Infertility is defined as the inability to conceive after a year of regular unprotected intercourse. It can result from various factors, including issues related to both male and female reproductive systems. Around 1 in 7 couples in the UK were estimated to experience fertility issues, where female factors contributed to infertility in about 35-40% of the cases and male factors were identified in about 30-40% of infertility cases, while approximately 20-25% of cases were categorised as unexplained infertility.

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What causes infertility? 
 

Abnormal uterine bleeding: 
Abnormal uterine bleeding relates to unusual menstrual bleeding before, during or after a woman's menstrual period. It can be caused by unbalanced hormones, or by more serious conditions such as uterine growths, uterine fibroids and uterine cancer. 

Age-related infertility: 
Age affects the chance of a woman to conceive and have a healthy baby. However, A woman's fertility starts decreasing at age 30, then it rapidly falls down after 35. There is only a 5% chance for a woman over 40 to get pregnant. In addition, Middle-aged men are also less fertile than young men in their 20s.

Anovulation: 
When a woman's ovaries do not develop and release oocytes or eggs, this is known as anovulation. It's a quite common cause of female infertility that accounts approximately 25% of the female infertility causes. If a woman only has her period every few months, or none at all, she may not be ovulating or ovulating infrequently, thus causing infertility.

Cancer treatment: 
Cancer treatments including radiation and chemotherapy can have a major impact on fertility due to removal or damage to reproductive organs, eggs, and sperm. Prior to beginning cancer treatments or undergoing any surgery to your reproductive organs, both women and men should consult with fertility specialists.

Ectopic pregnancy: 
An ectopic pregnancy occurs when a fertilised egg implants outside of the uterus. In most of the time, it happens in the fallopian tube. This occurs when the fallopian tube is blocked or damaged. However, the fallopian tube can't support the growth of an embryo, and the ectopic pregnancy may cause the fallopian tube to rupture and bleed, resulting in a potentially serious medical situation.

Endometriosis: 
Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus where such as ovaries, fallopian tubes, bladder or even intestines. It causes infertility by affecting the fertilisation and implantation. 

Fibroids: 
Uterine fibroids are common and can affect embryo implantation and general fertility. Fibroids growing in the cavity of the uterus (submucous) or distorting the endometrium affect fertility. 20% of women have fibroids during their childbearing age, and 50% of women will have fibroids by age 50.

Genetic causes of infertility in women: 
Many women are unable to conceive and deliver a healthy baby due to genetic factors as a result of inherited chromosome abnormalities or single-gene defects.

Hormone imbalance: 
The process of ovulation and implantation depends upon the balancing of hormones and the interactions of the hormones. Any disruption of the hormones can hinder the ovulation or the implantation of the fertilised egg in the uterine lining (endometrium).

Male infertility: 
In approximately 40% of infertile couples, male infertility is either the sole cause or a contributing cause of infertility. Problems with the sperm's shape, numbers, health and movement can affect the ability to conceive. Infertility may also result when there is a blockage or obstruction in the man's vas deferens that is small tubes that transport sperm from the epididymis to the ejaculatory ducts.

Miscarriage & recurrent pregnancy loss: 
Repeated pregnancy loss is defined as 3 confirmed miscarriages prior to 20 weeks. Although approximately 25% of all pregnancies result in miscarriages, less than 5% of women will experience two consecutive miscarriages, and only about 2% experience three or more miscarriages. 

Polycystic ovarian syndrome (PCOS): 
PCOS is a common cause of infertility. Severe hormonal imbalances cause eggs to remain immature, shrink and turn into cysts in the ovaries. The eventual cysts aggravate the hormonal imbalances. 

Polyps: 

There are two types of polyps that affect fertility: uterine polyps (which are also referred to as endometrial polyps) and cervical polyps. Uterine polyps are masses or lesions of the endometrium). Cervical polyps are smooth, finger-shaped growths in the cervix, which is the passage between the vagina and uterus. Polyps can affect the fertilisation or embryo growth.

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Sexually transmitted diseases: 
STDs, particularly Chlamydia, can damage a woman's fallopian tubes and cause infertility. Men may also experience decreased fertility as a result of STDs.

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Fallopian tubal disease: 
Fertilisation occurs in the woman's fallopian tubes. This fertilised egg travels down the tube into the uterus, where it develops into a baby. Any blockage of the tubes is called fallopian tubal disease and will prevent fertilisation of sperm and egg or may cause ectopic pregnancy. The fallopian tubal disease accounts for about 35% of all infertility problems.

Uterine abnormalities & malformations: 
Uterine abnormalities include uterine fibroids, polyps, adhesions and scar tissue, which can interfere with egg fertilisation or embryo development. 

Uterine adhesions: 

Adhesions (also known as Asherman syndrome) are bands of scar tissue that form between or inside of abdominal organs. In very severe cases, adhesions may block or distort the inside of the uterus, as a result, the fertilised egg may be unable to bring it to full term.

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Exercise: 
Both over-exercising and lack of exercise are linked to fertility problems in men and women.

 

Smoking and alcohol: 
Smoking and excessive alcohol consumption by either men or women may affect fertility.

 

 

Stress and infertility: 
Some studies indicate that mental stress may affect ovulation and sperm production, thus causing infertility.

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Obesity: 
Obesity is a major risk factor for infertility. Ovulation may be affected by obesity and many diet disorders can alter the balance of hormones and affect fertility.

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