Causes of infertility

Ovulation problems

This is the commonest cause of female infertility and it is also the one with the best chance of successful treatment. The woman usually presents with infrequent or very scanty periods, irregular periods or absent periods altogether (amenorrhoea). However, ovulation dysfunction can occur with apparently regular cycles. Sometimes women may notice an increase in body and facial hair, acne, milk secretion from her breasts etc.

Ovulation disorders can be classified into:

• Annovulation i.e. lack of ovulation
• Oligoovulation i.e. infrequent ovulation
• Luteal phase defects

Incidence

20-25%

Causes

Primary

Here, the problem is in the ovary itself e.g.

• The ovaries were surgically removed.
• The ovaries were damaged by radiotherapy or chemotherapy treatment for cancer.
• The ovaries only have a few eggs in them i.e. premature menopause which affects 1-2% of women below the age 40 years.
• The woman was born without ovaries.
• Some women have polycystic ovaries.

Secondary

Here, the ovaries are not the problem, but the lack of hormones released from the pituitary gland or hypothalamus. Causes include the following:

• Severe stress.
• Recent great gain or loss of weight.
• Certain drugs.
• Tumor (growth).
• Excess production of  the hormone prolactin.
• Disturbances involving the thyroid gland and the adrenal glands.

Luteal phase defect

This is defined as either a defect of progesterone secretion by the corpus luteum or a defect in the lining of the womb response to hormonal stimulation. This results in an inadequate lining of the womb for embryo implantation. It is estimated that luteal phase defects affects 3-20% of infertile couples.

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