Causes and Treatment of Infertility

To treat infertility, the doctor begins by trying to discover the causes. They do this to make sure they choose the appropriate treatment. The doctor may treat infertility with drugs or surgical procedures, and he may also recommend the use of an assisted reproductive technology such as: IVF and intrauterine insemination. This is done if it was found that treatment with medications or surgical procedures may not be sufficient to treat infertility, or in the event that it is not possible to identify a clear cause of infertility in both spouses.

It is worth noting that infertility treatment may require resorting to one or more of the available treatment options, and the selection of the appropriate treatment depends. It depends on several factors in addition to the cause of infertility, such as:

• The duration of suffering from infertility.
• The personal preference of the spouses.
• The age of each one of them.

As mentioned previously, the problem of infertility is a relatively common health problem. Delayed pregnancy may be caused by one of the health disorders of the woman, the man, or both. In many cases the main cause of infertility cannot be determined, so it is worth Indicating the need for both spouses to undergo a medical evaluation to determine the factors causing infertility. The tests used to find out the cause of infertility in women include blood tests to detect the level of certain hormones, imaging tests, and in some cases, some medical procedures may be resorted to, such as: laparoscopy and hysteroscopy. This provides an opportunity to examine the internal genital parts of women. As for men, they do a sperm analysis and blood tests to detect the level of some hormones, at times imaging tests may be performed.

Awareness before infertility treatment

It is important to educate the couple before starting treatment that infertility or delayed pregnancy may be linked to some factors that can be avoided without the need for treatment. Also the timing and number of times of sexual relations plays an important role in the process of fertilization. This is because the practice of sexual relations periodically increases the chance of pregnancy every 2-3 days.

In addition to trying to determine the date of ovulation for a woman to practice sexual relations during the fertile period. The following is a statement of some of the factors that may affect the fertilization process and reduce the chance of pregnancy;

• Women suffering from overweight/underweight.
• Women who do too much exercise.
• Men or women who drink too much alcohol.
• Smoking it may have an effect in reducing the number of sperms in a man, and impairing their motility.
• Using a lubricant during intercourse; some types of lubricants may have an effect on impeding the sperm from reaching the egg.

Causes of male infertility

The treatment of male infertility depends mainly on the cause of infertility, and infertility is often caused by a sperm disorder such as having a decrease in number or suffering from ejaculation, below are some reasons why:

Secondary hypogonadism

This is caused by some disorders of the pituitary gland, or the hypothalamus in the brain which is responsible for secreting hormones that stimulate the testicles to produce testosterone, and this type of disorder accounts for only 1-2% of male infertility cases.

Primary disorders in the testicles

Examples are orchitis, varicocele or some problems related to testicle growth development. These constitute 30-40% of male infertility cases.

Sperm transport disorder

This accounts for 10-20% of male infertility cases.

Cases of unknown cause

They make up 40-50% of infertility cases.

Medical treatment of male infertility

There are a group of medications that a doctor may resort to treat male infertility, including:

Gonadotropins

A synthetic form of gonadotropins secreted by the pituitary gland may be described and used if a man suffers from insufficiency as these hormones directly stimulate the testicles.

Alpha-receptor agonists

The doctor may prescribe pseudoephedrine, which is one of the alpha-receptor agonists, if the man suffers from retrograde ejaculation. It is a condition represented by retrograde ejaculation towards the bladder instead of its exit through the urethra to the outside of the body, as these drugs block the opening that leads to ejaculation towards the bladder.

Premature ejaculation and erectile dysfunction medications

There are some medications that help with premature ejaculation, and other medications for erectile dysfunction such as sildenafils.

Bromocriptine or cabergoline

The treatment for cases of high milk hormone or what is known as hyperprolactinemia in men varies depending on the cause, and medical treatments for this condition. The doctor prescribes bromocriptine, or cabergoline to help restore the natural level of the hormone in the body, and surgery or radiotherapy may be used in some cases.

Antibiotics

They may be prescribed in the event of suffering from infections in the male reproductive system. It is worth mentioning here that the antibiotics used are for one infected one with STDS and can end up causing infertility. A genital infection can block the tubes that carry semen or sperm and require surgery to remove the blockage.

Surgical treatment of male infertility

There are several surgical treatments that may be used to treat male infertility as well, including:

Remove the semen blockage

If a man suffers from a blockage that hinders the exit of sperm or semen in a man, one of the surgeries may be performed that helps to remove this blockage, which may be caused by an injury, infection in the reproductive system.

Surgical treatment of varicoceles

It is not usually recommended to perform a surgical procedure to treat varicoceles, except in severe cases in which a person suffers from the formation of large varicose veins in the testicles, and the presence of other factors that impair a man’s fertility. The veins causing the problem in the testicle are removed, and it should be noted that this process may not help restore the natural fertility of the man in some cases, especially in the case of suffering from varicocele for a long period of time and not obtaining appropriate treatment. This may cause permanent damage to the testicles.  

Surgical extraction of sperm

The sperm may be surgically extracted from the man for use through assisted reproductive techniques, and this surgical procedure is done in some cases.

Treating the causes of infertility in women

Infertility treatment in women depends on the main cause of infertility. It may be caused by a number of different reasons, such as:

• Old age ovulation disorders that could be caused by polycystic ovary syndrome, in addition to blockage of the fallopian tubes.
• Previous STD infection such as Gonorrhoea, and pelvic inflammation, where the blockage leads to the inability of the sperm to reach the egg or the failure of the egg to reach the uterus for implantation.
• Also the growth of endometrial polyps, and endometriosis.

Medical treatment of female infertility

• Drug clomiphene
• Gonadotropins
• Metformin
• Aromatase inhibitors
• Bromocriptine or cabergoline

Surgical treatment of female infertility

Transabdominal or uterine surgery

This type of surgery aims to get rid of disorders or problems in the uterus or pelvis, and to help increase the chance of childbearing and fertility in women, and is often performed through simple endoscopic surgery, according to the health problem that the woman suffers from. Among the health problems that may be treated through this type of surgery are the following:

• Endometriosis.
• Removal of submucous uterine fibroids.
• Polycystic ovary syndrome.
• Uterine polyps.
• Correcting some congenital anomalies in the uterus.
• Removal of adhesions formed in the pelvis or uterus.

The process to correct the blockage of the fallopian tubes

This supports this process on the severity of the situation and the fact that the blockage in one of the fallopian tubes, or both. The blockage in one of the fallopian tubes is only accompanied by a pooling of fluids in the channel known as Hydrosalpinx is conducted.

Assisted Reproductive Technologies

There are a number of assisted reproductive technologies that may be used to treat infertility, and whose use is very common in the treatment of infertility, including;

Intrauterine injection

In the process of intrauterine insemination, semen is obtained from the man, then the semen is washed with an appropriate solution that does not affect the integrity of the sperm or the egg, then the healthy sperm is separated from the weak sperm and injected into the uterus of the woman using a special needle. This directly increases the chance of fertilization of the egg and pregnancy. This process may be used in some cases, such as:

• A decrease in the number of sperms in a man or a disturbance in their movement.
• Inability to have an erection in a man
• A woman suffering from scarring/distortion in the cervix.

IVF baby

The process of IVF or what is known as in vitro fertilization is where ovulation is stimulated in the woman using the ovulation stimulation drugs mentioned previously, then the man’s semen is extracted, and several eggs from the woman during the ovulation period. Then healthy sperms and healthy eggs are isolated and collected in the laboratory under conditions suitable for insemination to occur. 

Facts about fertility and sterility

To understand the causes of infertility and how to treat each case, it is necessary to clarify what happens in the normal fertility situation in both men and women;

Female fertility

The hypothalamus area in the brain stimulates the pituitary gland to secrete hormones known as gonadotropins, which in turn stimulate the release of a mature egg from one of the ovaries in each menstrual cycle. In the event that this egg is fertilized by one of the man’s sperm, the fertilized egg moves to the lining of the uterus and implants in it, and therefore any problem in the process of ovulation or the ability of the egg to move to the uterus and implant in it after fertilization, may cause the woman to suffer from infertility.

Male fertility

The hypothalamus in the brain stimulates the pituitary gland to secrete gonadotropins, which in turn stimulates the production of testosterone in the testicles, which is necessary for the production of sperm. An ejaculatory duct is formed where the semen from the seminal vesicles goes through the cervix, the uterus and down to the fallopian tube.