The causes of infertility are many, there are secondary infertility and primary infertility, but before talking about the causes, it is necessary to properly understand the meaning of infertility, which refers to the inability of a man or woman to conceive despite the existence of a continuous intimate relationship for a year of marriage without using contraceptives, if the woman’s age is less than 35 years. However, if the wife’s age is more than that, it is preferable to search for the causes after six months of marriage, and we will tell you more about all the information about the causes for men and women and the different treatment mechanisms.

Causes of infertility in men

The causes of infertility in men are different, including: Following: 

• Azoospermia:

This problem is one of the causes of infertility in men, and it means the absence of sperm in the fluid and occurs as a result of a blockage of the ejaculatory duct or an imbalance in hormone levels. 

• Low sperm count:

This means that the sperm count is less than 10 million sperm per milliliter. 

• Sperm abnormalities:

It is a widespread and common condition in which the number of sperm in the fluid is very high, but the sperm are deformed and underdeveloped, which makes them unable to swim and reach the egg. 

• الإصابة ببعض الأمراض الوراثية:

When researching and talking about the causes of infertility, hereditary diseases must be mentioned, including Klinefelter syndrome, which means the presence of an extra 

• Hormonal disorders:

  Especially produced by the pituitary gland. 

• Suffering from varicocele:

It is among the common conditions, but it is easy to treat, either through surgical procedures or taking medications, depending on the case.

• Exposure to chemotherapy or radiation:

Especially on the pelvic and abdominal areas. 

• Impotence:

Any problem related to the inability to have an erection, the inability to complete the sexual intercourse process properly, and complete ejaculation or even retrograde ejaculation are among the causes of infertility in men. 

• Some unhealthy habits:

Such as drug and alcohol abuse, smoking, weight gain, or exposure to heavy metals, and taking some medications such as antiepileptics and depression have an impact on delayed pregnancy. 

The most difficult cases of infertility in men

After learning in detail about the causes of infertility in men, between primary and secondary causes, we will tell you about the most difficult cases of infertility for men and who Among them: 

• Azoospermia:

The lack of sperm in the fluid is one of the causes of infertility in men that is difficult to treat if there is testicular atrophy, or if a testicular scan is performed and sperm production is not observed among the reasons. 

• Obstructive azoospermia:

It is one of the difficult problems, but it is less than the non-obstructive absence of sperm, and it is one of the most difficult causes of infertility in men. Here the testicle produces sperm, but it is difficult for it to come out during ejaculation as a result of a blockage in the spermatic cord. Here, treatment is done by withdrawing sperm from the testicle. 

How does a man know that he is free from infertility?

Initial signs that may reassure a man

There are signs that a man notices without an analysis that may indicate that he is healthy and does not have infertility, but they are not confirmed, including:

• Having a normal and regular marital relationship.
• Regular ejaculation in normal quantity.
• There is no pain or swelling in the testicles.
• Absence of chronic health problems.
• The absence of a medical history that affects reproduction.

• Semen analysis

To fully ensure that a man is free of the causes of infertility, it is recommended to perform a semen analysis, which is the basic examination to evaluate fertility in men and rule out infertility in men, preferably after 2-5 days of abstinence from ejaculation, in which a group of important indicators are examined, including:

• Sperm count 

If the number is in the normal range of 15 million/ml or more, this is a good sign of fertility.

• Sperm movement 

This analysis indicates the sperm's ability to swim toward the egg.

• Natural shape

The number of sperm with a normal shape (head, neck, and tail) is measured, and its percentage is calculated for deformed sperm. The normal percentage is more than 4% according to the “Kruger” criterion. The shape of the sperm affects its ability to penetrate the egg and is one of the causes of infertility in men.

• Size, viscosity and acidity

These factors affect the appropriate environment for sperm movement and survival. The volume of semen ranges from 1.5 to 6 ml, and its acidity should tend to be slightly alkaline, between 7.2 and 8.

Additional checks

There are additional tests and examinations that the doctor may request when needed, which are:

• Analysis of sex hormones (such as testosterone, FSH, LH, and prolactin).
• Ultrasound imaging of the testicles.
• Varicocele examination if symptoms are present.
• Genetic analysis if azoospermia is found.

You can get to know What are the strongest reasons for treating infertility? 

What are the risk factors that increase the possibility of infertility in men?

The factors that cause infertility or increase the possibility of its occurrence are multiple, and include the man’s health condition, factors related to lifestyle, the surrounding environment, and the medications that the man takes, including:

• Varicocele

Varicocele in the testicles affects the quality of semen, sperm movement and number, due to high temperature around the testicles, and is considered one of the most common causes of infertility.

• Exposure to excessive heat

Exposing the testicles to heat while using sauna baths, placing the computer on the thighs for a long period, or exposure to heat from any other source for a long period affects the testicles’ sperm production.

• Smoking 

Smoking reduces the number, quality, and motility of sperm, and causes deformities in them. Smoking and other narcotic substances also negatively affect hormones and fertility, and also lead to erectile dysfunction.

• Some medications

You must read the medication leaflet before taking it and ask the doctor about its effect on fertility, because some medications affect sperm and are considered a cause of infertility in men. Examples include: chemotherapy drugs for cancer, antidepressants, some high blood pressure medications, and sports steroids for bodybuilding.

• Sexual infections and infections

Some diseases, such as chlamydia, gonorrhea, and mumps, if they affect the testicles, cause blockage of the sperm ducts or damage to the testicular tissue.

• Obesity or extreme thinness

Obesity or excessive thinness affects the balance of sex hormones, such as decreased testosterone and increased estrogen, which impairs sperm production.

• Exposure to chemical contamination or radiation

Occupational exposure to radiation or industrial solvents such as pesticides and heavy metals (lead, mercury) negatively affects the testicles and their productivity, and may cause genetic changes.

• Genetic factors

The presence of a defect in chromosomes or genes related to sperm production, such as Klinefelter syndrome (XXY), leads to a disorder in the development of the testicles and a lack of sperm production, and sometimes the problem is genetic in the seminiferous tubules.

• Chronic diseases

Some chronic diseases, such as diabetes, kidney failure, and pituitary or thyroid disorders, may cause nerve damage, affecting erection and ejaculation. Some of them also affect hormonal balance and sexual ability.

• Ejaculation problems

Such as reverse ejaculation, where semen is ejaculated in the opposite direction and goes into the bladder instead of outside, or weak ejaculation in men, which is one of the causes of infertility. It often occurs due to certain medications, nerve problems, or after prostate surgery. It reduces the chances of pregnancy despite the presence of sperm.

• Injuries to the pelvis or testicles

A forceful blow or twisting of the testicle may damage the tissue responsible for sperm production. Some surgeries, such as inguinal hernias or prostate operations, may also affect the sperm ducts.

How can infertility be avoided?

Infertility can be avoided in many ways, except in hereditary or congenital cases, by following a healthy lifestyle and avoiding risk factors. The most prominent of these methods are:

• Maintain a healthy weight:

By following a balanced diet and exercising regularly.

• Quit smoking, alcohol and drugs:

Stopping them improves the reproductive capacity of the body and reduces the risk of fetal malformations.

• Chronic disease monitoring:

Such as diabetes, thyroid disorders, and high blood pressure, and early treatment of them to prevent hormonal disorders.

• Avoid exposure to excessive heat:

Especially for men, keeping the testicles cool is essential for producing healthy sperm.

• Preventing sexual infections:And treat it as soon as possible.

• Treating any reproductive system problems early:

Such as endometriosis, polycystic ovary syndrome, and menstrual irregularity in women. The earlier treatment begins, the greater the chances of preserving reproductive ability.

• Avoid harmful chemicals:

Like pesticides and paint, protective equipment should be worn in workplaces exposed to these materials.

• Refrain from using stimulants or unprescribed medications: Such as bodybuilding drugs.

• Conduct periodic fertility tests when needed:

Especially when there is a family history, or delayed childbearing after marriage for more than a year.

• Freezing eggs or sperm:

And that In the event of delayed marriage, or the start of chemotherapy or radiation treatment.

 What test is performed to evaluate male fertility?

Semen analysis is the most common laboratory test to evaluate a man's ability to reproduce. The analysis measures:

•  Sperm count:

The number must not be less than 15 million/ml.

• Sperm movement:

Naturally, calculating the percentage of sperm that move forward at a good speed should not be less than 40%.

• Shape:

The normality of sperm shape and the percentage of deformity are measured according to the Kruger criterion.

• Semen volume:

Which indicates a blockage or problem in the accessory sex glands.

• درجة الحموضة (PH):

Normally, it is between 7.2 and 8. Deviation from this indicates an infection or problem in the prostate.

• The presence of pus cells or blood:

It is considered an indication of inflammation or infection in the reproductive system.

Infections that affect fertility in men?

There are many infections that affect male fertility, and they may affect the reproductive system directly or indirectly. Some of them cause blockage of the ducts that transport sperm, or lead to damage to testicular tissue, or poor sperm production. The most important of these infections are:

• Orchitis

It is often caused by a viral infection, such as mumps. It may lead to damage to testicular tissue, poor sperm production, and may lead to infertility if the infection affects the testicles.

• Epididymitis

The epididymis is the tube that transports and stores sperm. Inflammation occurs due to bacterial infections such as chlamydia and gonorrhea, which are sexually transmitted diseases. It causes severe pain and may lead to damage to the epididymis.

• Prostatitis

It causes pain during ejaculation or urination, and affects the quality of semen. Chronic inflammation may cause a decrease in sperm motility or change the viscosity of semen.

• Sexually transmitted diseases

Such as chlamydia, gonorrhea, syphilis, and genital herpes, may cause blockage of the ducts, or chronic infections that affect the number and shape of sperm.

• Recurrent urinary tract infections

Due to recurring bacterial infections in the urinary system, the infection may extend to the testicles, causing scars and changes in the sperm transport pathway and negatively affecting them.

Causes of infertility in women

There are many causes of infertility in women and vary according to age, health condition, and lifestyle. Here are the most important reasons:

• Ovulation disorders

It is one of the most common causes of infertility in women, and includes problems such as polycystic ovary syndrome or premature ovarian insufficiency. These disorders affect the maturation of the egg, and the egg does not come out regularly, or prevents ovulation completely.

• Blockage of the fallopian tubes

The two ducts transport eggs from the ovary to the uterus. If a blockage occurs, the sperm will not reach the egg and fertilization and pregnancy will not occur. The cause of this blockage may be the presence of infections, previous surgeries, or an ectopic pregnancy.

• Endometriosis

The uterine lining grows in an abnormal place in this disease, such as the ovaries or fallopian tubes.

• Uterine problems

Deformities or tumors in the uterus may prevent the attachment of the fetus or cause recurrent miscarriages. These deformities and tumors include the uterine septum, fibroids, or intrauterine adhesions.

• Poor egg quality and stock out

The quality of eggs naturally decreases with age, especially after the age of forty. Some women also have premature ovarian insufficiency, causing them to lose fertility and menopause before the age of forty. Its causes are genetic or immunological. It is measured by analyzing the anti-Müllerian hormone (AMH) or the number of follicles with ultrasound.

• Hormonal imbalances

An imbalance in the pituitary or thyroid hormones, or an increase in prolactin (the lactation hormone), affects the regularity of the cycle and ovulation and hinders pregnancy.

• Excessive weight or extreme thinness

Extreme thinness leads to interruption of the menstrual cycle and lack of ovulation due to a lack of fat necessary for the production of hormones. Obesity also affects the hormonal balance and increases insulin resistance, which disrupts ovulation.

• Problems with the cervix or uterine mucus

Some operations or infections change the shape and function of the cervix, preventing the passage of sperm into the uterus.

• Immunological or chronic diseases 

Diseases such as (diabetes, lupus, liver or kidney problems) affect the balance of hormones and reproductive ability, some of which cause repeated miscarriages due to the influence of immunity or blood vessels.

• Advanced age

The number and quality of eggs decrease over time, the chance of chromosomal disorders in the fetus increases, and miscarriage rates rise.

• Smoking and drinking alcohol 

It reduces the quality of eggs, increases menstrual disorders, and may accelerate premature ovarian failure.

You can read How can infertility be treated?

Infertility treatment

After we devoted a large space in which we learned about the causes of infertility in men and women and explained the primary and secondary causes that must be talked about treatment, we at Al-Mousa Hospital have the latest devices and modern techniques used to find the exact cause and reveal the reason behind delayed pregnancy, and then develop a treatment plan that suits each case and this is done by doctors with experience in such a matter. Among the treatment methods are: Following: 

• Take medication to stimulate the production of eggs and help them emerge from their follicles if the problem is in the quality of the eggs.
• Prescribing medications that help strengthen the uterine wall and stimulate the ovaries. 
• If a woman suffers from adhesions in the uterus or fallopian tube or has tumors in the uterus, surgical intervention is necessary to solve these problems. 
• Prescribing medications to the man that stimulate the testicles to produce sperm, in addition to vitamins and minerals that improve their quality.
• Surgical intervention to treat some problems such as obstruction of the spermatic cord, removal of varicose veins, or removal of the testicle if it is undescended.
• If the previous treatment methods do not produce the desired results for pregnancy, the doctor resorts to assisted fertilization methods such as artificial insemination and ICSI. 
• In the end, you must know that treatment depends on a good diagnosis, identifying the cause, and taking into account many factors, most notably the wife’s age and the percentage of ovarian reserve.

Book your consultation now at Fertility center At Al Mousa Specialist Hospital 

How common is infertility among couples?

The percentage of couples around the world who suffer from infertility is estimated at about 15%, meaning that approximately one out of every six couples faces difficulty conceiving after a year of regular marital relations without using contraceptives. The cause is solely caused by the wife in about 35% of cases, and in another 35% the husband is solely responsible for infertility, while the cause is shared between both parties in 20% of cases. There is also a percentage of infertility cases whose causes of infertility are unknown.

Frequently asked questions

What are the causes that lead to infertility?

There are many reasons that lead to infertility, such as the presence of blockage in the testicle or low sperm count, undescended testicle, testicular atrophy, exposure to chemotherapy and radiation, in addition to the presence of some secondary causes such as azoospermia and partial blockage of the spermatic cord.”

How do you know that you are free from infertility? 

You can find out that you are capable of having children by going to the doctor and undergoing a reproductive health test, semen analysis, and hormone levels, in addition to a physical and clinical examination.

How do you know that you are unable to have children?

The main symptom that indicates infertility is delayed pregnancy despite continuous intercourse, but diagnosis and medical examinations are the only means by which the diagnosis is made, so you must go to the doctor, and we at Al-Mousa Hospital have a cadre of doctors who are experienced in treating infertility cases.

How does a man know that he cannot have children?

A man cannot know for certain that he is unable to conceive unless he performs a semen analysis. Even if pregnancy is delayed, erectile dysfunction, ejaculation, lack of semen, or pain or swelling in the testicles, it is not possible to confirm that he is infertile unless he performs the analysis and goes to consult a male doctor.

Thus, we have learned in detail through this previously presented article Al-Mousa Hospital About the causes of infertility in men and women in detail, in addition to talking about how to treat it, whether medically, surgically, or by resorting to assisted fertilization methods, and these techniques are provided by the hospital, which is keen to follow up on everything new in the treatment of infertility, and there is hope for treating all cases.

Sources and references 

National Health Service – nhs

Fertility and Sterility Journal – fertstert