The most common causes of infertility are:
A woman’s fertility is at its peak at the age of 20-25. Thereafter, it decreases at a relatively slow rate until the age of 35 at which point it begins to decline significantly up to the age of 40.
From 40 onwards, fertility decreases dramatically and by 45 is almost non-existent.
Therefore, a couple should take age, as well as other factors, into account when considering when to visit a Gynaecologist.
It should be added that, in some cases, “ovarian age” is different from a woman’s actual age.
In order to assess ovarian age, a measurement of AMH level is recommended, which monitors ovarian reserve (number of oocytes remaining in the ovaries).
Endometriosis is a benign disease that affects many women of childbearing age. It is characterized by the ectopic presence of endometrial cells (the endometrium is the internal lining of the uterus) in places such as the wall of the uterus (adenomyosis), the ovaries, peritoneum, abdomen and other rare sites such as the bladder, bowel wall, etc.
The exact cause of the disease is not completely known. It is possibly due to a genetic predisposition and abnormal structure. Endometriosis may also be caused or magnified by the reflux of blood during a woman’s period through the fallopian tubes and the implantation of endometrial cells in the lining of the uterus or the abdomen.
This ectopic aggregation of endometrial cells acts as a receptor of hormonal stimulation and bleeding during the menstrual cycle.
Endometriosis can cause menstrual pain (dysminoroia), pain during sexual intercourse (dysparefneia) or atypical pain at various stages of the cycle and during random activities (chronic pelvic pain). Moreover, endometriosis can cause scarring (adhesions) in the fallopian tubes, ovarian cysts and adhesions on internal organs of the abdomen.
Symptoms of endometriosis therefore include pain, bleeding and infertility. Often, even severe endometriosis can evade diagnosis given the absence of significant symptoms.
Endometriosis is a common problem in women and concerns approximately 10 – 20% of women of reproductive age and 15 – 40% of infertile women.
Pelvic infections (inflammation)
Pelvic infections are often sexually transmitted (eg Chlamydia), but can also occur after surgery in the womb or cervix (eg curettage, cone excision). In many cases, there may be no clear cause of the inflammation.
Usually, severe abdominal pain occurs, but some cases are asymptotic. Infection are usually treated with antibiotics and, in more severe cases (eg hydrosalpinx), surgery may be necessary.
A pelvic inflammation may affect the function of the fallopian tubes and also lead to inflammation and endometrial adhesions.
Young women often undergo ovarian surgery, usually due to cysts (eg corpus luteum cyst, endometriosis, dermoid, etc.).
In such cases, the amount of healthy ovarian tissue is reduced, as well as the ovarian reserve and ovulation ability.
Moreover, adhesions are likely to develop that may affect and hinder the functionality of the fallopian tubes.
For these reasons, surgery for ovarian cysts in women of childbearing age is recommended only when absolutely necessary. Moreover, it is advised that laparoscopy be preferred and performed by an experienced Gynaecologist, keeping fertility preservation a priority.
Uterine malformations are a congenital condition and are usually associated with malformations of the genitals, the urinary tract or rectum.
They occur in approximately 5% of the general population.
Usually, initial diagnosis is made via a transvaginal ultrasound and confirmed by a hysteron-salpingography, a hysteroscopy, laparoscopy or an MRI (magnetic resonance imaging).
There are different types of malformations of the uterus of which the septated uterus (uterine septum or partition) is the most common.
Types of uterine malformations:
- Μερική αγενεσία ή υποπλασία
- Class II: Unicornate uterus (a one-sided uterus)
- Class III: Uterus didelphys (double uterus)
- Class IV: Bicornuate uterus (uterus with two horns)
- Class V: Septated uterus (uterine septum or partition)
- Class VI: DES uterus
Surgical intervention (hysteroscopy) is not required for all types of malformations in order to restore fertility.
Nevertheless, it is recommended that a septated uterus be surgically corrected before a patient tries to become pregnant.
It is a simple procedure, applying hysteroscopic techniques, without serious side effects, and it dramatically improves the couple’s chances of natural pregnancy.
Irregular menstrual cycle
The menstrual cycle plays a vital role in achieving pregnancy.
Not only is it responsible for ovulation, but it also prepares the endometrium to receive the embryo. The usual duration of a cycle is 28 days with ovulation around Day 14. Significant changes to the cycle are associated with irregular ovulation or even lack of ovulation. In these cases, it is difficult to identify the woman’s fertile days, greatly reducing the likelihood of pregnancy.
The most common cause of an irregular cycle is polycystic ovary syndrome (PCOS), characterized by the following:
- irregular menstrual cycle
- ovarian morphology in which multiple follicles are visible
- hyperandrogenism: hirsutism and a tendency for accumulation of fat in places unusual for women, such as the tummy
Besides affecting fertility, PCOS can cause changes in metabolism.
For this reason, a correct diagnosis and treatment is essential to improve the patient’s health and quality of life.
Another abnormality of the menstrual cycle is amenorrhoea (the absence of menstruation). Amenorrhoea is associated with infertility, as well as changes to bone mass (osteoporosis) if the problem persists for a long time.
It is important to identify the cause of amenorrhoea and seek proper treatment in order to avoid secondary side effects, especially to bone structure.
There are many different treatments for amenorrhoea depending on the cause of the problem.
Testicular pain is associated with the presence of varicocele (swollen veins in the testicles), which can contribute to infertility.
Anomalies in the testes during childhood (cryptorchidism, genital malformations, etc.). All these defects are associated with poor development of the genital organs during embryonic development. In such cases, the is an increased likelihood of birth defects affecting sperm quality, particularly when associated with abnormal sperm, recurrent miscarriages or unexplained infertility.
Impotence and other problems related to sexual function, which lead to reduced reproductive capacity, can be treated effectively without side effects.