There are many factors that influence both male and female fertility. In approximately 40% of infertile couples, it is found that the infertility is caused by a combination of male and female factors.
The main causes of infertility in Africa are the result of genital infection, which may have been sexually transmitted, or caused by traditional practices, such as female genital mutilation or unsafe abortions and home deliveries in unhygienic circumstances. These infections, if left untreated often result in bilateral tubal occlusion.
Other causes of infertility include ovulatory dysfunction (approximately 20%), for example in poly cystoid ovary syndrome (PCOS), diabetes and or in severe obesity. In a significant number of cases no cause for infertility can be diagnosed.
The Process of Conception
In order to understand the fertility tests and treatments you may be offered, it is important to understand how conception naturally occurs. First, your ovary must release (ovulate) an egg. This usually occurs once a month, approximately mid-way through the menstrual cycle. The egg must be picked up by the fallopian tube. Sperm must travel through the vagina, into the uterus, and up into the fallopian tube in order to fertilize the egg. The fertilized egg, or embryo, then travels down the fallopian tube to the uterus, where it implants in the uterine lining and develops.
A problem in any part of this process can lead to infertility.
Causes of Infertility
Infertility can be caused by male factors, female factors, or a combination of the two.
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In approximately 10% of couples trying to conceive, all of the above tests are normal and there is no easily identifiable cause for infertility. In a much higher percentage of couples, only minor abnormalities are found that should not be severe enough to result in infertility.
In these cases, the infertility is referred to as “unexplained”. Couples with unexplained infertility may have problems with egg quality, fertilization, genetics, tubal function, or sperm function that are difficult to diagnose and/or treat.
Fertility drugs and IUI have been used in couples with unexplained infertility with reasonable success.