Infertility

In 20% of cases, the cause is found in the man, in 25% in both, while in approximately 15% of cases, the investigation is unable to determine a cause. The percentage of infertile couples is difficult to determine, but it is believed to be around 15%, a significantly high number. It is estimated that this number is increasing, constituting a very significant problem for modern youth.

The practice is to begin investigation after one year of unprotected intercourse without conception. However, we start earlier when the woman is over 35 years old or when there is something in the history of the man or woman that may be a possible cause.

The most common cause of infertility in women is anovulatory disorders. Already from the history, which is the first step of the investigation, we get important information. Cycles of 28 to 32 days can rule out an ovulation disorder with great certainty. On the contrary, cycles longer than 40 days safely prove the opposite.

If the cycles are shorter than 26 days but regular or are between 25 and 35 days but vary by more than 4 days from cycle to cycle, ovulation disorder is likely. In case of uncertainty, checking the progesterone in the woman’s blood in the second half of the cycle solves the problem. In 75% of cases of anovulation, the cause is Polycystic Ovary Syndrome.

Anatomical disorders constitute a large group of causes of infertility. Polyps and adhesions of the endometrium are detected by hysteroscopy or by simple ultrasound after the injection of saline into the uterus. Fibroids that are in contact with the uterine cavity are mainly involved in miscarriages and inability to conceive. However, the most common category of anatomical abnormalities are adhesions and stenosis of the fallopian tubes. They are found with hysterosalpingography, a simple and painless examination. These lesions are caused by inflammation of the fallopian tubes.

Here we should emphasize the following: a type of germ called chlamydia can be found in a woman’s cervix, without causing symptoms. They can also silently cause inflammation in the fallopian tubes with the results we mentioned above. For this reason, we must be “generous” in testing for chlamydia in the cervix of young women, which is done by simply taking a fluid and culture.

The main endocrine disorders as causes of infertility are hyperprolactinemia and thyroid diseases. Both are easily detected with blood tests. Finally, a less common cause of infertility is cervical mucus disorders.