Sterility

Causes of Infertility

An unfulfilled desire to have children can have many causes. The cause is not always pathological and can be found in either the woman or the man. Therefore, it is necessary for both partners to participate in the diagnosis and treatment.

Female Causes:

• Hormonal disturbance of egg maturation
• Absence of ovulation
• Partial or no patency of the fallopian tubes
• Endometriosis (growth of uterine lining outside the uterus)
• Malformations of the ovaries, fallopian tubes, or uterus
• Antibodies against one’s own eggs or sperm

Male Causes:

• Insufficient production of motile sperm
• Blockage of the vas deferens

Psychological Causes:

In some cases, the causes of involuntary childlessness can be found in both partners. If no organic causes for infertility are found, stress may be the main cause. This stress can also be the reason for involuntary childlessness. The longer it takes to conceive a child and the more the couple wants it, the more often this stress is the reason why fertilization does not occur despite all efforts. Stress can affect hormones, preventing ovulation in women and inhibiting sperm production in men.

Diagnosis

Anamnesis

In all medical questions, including the assessment of childless couples, discussing and evaluating possible factors associated with childlessness is of utmost importance. This creates a basis of trust, which is crucial considering the psychosomatic dimension of sterility.

Age is a significant factor when advising whether a woman's desire to have children can still be fulfilled, as conception rates drop sharply after the age of 30. Many women start planning a family after 30 due to career and educational commitments, which reduces the probability of conception.

Diseases and operations can provide clues to the causes of sterility. Inflammations and surgical interventions in the pelvic area suggest tubal factors and require a closer examination of the fallopian tubes. Diseases of hormone-producing organs like the thyroid, pituitary gland, and adrenal glands are often associated with sterility and must be evaluated before treatment.

Hormone Diagnostics

Endocrine examination of the infertile woman is necessary if cycle irregularities or anovulation detected by basal temperature measurement indicate a hormonal cause.

Ovulation Diagnostics

The easiest way to evaluate ovulation is by measuring basal body temperature. Progesterone-induced changes in body temperature can indicate ovulation. Vaginosonographic folliculometry and the evaluation of luteinizing hormone and estradiol can also provide information about ovulation.

Eustachian Tube Diagnostics

With the increase in sexually transmitted diseases, tubal factors are becoming more important for female sterility. Sonographic tube imaging and laparoscopy with chromoperturbation are methods used to evaluate tubal patency and the presence of endometriosis.

Treatment

Once the causes have been identified, treatment can begin. There are various ways to remedy infertility.

Hormonal Stimulation

Hormonal treatment involves injecting fertility hormones, starting on the third day of the cycle. Egg maturation is monitored with ultrasound and blood tests, and ovulation is triggered with another dose of hormones.

Insemination

Insemination is used when sperm count or mobility is reduced. Sperm are introduced directly into the uterus via a catheter at the time of ovulation.

In Vitro Fertilization (IVF)

IVF is considered if other methods are unsuccessful. Eggs are fertilized outside the womb and then inserted into the uterus via a catheter.

Intratubal Gamete Transfer (GIFT)

In this method, eggs and sperm are placed in the fallopian tubes via a catheter, allowing natural fertilization.

Micro-Injection

This method is an advancement of IVF. A single sperm is injected directly into an egg cell using a thin pipette.