Causes of infertility

Damage to the Fallopian tubes can be caused by infections, such as gonorrhea or chlamydia, that spread from the cervix or uterus to the tubes. Other causes include appendicitis, previous pelvic surgery that has caused adhesions at the tubal level, or endometriosis.

There is a close relationship between endometriosis and infertility, as endometriosis affects 10% of women. 35% of infertile women suffer from it. Endometriosis is the presence of endometrial tissue outside the uterus, in the ovaries, Fallopian tubes, or intestines. While some women experience no symptoms, the most common ones are pain, irregular menstruation, and infertility.

Regarding infertility caused by endometriosis, it is related to the changes that occur in the pelvic anatomy of these women during their menstrual cycles. This tissue outside the uterus can cause Fallopian tube obstruction or the formation of endometriotic ovarian cysts that often require surgery and consequently lead to loss of ovarian tissue and decreased fertility. Currently, there are medical and surgical treatments for this condition, and in some cases, pregnancy can halt or improve the progression of the disease.

Our center can hypothesize that a patient has endometriosis if the ultrasound has visualization of chocolate cysts; however, to achieve an accurate diagnosis, it is necessary to directly visualize the lesions through laparoscopy.

Depending on the size of the cyst and the ovarian reserve or the ovary’s responsiveness, the gynecologist will provide guidance on how to proceed with treatment. In Vitro Fertilization is a suitable treatment for women with endometriosis to achieve pregnancy, temporarily improving endometriosis.

A polycystic ovary has a greater number of antral follicles on its surface and can only be detected with an ultrasound. Although the term “polycystic” may lead us to think it is an ovary with many cysts, this is not the case; it refers to multifollicular ovaries. Approximately 20% of women have polycystic ovaries, although not all have ovulation or fertility issues. A percentage of those women them may later develop Polycystic Ovary Syndrome, a hormonal disorder that directly affects ovulation, causing irregular menstrual cycles or an absence of menstruation, making it difficult to conceive.

The absence of ovulation can be triggered by various factors such as stress, significant weight fluctuations, excess prolactin (the hormone that produces breast milk), or having polycystic ovaries, a common condition in women.

To assess fertility in men, an analysis must be conducted to test the number, activity, and shape of sperm. The ideal number for conception is to have more than 39 million sperm in the semen with 32% of sperm showing progressive movement and 4% with normal shapes. If the numbers are lower than these, the likelihood of achieving pregnancy decreases significantly.

Low sperm production can be due to hormonal reasons, i.e., originating in the pituitary or hypothalamus glands, which are responsible for producing hormones that regulate sperm formation. It can also be due to genetic abnormalities such as Klinefelter syndrome or problems in the testicles, such as underdevelopment, anomalies, or lack of descent into the scrotum.

Abnormalities in sperm can affect their movement, shape, or vitality. Causes can be due to infections or the presence of antibodies, altered chromosome numbers, among other factors. Diseases such as diabetes, kidney and liver failure, or thyroid problems can cause sperm abnormalities. Some abnormalities are related to the use of certain medications, drugs, tobacco, and stress.