysis to assess sperm quality and undergo genetic and infection tests.
Infertility diagnosis and treatment is carried out in clinics in Turkey, Israel, Spain, South Korea, Poland and Lithuania.
Contact MediGlobus to organise your trip to one of the fertility clinics abroad as soon as possible. We will help you make an appointment with an experienced reproductive specialist, prepare the necessary documents, organise your trip and accompany you 24/7.
Sources:
- World Health Organisation: 1 in 6 people globally affected by infertility: WHO
- World Health Organisation: Infertility
- SingleCare Administrators: Infertility statistics 2024: How many couples are affected by infertility?
- NHS: Infertility
- NHS: Polycystic ovary syndrome
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