Primary Infertility
by Ioannis Gryparis
Fertility Consultant
Medical Director South Europe
Infertility is defined by the failure to achieve a pregnancy after 12 months (or six months if you’re 35 or older) or more of regular unprotected sexual intercourse. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previously successful conception.
How common is infertility?
Infertility is a global health issue affecting millions of people of reproductive age worldwide. Available data suggests that one in six people experience infertility in their lifetime.
Causes of infertility
Infertility may occur due to male factors, female factors, a combination of male and female factors or may be unexplained. Studies show that:
- 35% of infertility involves the male partner.
- 35% of infertility involves the female partner.
- 30% of infertility involves both partners, or is unexplained.
Twenty-five percent of infertile couples have more than one factor that contributes to their infertility.
What is the cause of primary male infertility?
Causes of male infertility can be due to low sperm count, malformed sperm, low sperm motility or no sperm at all.
Causes of poor sperm quality or low sperm count include:
- Testicular abnormalities such as orchitis, vasculitis, varicocele or male sex hormone abnormalities.
- Genetic disorders, such as cystic fibrosis.
- Chromosomal disorders, such as Klinefelter syndrome.
- High heat exposure to the testicles from tight clothing, frequent use of hot tubs and saunas, and holding laptops or heating pads on or near the testes.
- Low testosterone (hypogonadism).
- Misuse of anabolic steroids.
- Use of drugs affecting sperm quality such as drugs to treat stomach pain, high blood pressure.
- Sexual dysfunction, such as erectile dysfunction, anejaculation, premature ejaculation or retrograde ejaculation.
- Sexually transmitted diseases, may lead to inflammation of the vas deferens, causing narrowing of the passageway that transports sperm from the testicles to the penis
- Various diseases: Urinary tract infections, epididymitis due to complications of mumps; Tuberculosis of the testicles, varicose veins that cause sperm to be deformed. Diabetes, high blood pressure or advanced age, low sex drive.
- Previous chemotherapy or radiation therapy.
- Due to alcoholism, tobacco.
- Due to prolonged stress.
What is the cause of primary female infertility?
Causes of female infertility are often due to tubal and peritoneal disease (accounting for about 70%), ovulatory disorders (about 20%) and 10% of unknown causes. There are many causes of primary infertility in women, most of which are caused by gynecological diseases, the following are the main causes:
- Inflammatory diseases in the pelvic area, caused by bacteria such as Chlamydia, gonorrhea.
- Endometriosis.
- Polycystic ovary syndrome: The phenomenon of ovaries having many small cysts, irregular menstruation (only one period every few months) or ovulatory disorders.
- Blocked fallopian tubes preventing the passage of eggs and sperm, causing infertility.
- Primary ovarian insufficiency or poor egg quality. This usually occurs with advanced age. Women after the age of 35 have a harder time getting pregnant than younger women.
- Autoimmune conditions like celiac disease or lupus.
- Hypothalamic and pituitary gland disorders.
- Abnormalities in the uterus: Uterine fibroids, uterine polyps, septate uterus.
- Other diseases such as: gout, obesity, diabetes, kidney disease, liver disease, thyroid disease.
- Genetic or chromosomal disorders.
- Use of drugs, health status (smoking) and nutrition also affect fertility.
Diagnosis and Tests
Female infertility is assessed by checking is the patient is ovulating regularly, whether the fallopian tubes are open in order for the egg and sperm to meet, and last if the internal lining of the uterus is normal. In order to detect if there is any issue with any of the above processes, the patient has to undergo:
- Pelvic examination
- Blood tests (including hormone profile and AMH)
- Tubal patency test
- Transvaginal ultrasound
- Hysteroscopy
- Laparoscopy to check for endometriosis
Male infertility is diagnosed by making sure a person ejaculates healthy sperm. Consequently, it is essential that the male partner has to undergo a semen analysis test, and possibly blood tests as well as a scrotal ultrasound.
How is primary infertility treated?
Treatment for infertility depends mostly on the cause. Your age, how long you’ve been trying to conceive and your personal preferences are factors in deciding on a treatment. Sometimes, treatment involves both partners.
In most cases, people and couples with infertility have a high chance of pregnancy. Things like medication, surgery or assisted reproductive technology (ART) can help. Often, lifestyle changes or improving the frequency and timing of intercourse can improve your chances of pregnancy. Treatment can also include a combination of methods.
How can we help?
NOW-fertility offers a variety of assisted conception techniques, in order to help you achieve pregnancy. Our most common services include IVF with ICSI, egg or sperm or embryo donation, and egg freezing for cryopreservation of your fertility for future use.
Ready to start your journey?
Our commitment is to make fertility care accessible, successful and stress free for patients.
If you are ready to start your journey, book a consultation with one of our experienced fertility consultants.
