Causes of involuntary childlessness
In our clinics, the fertility treatment is always tailored to your individual circumstances. During the first in-depth conversation, we touch on various aspects of childlessness and talk about the possible causes. The causes of involuntary childlessness are usually a complex interplay of various factors, which apply to both men and women. That is why we always examine both parties in our fertility clinics.
Physical causes in the woman
Disturbance in egg maturation
The production and secretion of the hormones is affected by various factors. Eg. stress, certain types of medication, weight or metabolic disorders can have a negative impact on hormone balance. A hormone imbalance has a major impact on the natural course of the menstrual cycle.
Decreased function of the fallopian tubes
After ovulation, the egg must pass through the fallopian tube, where it must be fertilized by the sperm cells. In some women, the fallopian tubes are blocked or damaged. This can, among other things, due to inflammation (eg chlamydia), scar tissue (after surgery or perforated appendix) or endometriosis. If the fallopian tubes have been damaged, there is a greater risk of an ectopic pregnancy. If the fallopian tubes are closed, it is necessary to have fertility treatment with IVF.
Muscle knots in the uterus
Muscle knots in the uterus are also called myomas or fibroids. They are benign, but can interfere with a fertilized egg from attaching to the lining depending on the location. If there is doubt as to whether a muscle knot can affect the chance of pregnancy, a 3D scan or a hysteroscopy can be carried out to investigate it further. In some cases, it may be necessary to remove the muscle knot before fertility treatment.
During intercourse, the motile sperm cells are pushed out via the vas deferens and urethra by means of muscle contractions during ejaculation. The motile sperm penetrate via the vagina into the cervix and uterus and into the fallopian tubes. If there is a mature egg in the fallopian tube, the sperm cells try to break down the egg’s cell wall and get stuck inside the cell – the egg is fertilized. On their way into the fallopian tube, many sperm succumb, and therefore a single ejaculation contains 200-300 million sperm (2-5 ml). If the quantity of sperm cells is significantly below this average, or if the sperm cells in the ejaculate are not sufficiently mobile, the man’s ability to reproduce can be negatively affected.
Which factors are decisive for sperm quality?
The reasons for non-pregnancy can lie with both the woman and the man. The most frequent reason for a male fertility disorder is insufficient production of normally shaped, motile sperm. For a ‘normal’ sperm quality, the following factors apply according to the WHO guidelines:
- The amount of the ejaculate: 1.5 ml or more.
- Total number of sperm cells in the ejaculate: at least 40 million. sperm cells.
- The concentration of sperm cells: at least 20 million. sperm cells/ml.
- Sperm morphology: at least 15% normally shaped.
- Sperm motility: at least 50% with forward motility or 25% with progressive motility within 60 min. after ejaculation.