Causes Of Infertility:- Modern View

Causes Of Infertility:-Modern View

In modern science also the essential factors for infertility are explained which are as below:Causes Of Infertility, The male must produce an adequate number of normal spermatozoa and must be able to deposit them in the upper vagina at the appropriate time of the female cycle.

Causes Of Infertility

The female’s ovulatory mechanisms must be normal, there also must be sufficient estrogen in preovulatory phase to stimulate the production of normal cervical mucus and sufficient progesterone in the luteal phase to support implantation and maintenance of pregnancy. The quality and quantity of cervical mucus must be permit spermatozoa.
The oviducts must be patent and sufficient mobile to allow fertilization as well as transport of the ovum from ovary to uterus.
The uterus must be capable of supporting implantation and fetal growth through out pregnancy.
If anyone of these factors is abnormal, the woman does not conceive.

Causative factors of infertility :


(1) Systemic factors -

  • Pulmonary Tuberculosis
  • Severe anaemia 


Which can suppress ovulation. But many women conceive easily despite of having these diseases in our country. 


(2) Physiological factors -

  • Before menarche
  • During pregnancy.
  • After menopause
Sometimes during lactation because of hormonal imbalance.

(3) Endocrinopathy factors -

  • Frohlich’s syndrome
  • Stein leventhal syndrome
  • Thyroid disturbances
  • Hypogonadotrophic amenorrhoea.
  • Metropathic bleeding


All these factors affect infertility by an ovulation


(4) Psychological factors -

  • Fear
  • Nervous tension
  • Marital disharmony. 


It may affect fertility perhaps through tubal spasm and infrequent coitus.


(5) Genital factors :

The pelvic conditions which may be found to be responsible for infertility in female are :


(A) Vaginal factors :

  • Narrow vaginal introitus
  • Vaginitis
  • Vaginisms
  • Tight hymen
  • Vaginal atresia
  • High vaginal acidity.
Immediate escape of semen after coitus.


(B) Uterine factors :

Uterine fibromyoma of sub mucus or interstitial type causing distortion of uterine cavity may be a factor.
Adenomyosis works through unhealthy endometrium.Uterine hypoplasia often with acute flexion or retroflexion is an important cause.
Infantile uterus.
Rudimentary or rarely absence of uterus.


(C) Tubal factors :

Tubal occlusion or peritubal adhesion from salpingitis (gonococcal, pyogenic or tubercular)
Appendicitis may lead to peritubal adhesions.
Congenital tube defects like elongation or hypoplasia.


(D) Ovarian factors :


  • Anovulatory cycles.
  • Chronic oopheritis (tubo ovarian mass)
  • Chocolate cyst.
  • Ovarian tumour.
  • Streak gonad in Tuner’s syndrome, or testicular feminization syndrome is the absolute factor of sterility.


    (6) cervical factors :

    J. M. Sims, 1866 first called attention to cervical factors in infertility. They are following :
    Hormonal factor good estrogenic effect can be seen on cervical mucus as positive fern test and formation of spinnbarkeit.


    Anatomical factor -

    - Cervical hypoplasia (because of poor mucus)
    - Elongation
    - Intracervical obstruction
    - Prolapse
    - Post conization or cauterization
    - Cervical scaring are important anatomic abnormality to effect sperm transmission.


    Ineffective cervical factor -

    - Chronic cervicitis (pyogenic or tubercular)
    - Cervical erosion
    - Ectropion


    Neoplastic -

    - Mucus or fibroid polyp.
    - Cervical carcinoma in situ lesion
    - Immunological
    Recent studies show that cervical secretion may contain ABO antibodies. Thus, it can be suggested that ABO incompatible mating sperm carrying
    antigens maybe agglutinated in the cervical mucus.
    The subject is dealing with cervical factor. So, the causes of cervical factor are described.


    Causes of cervical factor of Infertility :

    • Stenosis / scarring
    • Poor mucus.
    • Anti bodies
    • Malposition
    • Congenital absence.


    Etiology of the cervical factor in Infertility :

    Cervical stenosis :

    The cervix can be scared or become stenosed from previous surgery. This would prevent sperm from entering the endocervix.

    Some of the common surgical procedures resulting in the above condition include :

    - Cryosurgery - LEEP
    - Electro cauterization - Cone biopsy
    - Dilatation and curettage Occasionally, prenatal exposure to diethyl stilbesterole (DES) can also cause cervical stenosis. Apart from causing stenosis, these condition can also be responsible for the destruction of the endocervical glands and the absence of mucus can further hinder
    - Chronic cervicitis, infection in the cervical crypts will destroy the endocervical glands that are responsible for the secretion of cervical mucus. Also a chronic infection will be associated with leukocyte infiltration into the mucus, that can destroy the sperms.


    Poor mucus :

    Poorly estrogenized mucus is hostile to sperms. This type of mucus may be seen in women on treatment with antiestrogens, or with on inadequate preovulatory peak of estrogen.


    Antibodies :

    Presence of antibodies within the cervix may also block the passage of the sperm, both anti – IgG and anti IgA antibodies may be found here. In fact , 3 to 10 percent of women will have antibodies in cervicovaginal secretions in the absence of humoral antisperm antibodies. For this reason, it is necessary to study cervical mucus when there is poor sperm survival despite negative serological tests for antisperm antibodies.


    Malposition :

    Lastly, it is the factor of inadequate insemination due to mal positioning of the cervix seen in association with an acutely retroverted uterus where the cervix will not be ‘bathed’ in the pool of semen in the posterior vaginal fornix.


    Etiologic classification of abnormal sperm–cervical mucus interaction :


    Female related causes:


    (1) Inappropriate timing.


    (2) Ovulatory disorders :

    • Anovulation
    • Subtle anomalies of ovulatory process.


    (3) Deposition problems :

    • Dyspareunia
    • Prolapse
    • Congenital and anatomical anomalies


    (4) Anatomical and organic causes :

    • Amputation or deep conization of the cervix .
    • Deep cauterization of the cervix
    • Tumour : Polyp. or Leiomyoma
    • Cryotherapy
    •  Severe stenosis
    • Endocervicits


    (5) Hostile cervical mucus :

    • Increased viscosity
    • Increased cellularity (infection)
    • Acid mucus.
    • Presence of sperm antibodies.

    (6)Male related causes :

    (1) Deposition problems :

    • Impotence
    • Retrograde ejaculation
    • Hypo spadias

    (2) Semen abnormalities:

    • Low concentration
    • Low motility
    • High percentage of abnormal forms.
    • High volume (above 8 ml)
    • Low volume (below 1 ml)
    • Non-liquefying semen.

    (3) Anti sperm antibodies in semen or seminal plasma.

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