Infertility is the inability to naturally conceive a child or the inability to carry a pregnancy to term. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance.
The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if:
- they have not conceived after a year of unprotected intercourse, or after six months in women over 35;
- there is incapability to carry a pregnancy to term.
Healthy couples in their mid-20s having regular sex have a one-in-four chance of getting pregnant in any given month. This is called "fecundity".
According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are "unexplained".
A Robertsonian translocation in either partner may cause recurrent abortions or complete infertility.
"Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.
Factors relating to female infertility are:
- Diabetes mellitus, thyroid disorders, adrenal disease
- Significant liver, kidney disease
- Psychological factors
- Hypothalamic-pituitary factors:
- Kallmann syndrome
- Hypothalamic dysfunction
- Polycystic ovary syndrome
- Diminished ovarian reserve
- Luteal dysfunction
- Premature menopause
- Gonadal dysgenesis (Turner syndrome)
- Ovarian neoplasm
- Pelvic adhesions
- Pelvic inflammatory disease (PID, usually due to chlamydia)
- Tubal occlusion
- Uterine malformations
- Uterine fibroids (leiomyoma)
- Asherman's Syndrome
- Cervical stenosis
- Antisperm antibodies
- Insufficent cervical mucus (for the travel and survival of sperm)
- Vaginal obstruction
- Various intersexed conditions, such as androgen insensitivity syndrome
Factors relating to male infertility include:
- Endocrine problems, i.e. diabetes mellitus, thyroid disorders
- Hypothalamic disorders, i.e. Kallmann syndrome
- Hypogonadism due to various causes
- Psychological factors
- Drugs, alcohol
- Genetic causes, e.g. Klinefelter syndrome
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Vas deferens obstruction
- Infection, e.g. prostatitis
- Retrograde ejaculation
Some causes of male infertility can be determined by analysis of the ejaculate, which contains the sperm. The analysis includes counting the number of sperm and measuring their motility under a microscope:
- Producing few sperm, oligospermia, or no sperm, azoospermia.
- A sample of sperm that is normal in number but shows poor motility, or asthenozoospermia.
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