Hypofertility - Causes and Symptoms

Definition

By hypofertility is meant a reproductive capacity lower than normal. This condition can make conception difficult in the case of unprotected sex.

The causes that lead to hypofertility can be multiple.

Male causes of fertility

The reduced male reproductive capacity derives mainly from more or less serious alterations of the seminal fluid.

For the purpose of fertility, the determining factor is represented by the characteristics of the spermatozoa produced at testicular level: the latter must normally be conformed and quantitatively adequate (more than 20 million per ml). Their fertilizing power also depends on correct motility.

The total absence of spermatozoa (azoospermia), their presence in reduced numbers (oligospermia), the decrease of their motility (astenospermia) and the anomalies of their morphology may depend on causes that act directly on the testicle, damaging the seminal cells or altering them the maturation processes.

Seminal fluid abnormalities may depend on endocrine conditions, such as hypothalamic-pituitary-gonadal abnormalities, adrenal pathologies, hyperprolactinemia, hypogonadism and hypothyroidism. Hypofertility can also result from testicular damage secondary to trauma and torsion, cryptorchidism, orchitis, epididymitis, varicocele, exposure to toxic substances of various kinds and to heat sources, the use of cytotoxic drugs and hormonal therapies.

Defects in sperm quality and quantity can also be found in Klinefelter syndrome, in microdeletions of parts of the Y chromosome and in disorders of sexual differentiation.

The reduced reproductive capacity may also depend on pathological processes affecting the structures through which the seminal fluid is conveyed to the outside (as an epididymis and vas deferens), causing its obstruction or blockage; these conditions include: congenital malformations, uro-seminal infectious processes (gonorrhea, syphilis and chlamydia) and surgical treatments of the genitourinary system (eg retroperitoneal dissection and prostatectomy).

Other causes of male hypofertility include erectile dysfunction, cystic fibrosis, neurological disorders and diabetes.

Female causes of fertility

Female hypofertility derives from anatomical or functional changes that occur in the organs of the reproductive system (ovary, tube and uterus).

At the ovarian level, the most common verifiable defect is an altered ovulation, irregular or absent (ovulatory dysfunction), a condition for which the egg cell is not available for the encounter with the sperm of male origin. Various factors contribute to ovulatory dysfunctions, including excessive stress, eating disorders, hyperprolactinaemia, hypothalamic disorders (eg hypothalamic amenorrhea) and other conditions that cause anovulatory menstrual cycles (reduced or absent ovarian reserve, polycystic ovary syndrome, hypothyroidism, etc.). .

Other situations of hypofertility can be those that induce menstruation often irregular or absent (amenorrhea), such as early menopause or genetic syndromes (eg Turner syndrome). As for ovarian dysfunctions, there are also defects in the luteal phase, in which hormonal production is inadequate after fertilization.

Hypofertility can result from diseases that lead to tubal abnormalities, such as sactosalpinge, adnexa and pelvic inflammatory disease. An obstruction or closure of the fallopian tubes can be caused by ectopic pregnancy, intrauterine devices (a rare cause of pelvic infection) and surgery on the pelvic organs that cause the formation of adhesions.

At the level of the uterus, on the other hand, the reduced reproductive capacity can result from some congenital malformations of the organ, stenosis of the cervical canal and serious infections.

Pelvic lesions that can prevent fertility include intrauterine adhesions (Asherman's syndrome) and fibroids that obstruct the fallopian tubes or alter the uterine cavity. Also the bad quality of the cervical mucus can cause hypofertility, obstructing the passage of the spermatozoa.

Endometriosis can cause tubal, uterine or other injuries that impair fertility.