Causes that lead to infertility and to the necessity to do IVF in the future



is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 12 months of unprotected sex. According to the WHO data, infertility suffers from 60 up to 80 million people.

Both men and women can contribute to infertility. Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. The problem may be solved only in case if the couple supports each other. As often the treatment is needed for both partners. 

About 20-30% of the cases of infertility caused by male infertility, 20-30% – by female, and 25-40% are caused by the “combined” problems when two partners are involved. In 10-20 cases, the causes of infertility can not be recognized.

There are 2 types of infertility: Primary infertility refers to couples who have not become pregnant after at least 1 year of having sex without using birth control methods. Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable. Also, there is relative infertility (is not possible to figure out the cases) and absolute (non-treated changes of the reproductive system).

Causes of the female infertility

  • Ovulation problems. Ovulation issues may be caused by polycystic ovary syndrome or PCOS
  • Older age
  • Endometriosis
  • Unhealthy body weight.
  • Abnormal cervical mucus
  • Tubal issues
  • Uterine abnormalities.

Causes of the male infertility

  • Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm
  • Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
  • Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate, or urethra.
  • Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
  • Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
  • Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have several possible underlying causes.
  • Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma, or abnormal development, such as with cystic fibrosis or similar inherited conditions.
  • Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, and Kartagener’s syndrome.

During the sperm evaluation the following terms are used:

Normospermia – normal tests results

Oligospermia – a decrease of the concentration of the spermatozoids in the sperm

Azoospermia – there is no spermatozoids in the sperm

Teratospermia – the amount of the spermatozoids with the normal morphology less than 30%

Astenozoospermia – decreased mobility of the spermatozoids (less than 25%)

Different combinations of these conditions exist

The term ‘idiopathic infertility’ has different meanings in andrology and gynecology. In gynecology, the term ‘female idiopathic infertility’ refers to a condition in which clinical examination does not reveal any pathological finding which might explain the infertility of the couple. Here it would be more accurate to speak of ‘unexplained infertility’.

‘Male idiopathic infertility’ does not imply absolute infertility, unless azoospermia is found. Patients with idiopathic infertility might father children, but the likelihood of paternity is reduced and the time taken to achieve pregnancy is extended.

The term ‘idiopathic infertility’ designates diagnosis by exclusion. Only after all other possible causes of infertility have been eliminated can the diagnosis of idiopathic infertility be established. Seminal parameters are frequently abnormal and may be associated with elevated follicle-stimulating hormone (FSH), indicating spermatogenic failure. No other endocrine abnormalities are usually found. Testicular biopsies often show abnormalities in spermatogenesis or spermiogenesis, which range from complete or focal Sertoli cell-only (SCO) syndrome to spermatid arrest (Chapter 9.4.2). Descriptive histological findings fail to contribute either to the explanation of pathogenesis or to rational treatment.

The treatment tactics are divided into traditional and assisted reproductive technologies

If the traditional ones do not work then ART is used

There are many reproductive technologies

– Planed sexual intercourse

– Intrauterine insemination

In vitro fertilization

– Eggs donors

– Intracytoplasmic sperm injection


The method will be chosen by your reproductologist.

Also, I would like to add that nowadays couples do not willing to see the doctor and just postpone their doctor’s appointment and as a result may face the absence of the possibility to help to treat their problem, of infertility, as it becomes too late. 

Remember, the main enemy in this case – is the time!

In ADONIS there is a free consultation available, so do not miss your chance to be a happy family with a lovely child/children!

Edited by

MD., Obstetrician-Gynecologist, Fertility Specialist, Ultrasound Specialist Professional Skill: Screening and preparing couples to ART Ultrasound...

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