The table below will shows you how GP’s and specialists tend to break down the most likely causes of infertility. Do not forget that there can be multiple factors at work in infertility – there may be several problems involving either the male or female, or equally both partners.
|Causes of infertility of patients presented to GPs||Incidence (%)|
|Male fertility problems (infections, testicular injury, sperm defects, damage to the penis etc.)||35|
|Tubal (tubal damage due to pelvic adhesions, endometriosis, ectopic pregnancy etc.)||20|
|Ovulatory (polycystic ovarian syndrome, premature ovulation failure, lack of ovulation etc.)||20|
|Unexplained infertility (specialist help has failed to uncover an obvious reason for their infertility.)||15 (varies)|
|Cervical (infections, previous cervical surgery etc)||10|
- Unexplained fertility
- Premature Ovarian failure (POF)
- Ovulation problems
- Thyroid problems
- Uterine fibroids
Diagnosis– Blood tests, Laparoscopy, HSG, Ultrasound scans, Basal body temperature charts.
This is the most frustrating and difficult areas to deal with. Generally all the diagnostic tests will have been performed on both the female and male partners i.e Blood tests for FSH to check ovarian reserve, LH to check ovulation, Progesterone to check whether ovulation has occurred.
HSO: Hysterosalpingogram – This is an x ray of the inside of the uterus and fallopian tubes which is achieved by injection of a dye through the cervix. This dye is forced in the uterus and tubes under pressure until it spills into the pelvic cavity. If the dye does not enter the pelvic cavity it is assumed the tubes are blocked.
Laparoscopy – Also a surgical procedure by which a surgeon looks directly into the pelvic cavity by means of a small fibre optic tube. This is used to diagnose blocked tubes, cysts or endometriosis.
Sperm analysis – A sample of sperm is provided and assessed on 3 different counts
There seems to be a fairly standard protocol for the treatment of unexplained fertility. This is particularly frustrating for the Chinese medicine practitioner as some external markers i.e cervical mucus production and Basal Body Temperatures, tongue and pulse diagnosis can show a clear picture pieced together giving rise to many clues for the course of infertility. Once a clear course has been found (often despite Western Medicines diagnosis of “unexplained infertility”) this can be corrected giving the couple much greater chance of success.
Male fertility problems account for up to 40% of fertility difficulties. Sperm counts have been declining at a very rapid rate over the last 50 years.
Sperm counts have dropped dramatically in the past 50 years. A quarter of all couples planning a baby have trouble conceiving. In four out of ten cases the problems are on the male side, with 30% of men sub fertile whilst 2% are totally infertile. A poor sperm count can be a result of an infection called mumps. A low sperm count can be due to a poor diet, nutrient deficiencies and/or environmental toxins such as lead, mercury and cadmium. Food additives, smoking, alcohol, food intolerances, urinary tract infections plus stress can all affect fertility. Common organisms such as Mycoplasma hominis and Ureaplasma toxoplasmosis can infect the urinary tracts of men and women. They don’t always cause infertility, but there seems to be a higher number of these organisms in the secretions of couples who have unexplained fertility problems. Smoking and alcohol can also reduce sperm count. Many scientists now openly state that sperm counts in the Western world are dropping because of overuse of herbicides and pesticides, which have an oestrogen-boosting effect within the body that counteracts male testosterone.
Diagnosis: Sperm test – NHS . More independent sperm analysis at “The Doctors Lab” in London
- Wearing tight clothes/ underpants
- Drinking alcohol
- Exposure to toxins
- Hormonal imbalances
- Undescended testes
- Sexual diseases
- Hot tubs/Saunas
- Excessive gym training
- WHO Guidelines for classifiable of infertility
- Count – Less than 20 million/ml
- Volume – Less than 1.5ml
- Motility – Less than 40% motile
- Morphology – Less than 15% normal forms.
What can I do if I have a poor sperm count?
The good news is there is a lot that can be done to improve a poor sperm count quite often just implementing a few simple changes mentioned above. New sperm are constantly being produced over a 3 month cycle.
Causes of male infertility
- Obstructions (blockages in sperm- carrying tubes)
- Groin surgery (including hernia repair and fixation of undecided testes.
- Trauma/Disease/Injury. Even fairly minor sporting injury to the scrotum sac.
- Inflammation caused by infection.
- Chlamydia and tuberculosis.
- Previous Vasectomy
- Congenital bilateral absence of the vas deferens.
These are enlarged veins around the testes similar to varicose veins. These occur in approx 10-20% of the male population and account for 30-40% of men with fertility problems. It is thought that the varicocele either heats up the testes or impairs their blood supply which damages sperm production. Varicoceles can be removed by a surgical procedure called ligation.
Disorders with chromosomes occur in about 2-20% of infertile men.
Problems with erection and ejaculation
This occurs in about 5% of couples and can be due to impotence – this is the inability to attain or maintain an erection adequate for intercourse. Impotence can be caused by a number of physical conditions, including diabetes and diseases of the nervous system, which can be treated with hormone treatment or vibratory massage. However, in many cases the underlying cause in psychological and the stress that accompany the desire for a baby.
Testosterone deficiency caused by problems with the pituitary gland or the hypothalamus or hormonal imbalances caused by liver, kidney or thyroid problems.