What are the causes of male infertility?

The most common causes of male infertility are disorders affecting the production of sperm, anatomical obstructions, immunological factors, and defective delivery of sperm into the female genital tract.

Sperm Production Disorders

Sperm production disorders are the most common cause of infertility in men, and tend to affect the quality and quantity of sperm produced. There are several factors that can affect sperm production, such as infectious diseases, endocrine disorders, varicocele (or varicose veins in the scrotum), immunological disorders, environmental factors (e.g. pollution, stress), radiation, and cancer treatments. In the majority of cases no obvious cause is found.

Anatomical Abnormalities

Anatomical abnormalities of the male genital tract can affect fertility since they may partially or completely block the expulsion of semen. The abnormality could have been present from birth, or it may arise later in life. Several factors can cause obstruction of the male genital tract, such as infection, inflammation, and/or previous surgery.

Immunological Factors

Men may suffer from immunological disorders. In some cases, men make antibodies to their own sperm. As a result, the sperm are often not motile and may even agglutinate (or stick together). Both of these factors would be detrimental to fertilization.

Defective Delivery of Sperm

The most common causes of this problem are impotence and premature ejaculation.

What are the causes of female infertility?

Several problems can contribute to female infertility; however, the most common causes of infertility in women are: ovulatory disorders, Fallopian tube damage, endometriosis, and cervical/uterine factors.

Ovulatory Disorders

These are usually the most common cause of infertility. Infrequent menstruation (oligomenorrhea) or the lack of menstruation (amenorrhea) can serve as an indication of ovulatory disorders. However, even women with regular periods may have an ovulatory disorder. Ovulatory disorders result in problems with the process of ovulation, or the release of the egg from the ovary at specific time intervals. In order for pregnancy to occur, a single sperm must fertilize the egg. Therefore, if ovulation does not occur (annovulation) or if it is irregular and/or infrequent, it can be impossible or extremely difficult to achieve pregnancy. Hormonal imbalances, Polycystic Ovarian Syndrome (PCOS), diminished ovarian reserve, and ovarian cysts can all contribute to ovulatory disorders.

Fallopian Tube Damage

In order for fertilization to occur, the sperm must travel through a Fallopian tube in order to reach the egg. Furthermore, a fertilized egg must be able to travel along the Fallopian tube to the uterus so that implantation can take place. Therefore, if the Fallopian tubes are partially or completely occluded (blocked), fertilization and pregnancy cannot occur. Fallopian tube occlusion can result from Pelvic Inflammatory Disease (PID), endometriosis, adhesions due to surgery, ectopic pregnancies, and sexually transmitted diseases (STDs).


Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, grows outside of the uterus and causes internal bleeding during menstruation that culminates in painful adhesions. These endometrial lesions can then block the Fallopian tubes, impede the movement of the tubes, and impair ovulatory function.

Cervical/Uterine Factors

Anatomical problems with the cervix, cervical infections, and unfavorable cervical mucus can possibly impede fertility. Problems with the uterus that can contribute to infertility include uterine polyps, uterine fibroids, and severe scarring of the uterine wall.

What is the incidence of infertility of infertility worldwide?

The World Health Organization (WHO) approximates that 8-10% of couples worldwide experience problems with fertility. Infertility problems are not specific to a certain race or sex. Infertility is exclusively a male problem in approximately 10-30% of cases worldwide, and it is exclusively a female problem in approximately 30-40% of cases worldwide. Infertility can also be a result of combined problems between the male and female couple. Combined causes of infertility are estimated to occur in 15-30% of couples worldwide. Finally, even after careful investigation and evaluation, in some cases (5-10%) the reasons for infertility remain unexplained. When the cause for infertility cannot be deduced this is referred to as unexplained infertility.

What is the definition of infertility?

Infertility is often defined as the "the inability of a couple to achieve conception ... after a year or more of regular, unprotected intercourse." This definition usually applies to couples where the woman is in her reproductive age (15-44 years).

What are the events that take place during normal pregnancy?

During sexual intercourse and after ejaculation, the sperm must travel through the cervix and uterus, and into the Fallopian tubes. If sexual intercourse occurs at the time of ovulation, the sperm will meet an ovum in the Fallopian tube and fertilize it, forming a single fertilized cell or “Zygote” or embryo.

The zygote will then begin to divide or undergo cleavage as it moves through the Fallopian tube to the uterus, transforming sequentially from a single cell to the 2-cell stage after 24 hours, the 4-cell stage after 36-48 hours, and the 8-cell stage 72 hours after fertilization. The cells of the embryo continue their division forming a mulberry ball of cells or “Morula” after 4 days. After 5-6 days the ball of cells develops a fluid-filled area in its center forming a "Blastocyst."

In order for embryonic development to continue, implantation needs to take place. The blastocyst must hatch from the zona pellucida, a protein matrix that surrounds the embryo, and attach to the endometrial lining of the uterus. If implantation occurs, then the mother will begin the gestation period.

The gestation period for humans is nine months (about 40 weeks), and this time interval is usually divided into three trimesters (each 3 months long). Successful completion of the nine-month gestation period will result in childbirth.

What does the male reproductive system include?

The male reproductive system includes the testes, epididymis, vas deferens, ejaculatory ducts, seminal vesicles, prostate, bulbourethal glands, urethra, and penis. In order for reproduction to occur, the male must contribute healthy and living sperm. Each individual sperm cell is composed of a head, mid-piece, and tail. Sperm move by whipping their tail around in an elliptical cone. Furthermore, a sperm cell will either carry an X or Y chromosome. The Y chromosome will result in the production of an embryo with a male genome upon fertilization, whereas an X chromosome will result in the production of a female genome upon fertilization. Thus, it is the male that contributes to the sex of the zygote. During ejaculation, the sperm move through the vas deferens and into the ejaculatory ducts, where they are mixed with fluids from the prostate, seminal vesicles, and bulbourethal glands to form semen. The semen will then pass through the urethra and out of the penis.

What does the female reproductive system include?

The female reproductive system includes the vagina, cervix, uterus, Fallopian tubes, and ovaries. The female contribution to reproduction is the egg or ovum. An ovum is larger in size than the sperm cell and always carries an X chromosome. In every ovulating woman of reproductive years, every month (until menopause) a mature ovum is released from a follicle located in one of the ovaries. The ovum then moves into the Fallopian tube. If a sperm within the Fallopian tube fertilizes it, pregnancy may occur.

Am I using all my eggs by doing IVF?

During a normal cycle, the ovary selects one egg from several eggs to complete maturation and ovulation. The other eggs disintegrate, or undergo a process known as atresia. Ovulation Induction simply allows the harvesting of the eggs that would have otherwise disintegrated and died. As a result, a woman is not using up all her eggs by partaking in IVF.

Can I travel after the completion of the Egg Transfer procedure?

Travel in both cars and pressurized aircrafts is completely acceptable. The patient is advised to stay hydrated throughout the flight. Patients can leave the day after the egg transfer procedure.

Are IVF procedures painful?

The only procedure that may prove painful or be considered a minor surgery is the egg retrieval process. However, the patient is usually given general anesthesia during this process, and afterwards medication can be given to alleviate pain caused by cramping.

Are IVF injections painful?

Most of the injections can be administered sub-cutaneously, and therefore they are not extremely painful. Also in some cases, nasal sprays are now available for medications that previously required injections. The only injection that may prove slightly painful is the HCG injection, which is given intramuscularly. Even progesterone is available as a gel or suppository.

What are some of the problems that can occur with IVF?
  • Ovulation Induction (OI): The main problem that can occur during OI is Ovarian Hyperstimulation Syndrome due to the administration of gonadotropins. OHSS is very rare, however it can be serious. The ovary tends to enlarge due to excessive follicular development. This can cause the patient to suffer from bloating, dehydration, and nausea. Fluid can collect around the abdominal organs, and in severe cases around the heart and lungs. This can cause blood clots and strokes. If the ovary becomes too large in size, it may rupture and cause abdominal bleeding. In serious cases of OHSS, removal of abdominal fluid is sometimes required.

  • Oocyte Retrieval: Problems during and after egg retrieval are rare, since the procedure is done under the guidance of an ultrasound probe. However, in very few cases internal bleeding, vaginal bleeding, and infection occur.

  • Insemination and Fertilization: Several problems can occur during this step in IVF. First of all, the sperm may not fertilize the eggs within the first 24 hours. The unfertilized eggs do not have an extremely long life span; therefore fertilization failure is a serious problem. Re-insemination will usually not help, since eggs cannot usually be fertilized after the first day. Another problem that can occur during fertilization is polyspermy, or when more than one sperm fertilizes the egg. These embryos have abnormal chromosomal numbers and cannot be used for transfer. If fertilization occurs normally, problems can arise during cleavage. The embryo may stop dividing, and cleavage arrest may take place. These embryos can still be transferred, since sometimes division begins again within the uterus. Fragmentation of the embryo may also result. If fragmentation is severe, the likelihood of pregnancy is reduced. However, if it is mild then transfer can still take place. There is no evidence of mild fragmentation showing an increase in the probability of children with abnormalities or birth defects.

What factors influence the success of infertility treatment?
  • Age of the Female: In women, fertility is age dependent. The older a woman becomes the more difficult it can become to attain pregnancy. The probability of ARTs being successful is about 30% for women under the age of 38 years of age. For woman above 38 years of age, this number decreases drastically to approximately 15%.

  • Cause of Infertility: Certain causes of infertility are easier to treat than others. Anovulation (lack of regular egg production) can be treated through hormonal therapy and often proves successful. However, severe Fallopian tube damage, endometriosis, uterine pathology (cysts, fibroids, polyps), and severe male infertility factor can be very difficult to treat. Also, research is still necessary for certain areas of infertility treatment. It can be difficult to ascertain the cause of problems with implantation, and it can also be difficult to evaluate the genetic potential of embryos to produce babies.

  • Duration of Infertility: The longer the duration of infertility, the lower the chance of attaining pregnancy. Therefore, even with infertility treatments couples suffering long term infertility problems may find it difficult to ever become pregnant. Every couple should ensure that they receive the most appropriate treatment in a timely manner. Hayat promises to provide each couple with the most advanced treatment available and with the emotional support needed.

What are possible side-effects/complications of the stimulation phase of my treatment?

Sometimes a patient suffers from pelvic discomfort, which occurs due to the increase in ovarian size as multiple follicles begin to enlarge. If the pain is severe, a patient may be given analgesics. A patient may also suffer from abdominal distention (swelling). This occurs when patients have a dramatic response to ovarian induction. Too many follicles develop, and the patient can become extremely uncomfortable. Patients with polycystic ovaries are often at risk of excessively responding to drugs administered during ovulation induction, and the problem can eventually progress to a condition known as Ovarian Hyperstimulation Syndrome (OHSS). If ovarian hyperstimulation occurs, a patient is advised not to panic since the additional stress may negatively affect treatment. The condition is manageable, and doctors will provide the patient with the care they require.

What treatment will I need after egg collection?

After egg collection antibiotic tablets (Gentamycin or Penicillin) are usually administered for four days to prevent infection of the genital tract. During the egg collection itself, antibiotics are given through an intravenous line. Flagyl is also inserted after the egg collection to provide additional antibiotic cover. Aspirin is used to help improve blood flow to the uterus and facilitate implantation. Finally, progesterone (possibly in the form of Cyclogest) is often given to patients to help prepare the endometrial lining for implantation. This drug is often commenced on the day the egg collection takes place and is given until the pregnancy test. If the test proves to be positive, then the drug continues to be administered for twelve more weeks.

What happens to the extra embryos that are not transferred?

Embryos of good quality can be preserved for future use. Cryopreservation is an additional service, and will be charged as a separate fee.

How many embryos are transferred?

During ARTs, a successful outcome is not necessarily guaranteed. Therefore, multiple embryos are often transferred to increase the chances of implantation. The success rate for ART procedures is approximately 40-50%. Usually three embryos are transferred, however, two may be transferred if the couple has favorable factors or if triplet pregnancy is unsafe. The factors that contribute to the decision-making process are the age of the patient, the number of previous pregnancies and live births, the cause of infertility and its duration, previous failed treatments, and the quality of the embryos preserved. Often the number that will be transferred is discussed during the treatment phase, and is confirmed on the day of the transfer itself.

What should I do after the embryos are transferred?

After the embryos are transferred, we recommend that the woman relax for the remainder of the day and for the next couple of days. This is no way implies that the procedure requires strict bed rest after its completion. Strenuous activity is not advised, even though there are no scientific studies that show that excessive activity negatively effects implantation or pregnancy. A pregnancy test is usually carried out about 10-14 days after the embryos are transferred. If the test is positive, an ultrasound is used to confirm pregnancy approximately 2-3 weeks later.

What are the complications of early pregnancy?

Patients may suffer from lower abdominal pain and swelling, which is often an indication of Ovarian Hyperstimulation Syndrome (OHSS). If discomfort and pain are severe, a patient should contact their physician. OHSS requires careful monitoring and management. The woman may also find herself suffering from vaginal bleeding. The bleeding may be continuous, like that experienced during menses, or spotting may occur. In either case, the patient should seek medical care since this can indicate that implantation failed.

What could go wrong with my pregnancy?
  • Biochemical pregnancy: This is a situation when the blood pregnancy test is positive, however, no sac is visible on the ultrasound. Another ultrasound is usually repeated approximately 1-2 weeks after the first scan. If the result is negative, the patient is told to stop all medication.

  • Ectopic Pregnancy: This condition refers to any pregnancy where the embryo implants outside of the uterus. Ectopic pregnancies are extremely dangerous. A rising level of beta-HCG hormone in the blood without the presence of a gestation sac is often an indication of this problem. Pelvic pain and vaginal bleeding can also be accompanying symptoms. If an ectopic pregnancy is suspected, then laparoscopy will be conducted to confirm the condition. A patient suffering from an ectopic pregnancy will then be hospitalized. The incidence of occurrence of ectopic pregnancies during ART is extremely low (3%).

  • Abortion: In both natural and artificially induced pregnancies, abortion is a possibility. Normally, abortion occurs in approximately 20% of natural pregnancies. Investigations will be carried out in order to deduce the possible cause of repeated miscarriages. Information attained may help shed light on the reasons for infertility.

What are the chances of multiple pregnancies?

A well-known problem of infertility treatment is the increased probability of multiple births. Most assistive reproductive centers have singleton birth rates of 60-65%, twin birth rates of 30-35%, and triplet or more birth rates of 5%. During assisted conceptive treatments, multiple eggs are often transferred. This is done in order to increase the possibility of implantation and pregnancy. However, it may also have the negative side effect of resulting in multiple births. It is very difficult to find a balance between success and failure with these expensive, lengthy, and often emotionally draining procedures. Therefore, in order to possibly realize a dream, undesired consequences must sometimes be accepted.
Measures, such as blastocyst transfer, are being taken to try to reduce the possibility of multiple births. If a patient becomes pregnant with triplets or more, a doctor can perform an embryo reduction procedure.

Are there any long-term complications of fertility treatment?

There is no scientific evidence indicating that fertility drugs increase the probability of ovarian cancer. However, it is still advised that these drugs only be administered by a specialist in the field.
There is also no evidence proving that ovulation induction can cause early menopause.

Will my baby be normal following assisted reproductive treatment?

Presently, the incidence of birth defects or abnormalities in children conceived through the use of assisted reproductive treatments is similar to that of children conceived naturally.

How long will treatment take?

Treatment usually requires approximately 4-6 weeks. A majority of assisted reproductive treatments (ARTs), such as IVF, GIFT, and ICSI, begin with ovarian induction or stimulation. Ovarian induction is a fairly time-consuming process. The goal is to obtain enough oocytes to use during assisted reproductive treatments.