Causes of Infertility

1
Causes of Infertility

• Association of Reproductive Health Professionals
• www.arhp.org

2
Learning Objectives

• Define infertility.
• Differentiate between primary infertility and
  secondary infertility.
• List at least five factors that can contribute to
  infertility.

3
Basic Services for Infertile Couples
1. Educate on infertility causes and prevention
2. Conduct appropriate diagnostic workup
2. Conduct appropriate diagnostic workup
3. Offer information on treatment options
4. Provide resources for counseling and emotional
support
Stewart GK. 1998
4
Definition of Infertility


one year of well-timed and unprotected coitus
without conception...
Rein MS, Barbieri RL 1999
Rein MS, Barbieri RL. 1999.
5
Standard Definition Is Confusing

• Inability to conceive vs. delay in conception
• Majority of infertile couples do eventually
  conceive, whether or not they receive treatment
• Infertility is reversible, sterility is not

Stewart GK. 1998.
6
Male Female Factors Are Equal
Among couples with identifiable causes of
infertility
Nelson AL, Marshall JR. 2004.
7
Infertility Numbers Are Increasing

• Greater number of older women
• Women delaying childbearing

Stephen EH, Chandra A. Fam Plan Perspect.
2000. Chandra A, Martinez GM, Mosher W, et al.
2005.
8
Typical Conception Timetables
Meldrum DR. Infertility. 1998
9
Infertility Diagnoses
Nelson AL, Marshall JR. 2004.
10
Primary and Secondary Infertility
Despite having unprotected intercourse for at
least 12 months
Total Infertility Cases
Female Has never conceived
Male Has never impregnated a female
Female Has previously conceived but is
subsequently unable to do so
Male Has previously impregnated a female but is
subsequently unable to do so
Hatcher RA, Trussell J, Stewart F, et al.
1994 Stewart GK. 1998
11
Patient Education Fertility Principles

• Menstrual cycle
• Ovulation
• Techniques to maximize likelihood of conception
• Female and male reproductive systems

DiGeronimo TF. New Hope for couples with
Infertility Problems. 2002.
12
Male Fertility Requirements

• Normal spermatogenesis and ductal system
• Transmittal of spermatozoa to vagina
• Adequate sex drive
• Maintain erection
• Normal ejaculation
• Placement of ejaculate in vagina

Stewart GK. 1998.
13
Female Fertility Requirements

• Adequate sexual drive, sexual function
• Functioning reproductive anatomy, physiology
• Normal immunologic responses to accommodate
  sperm, conceptus, and fetal survival
• Adequate chemical, nutritional, and health status
  to maintain nutrition and oxygenation of placenta
  and fetus

Stewart GK. 1998.
14
Factors Related to Infertility
15
Reproductive KnowledgeTiming of Intercourse
6-day fertile window
Stewart GK. 1998. Stanford JB, et al. Obstet
Gynecol. 2002.
16
Reproductive KnowledgeCoital Frequency
6-day fertile window
Stanford JB, et al. Obstet Gynecol. 2002.
17
Frequency Probability of Conception
Hatcher RA, Trussell J, Stewart F, et al.
Contraceptive Technology. 1994. MacLeod J, Gold
RZ. Fertil Steril. 1953.
18
Douching, Lubricants

• Douching
• May interfere with sperm reaching ovum
• Increased incidence of ectopic pregnancy
• Lubricants
• May contain spermicidal agents
• May lead to decreased sperm motility

Stewart GK. 1998.
19
Female Age-Related Fertility Changes

• Impact becomes apparent in mid-30s

more
Stewart GK. 1998.
20
Female Age-Related Fertility Changes (continued)
Stewart GK. 1998.
21
Male Fertility Age

• Age-related decline
• Increased problems with sexual function
• Decreased coital frequency
• Diminished sperm output, morphology, vitality

Edge V, Miller M. Women's Health Care. 1994. Ng
KK, et al. Hum Repro. 2004.
22
Sexually Transmitted Diseases Infertility
Chlamydia
Gonorrhea
Human papillomavirus
Donovan P. 1993.
23
Problems in Past Pregnancies

• Infection
• Lacerations
• Uterine injury
• Hemorrhagic events requiring transfusion
• Hysterectomy
• Abdominal surgeries

Stewart GK. 1998.
24
Female Body Weight Infertility

Barbieri RL. Am J Obstet Gynecol. 2001 . Stewart
GK. 1998.
25
Toxic Agents Infertility
Stewart GK. 1998.
26
Tobacco Use Infertility

• Sperm production
• Motility
• Morphology
• Fertilization capacity

• Decreased rates of conception
• Increased rates of miscarriage
• Increased risk of ectopic pregnancy
• Increased risk of placenta previa
• Negative effects on fetus

Stewart GK. 1998. Bouyer J, et al. Am J
Epidemiology. 2003.
27
Alcohol Use Infertility

• Decreased rates of conception
• Increased rates of miscarriage
• Ovulatory infertility
• Negative effects on fetus

• Lower testosterone levels
• Decreased sperm production
• Impotence

Stewart GK. 1998.
28
Medication Use Infertility
29
Surgery Infertility
Stewart GK. 1998. Bouyer J, et al. Am J
Epidemiology. 2003.
30
Radiation Infertility
Stewart GK. 1998.
31
Physical Exertion / Heat Infertility
Men
Women
Athletes may experience reversible amenorrhea
without long-term effects
Frequent heat exposure can temporarily reduce
sperm production
Stewart GK. 1998. Shevnkin, et al. Hum Reprod
2005. Jensen TK, et al. Occupational Med. 2006.
32
Uterine Myomas Infertility

• Fibroids may
• Interfere with implantation of the embryo
• Lead to infertility
• Increase the risk of pregnancy loss
• Affect tubal function

Moore JG. 1998. Tropeano G, et al. Fertil Steril.
2004.