CAUSES OF INFERTILITY
The problem may lie in one of these areas:
• The woman—70 to 75 per cent of infertile couples have a female factor.
• The man—30 to 35 per cent have a male factor.
• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.
However, the most common causes of infertility are:
• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.
• Having blocked fallopian tubes—about 20 per cent.
• Sperm problems—about 20 to 30 per cent.
Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.
Tube problems. Not only do the sperm need to travel up the tube to meet the egg, but the fertilised egg must also make it down through the tube to the uterus. If the tube is kinked or narrowed it is less likely that a pregnancy will result. If the tube is completely blocked, then it’s pretty unlikely indeed.
Things that muck up tubes, such as the most common causes, infection and endometriosis. Chlamydia and gonorrhoea are the main causes of sexually transmitted pelvic inflammatory disease (PID). Non-sexually transmitted PID, for example infection following an abortion or other gynaecological operation, or related to an intrauterine contraceptive device (1UD), accounts for some cases. Scarring following pelvic surgery or appendicitis can also affect the tubes.
Endometriosis can damage the tubes if it causes scarring. It can also slow the rate at which things travel through the tubes, by exerting a type of hormonal effect.
Having an ectopic pregnancy (a pregnancy which settles in the tube or ovary rather than in the uterus) can damage the fallopian tube, as an operation is usually performed to remove the ectopic pregnancy. Generally that means removing some or all of the tube on that side. Surgeons try to be as careful as possible, and in some cases are able to conserve the tube.
Another reasonably common cause of tube problem is previous surgery. Some women who have had their fallopian rubes operated on (either cut and tied, or had clips applied), will request reversal of their operation to restore their fertility. Men who have had a vasectomy may also change their minds, and seek a reversal operation. Reversal may work, but success rates would vary depending on the surgeon and the degree of damage to the tube from the sterilization procedure. You should never have a sterilisation operation thinking you can change your mind later, because the results of reversal are so unpredictable.
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