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:
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 subfertility causes around 25% of infertility:
These are usually:
- Low sperm count (oligozoospermia)
- Poor sperm motility (asthenozoospermia)
- Abnormal forms (teratozoospermia)
- Drugs - alcohol, smoking, etc.
- Anti-sperm antibodies - autoimmune - common after vasectomies.
- Kallman syndrome - hypothalamus not releasing GNrH.
- Hypopituitarism - stops releasing LH and/or FSH.
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.
A tumour near the pituitary can cause abnormally high levels of prolactin. This will cause Amenorrhoea, along with headaches and other brain tumour symptoms.
If a patient has had a history of
- Pelvic infection generally from TB, or STDs such as gonococcus and Chlamydia
- 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
The secret with a patient with PCOS is to get them to lose weight. It is not easy!
Cessation of menses before age 40 – 1% of women in UK. Very often primary or secondary to chemo/radiotherapy
High levels of stress can cause amenorrhoea, although this can also be linked to weight change too.