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Infertility: Symptom, Causes And Treatment In Males And Females


Infertility is simply defined as failure towards achieving pregnancy. Female infertility, this has unfortunately become a point of concentration in Africa as many researchers are still coming up with valid causes. In this post we shall briefly be considering some of the symptoms, causes and treatment of infertility.

Symptoms of infertility in females

1. Irregular periods

The average woman’s cycle is 28 days long. But anything within a few days of that can be considered normal, as long as those cycles are consistent. For example, a woman who has a 33-day cycle one month, a 31-day cycle the next, and a 35-day cycle after that, is probably having “normal” periods.

But a woman whose cycles vary so greatly that she can’t even begin to estimate when her period might arrive is experiencing irregular periods. This can be related to hormone issues, or to polycystic ovarian syndrome (PCOS). Both of these can contribute to infertility.

2. Painful or heavy periods

Most women experience cramps with their periods. But painful periods that interfere with your daily life may be a symptom of endometriosis.

3. No periods

It’s not uncommon for women to have an off month here and there. Factors like stress or heavy workouts can cause your period to temporarily disappear. But if you haven’t had a period in months, it’s time to get your fertility checked.

4. Symptoms of hormone fluctuations

Signs of hormone fluctuations in women could indicate potential issues with fertility. Talk to your doctor if you experience the following:

  • skin issues
  • reduced sex drive
  • facial hair growth
  • thinning hair
  • weight gain

5. Pain during sex

Some women have experienced painful sex their entire lives, so they’ve convinced themselves it’s normal. But it’s not. It could be related to hormone issues, to

endometriosis, or to other underlying conditions that could also be contributing to infertility.

Symptoms of infertility in males

1 – Pain or Swelling in the Testicles

There could be many different explanations for swelling and pain in the testicular region. The pain may be in one spot or in a more generalized region. No matter the case, it is important that those experiencing these symptoms seek medical attention. Some of the following conditions are considered a medical emergency and it is better to be sure that you are in the clear rather than to assume. Common causes of testicular swelling include: Testicular torsion. This is a condition where the testicle has twisted inside of the scrotum. When this happens it causes an interruption of blood flow to the testicle. Without bloody supply the testicle can experience failure in the tissue. Epididymitis (testicle infection). In most cases, men develop epididymitis from a bacterial infection. This can occur at any age but it is most common between ages 20 and 39. The infection may lead to fever, penile discharge, and blood in the urine. A firm tube, called the epididymis, lies on the back surface of each testicle and can become inflamed which may also be the cause of the swelling in the testicle. Hydrocele. This is a build up of fluid around the testicle that is commonly caused by inflammation or injury to the scrotum. It is usually not harmful or painful and should not get in the way of a male’s ability to conceive. This could be a reason for the swelling, but medical attention is still recommended to rule out other possibilities. Hernia. A hernia can be the cause of swelling and pain in the testicular region and may require surgery in order to fix the damaged area. It is uncommon for an inguinal hernia to cause infertility, but there are certain rare instances where it could play a role. If the hernia is left untreated for too long it could damage a man’s vas deferens (the tube that sperm travels through). Varicocele. Varicoceles are veins that have become enlarged in the scrotum. They are known for affecting 40 out of 100 men with known infertility. Surgery can be done to repair the veins and improve the male’s fertility factor.

2 – Altered Sexual Desire

When a man experiences extreme changes in virility, this could indicate issues in his hormonal health which is linked to certain causes of infertility in men. Common causes of hormonal problems include: Pituitary tumors. These tumors are benign because they do not spread to other parts of the body. Still, reproductive issues can and do stem from them as most present symptoms of androgen deficiency and even infertility. Congenital lack of LH/FSH. Also referred to as male hypogonadism, it is responsible for 1-2% of male infertility. It may be congenital or acquired from aging, disease, drugs, or other factors. Diagnosis of its existence is confirmed by the analysis of hormone levels. Anabolic steroid abuse. The abuse of steroids can cause a male’s infertility to decline during use and possibly have lasting effects if the abuse goes on for long enough. However, fertility can normally be restored with abstinence from androgens and gonadotropin injections. It is important to note that there are many drugs that can alter a male’s hormonal health and steroids should be used with caution/only through prescription from a medical professional.

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3 – Erectile Dysfunction

Studies have shown that the presence of sexual dysfunction exists in about 20-25% of couples struggling with infertility. These issues are also commonly linked to hormonal imbalances like those listed above. In addition, common causes of erectile dysfunction are: Venous leak. When the veins that normally compress during an erection do not compress fully it can cause the erection to go away or not last long. This is usually the result of injury or disease. Neurovascular function. An erection cannot occur if the nerves don’t signal the blood vessels to push blood into the penis. These issues are commonly the result of medications or conditions like diabetes, arteriosclerosis (the hardening of the arteries), and a spinal cord injuryPsychological factors. 10-15% of erectile dysfunction is due to feelings of guilt associated with sex, depression, anxiety, and stress. Erectile dysfunction could stem from easily fixed or more serious internal complications. It is possible to approach this issue by considering:

  • Switching medications
  • Adjusting to a healthier diet and exercising more
  • Quitting smoking
  • Not using recreational drugs
  • Considering counseling
  • Speaking to a doctor about other possible causes if you are in good mental and physical health

4 – Issues With Ejaculation and Sperm Health

If a man is experiencing difficulty ejaculating it could indicate an issue involving sperm production or other physical dysfunctions. Without the ability to produce healthy sperm:

  • the sperm may not be carried into the semen and continue on to be ejaculated from the penis
  • there may not be enough sperm within the semen
  • the sperm may not be functional enough to travel well and penetrate the woman’s egg

Sperm production problems include:

  • Chromosomal or genetic causes. Right from birth, the chromosomes may not be coded correctly. For instance, the male may be born with the wrong combination or amount of chromosomes. Any number of genetic problems can have an affect on fertility and would need to be treated.
  • Undescended testes. When the testes fail to descend at birth it can cause infertility and also eventually result in torsion, hernia, and testicular cancer. Boy’s testes usually descend by the time he reaches 9 months but 1 in 20 unfortunately do not descend at all.
  • Torsion. As mentioned above, torsion is when the testes become twisted inside of the scrotum. This must be treated with surgical intervention or it can lead to permanent infertility.
  • Varicocele. Also mentioned above, this is when the veins flowing from the abdomen into the scrotum are enlarged. This is one of the most common causes of infertility in men, affecting the production and quality of sperm in 40% of males. However, this is also the most commonly reversible infertility problem in males.
  • Medicines and chemicals. Certain drugs are known to cause male infertility. These drugs usually include calcium channel blockers, cimetidine, nitrofurantoin, and chemotherapy agents. Certain antibiotics, such as nitrofurantoin, can lower the sperm count by disrupting the production process. Make sure to ask your doctor about effects on fertility whenever a medication is prescribed.
  • Radiation damage. Exposure to radiation can reduce sperm production but it will often return to normal. High doses of radiation, however, can cause be permanent damage.

Blockage of sperm transport can be the cause of:

  • infection
  • prostate-related problems
  • absence of vas deferens
  • vasectomy
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Furthermore, ejaculation issues could be the result of:

  • Retrograde. This is when the semen goes directly into the bladder instead of exiting out of the penis. It does not present any physical harm to the man, but it can make it difficult to conceive.
  • Delayed ejaculation. About 3% of men struggle with delayed ejaculation. Also some men are not able to reach orgasm at all during intercourse. This is often to due anxiety, depression, or medications prescribed for such issues.
  • Erectile dysfunction. As discussed above, erectile dysfunction can be the cause of greater or lesser serious health conditions.
  • Spinal cord injury. Depending on the extent of the injury, it can be known to lead to causing retrograde ejaculation or difficulties maintaining an erection.
  • Prostate surgery. Natural fertility is generally unlikely after one undergoes prostate surgery, though assisted methods are known to be recommended and quite successful.
  • Nerve damage. As mentioned earlier, nerve dysfunction can get in the way of normal reproductive function as the nerves are not able to signal the body to respond in it’s usual manner.

5 – Small, Firm Testicles

The health and quality of the males sperm depends greatly on the condition of the testicles. The size is not necessarily the issues, but rather what is occurring within the testicles that could be causing them to become constricted and firm. A fertility specialist will be able to properly assess the health of the testicles and whether or not they are able to function correctly and successfully during sexual reproduction.

Male Infertility Testing

In order to check for the presence of possible infertility in a man, specialists will most commonly begin with semen analysis. In order to do so they will:

  • Collect the sperm into a specimen jar and and bring it to a lab where it will be examined under a microscope to evaluate the shape, appearance, and mobility of the sperm.
  • The technician will also be checking the sperm count and concentration to see if it is above or below 20 million sperm cells per milliliter of ejaculation fluid.
  • If the sperm count is found to be low, the fertility specialist will then probably want to test the testosterone, FSH, LH and prolactin levels for clues as to why this is the case.
  • Urinalysis can be used to check the white blood cells for any existing infection. Urine can also be screened for any presence of sperm in the urine which could be an indicator of retrograde ejaculation.
  • If the male’s physical exam and sperm analysis, along with medical history, are found to be normal, the specialist will usually shift their focus to the female partner.

In some cases, results may require further laboratory testing or semen analysis, such as:

  • Sperm agglutination: checking to see if the sperm are clumping together by use of a microscope.
  • Sperm penetration testing: a lab test that analyzes the sperm’s ability to penetrate the egg – this test is rarely used as it requires the use of animal eggs for testing.
  • Hemizona assay: a lab test using a non usable human egg to test penetration.
  • Acrosome reaction: a lab test analyzing whether or not the sperm heads are able to go through chemical changes necessary to dissolve the outer shell of the egg
  • Testicular biopsy: when a small piece of tissue is removed from the tubules in the tests to check for sperm health and production.
  • Vasography: an x-ray exam that determines if there is blockage or leakage of sperm in the vas deferens.
  • Ultrasonography: an exam used to check for any damage of blockages in the reproductive tract.


Disturbance of oocyte maturation
The hormonal balance is an important factor for the ability to conceive. Hormonal dysfunctions may lead to disturbance of oocyte maturation, anovulation and luteal phase defect. Frequently, the causes for infertility can be found in elevated levels of male hormones (androgens) in conjunction with ovarian cysts. Other factors that may interfere with the hormonal balance are being underweight or overweight, rapid weight gain or weight loss, extreme physical load, disorders of thyroid function, tumours (rarely), medication and stress.

Tubal factor infertility

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In one third of the affected women, the tubes are the cause for infertility. The fallopian tubes may be partially or completely blocked. Most commonly, the tubes are damaged as a result of infection. Other causes can be previous ectopic pregnancies, adhesions after surgery, or spontaneous proliferation of the endometrium (endometriosis).


Endometriosis is the growth of the endometrium outside the uterus. It is yet unknown why this occurs. Probably during menstruation, small amounts of endometrial tissue enters the abdominal tissue through the fallopian tubes, where it attaches to organs and may lead to adhesions. This results in severe pain during period.

Abnormalities of ovaries, fallopian tubes, or the uterus
These occur very rarely (app. 5 in 100 women). The abnormalities can be developed to a greater or lesser extent and are usually inherited.

Antibodies against oocytes or sperm
Infrequently, the body cannot identify its own oocytes. The immune system produces antibodies against them. The production of antibodies against the man’s sperm in the cervical mucus occurs more frequently. Therefore, no sperm cells can find their way into the fallopian tubes. Thus, fertilization is not possible.


Disturbances of sperm maturation

The most frequent disorder of male fertility is the impaired production of normal and motile sperm in the seminiferous tubules. Normal quality of the male sperm means that the number of the sperm cell is above 20 million per ml.
30 percent of these should be normal-formed sperm and at least 50 percent should show good motility. If these levels are not met, the man’s ability to father a child is restricted. However, a functional disorder may also prevent the sperm entry into the oocyte, even if the results of the semen analysis are normal.
Impaired sperm maturation may be the consequence of a mumps infection during childhood. Varicose veins in the testicles (varicoceles) or tobacco use may also result in low sperm quality. Other factors are endocrine disorders, stress, environmental pollution, undescended testicles, surgery for cancer, or congenital causes, such as DNA damage (chromosome abnormality). Temporary impairment of sperm quality may also be due to acute infections.

Sperm transport disorders
In four percent of the cases a sufficient amount of sperm cells is produced but due to an obstruction of the vas deferens, they do not enter the woman’s body during ejaculation. This situation is similar to an obstruction of the fallopian tubes in the woman. Causes may be a previous vasectomy or underdevelopment or blockage of the epididymis. A blockage of the epididymis may be the result of an inflammation.

Causes involving both partners
In 15 to 30 percent of the affected couples the causes for infertility can be found in both partners. In 5 to 10 percent no organic cause can be found neither in the man nor in the woman. In this situation stress may be the cause

Treatment of infertility


if the cause is a varicoele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.



to treat infections in the reproductive organs.


Medications and counseling

 to treat problems with erections or ejaculation.


Hormone treatments

if the problem is a low or high level of certain hormones.

Fertility drugs and hormones

to help the woman ovulate or restore levels of hormone


to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes

Infertility in men and woman can also be treated with assisted reproductive technology, or ART. There are several types of ART:

IUI (intrauterine insemination):

Sperm is collected and placed directly inside the women’s uterus while they are ovulating.

IVF (in vitro fertilization):

The sperm and egg are collected and brought together in a lab. The fertilized egg grows for 3 to 5 days days. Then the embryo is placed in the woman’s uterus.


(gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer): The sperm and egg are collected and quickly placed in a fallopian tube. With GIFT, the both sperm and eggs are placed into the fallopian tube. With ZIFT, the sperm and eggs are brought together in a lab and then a fertilized egg is placed into the tube at 24 hours.


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