Causes of subfertility

There are several main causes of infertility. Once you've finished reading this, you should look at fertility management In those who aren't on contraceptive medication, the obvious one, they are as follows:

Ironically, this chap is suffering from hypopituitarism, sadly leading him unable to conceive.

Unexplained

This is the diagnosis in 25% of cases. Says a lot about modern medicine, really. What do we pay these bloody doctors for anyway?

Male

Male subfertility causes around 25% of infertility:

Sperm problems

These are usually:

• Low sperm count (oligozoospermia)
• Poor sperm motility (asthenozoospermia)
• Abnormal forms (teratozoospermia)

The causes:

• Idiopathic
• Drugs - alcohol, smoking, etc.
• Varicocele
• Anti-sperm antibodies - autoimmune - common after vasectomies.
• Kallman syndrome - hypothalamus not releasing GNrH.
• Hypopituitarism - stops releasing LH and/or FSH.

Female

Ovulation disturbances

For example, those who are very athletic do not make any FSH or LH. They put themselves into a pseudomenopause until they lower their exercise level. The same happens with obese or thin women. Returning a few kilos towards a normal BMI will often kickstart periods.

Hyperprolactinaemia

A tumour near the pituitary can cause abnormally high levels of prolactin. This will cause Amenorrhoea, along with headaches and other brain tumour symptoms.

Hypogonadal hypogonadism

A lack of LH and FSH production, caused by problems with the pituitary. Commonest cause is Kallmann syndrome, which causes Hypogonadal hypogonadism, and also anosmia – lack of smell!

Tubular disturbances

If a patient has had a history of

• Pelvic infection generally from TB, or STDs such as gonococcus and Chlamydia
• Endometriosis
• Peritonitis, for example from a perforated appendix
• Pelvis surgery

In mild cases of the disease, surgery can clear the occlusion, but in more severe cases, IVF is the only solution.

Polycystic ovary syndrome

• Commonest cause of anovulatory infertility
• Usually presents in 20-35 year old
• Presents with oligo/amenorrhoea
• Hirsutism/acne
• Obesity

The secret with a patient with PCOS is to get them to lose weight. It is not easy!

Premature Menopause

Cessation of menses before age 40 – 1% of women in UK. Very often primary or secondary to chemo/radiotherapy

Anxiety

High levels of stress can cause amenorrhoea, although this can also be linked to weight change too.