English: infertility, aridity
In researching causes of infertility, both partners must always be considered. Priority should be given to exploring andrological causes so as not to expose the woman to unnecessary invasive measures. The impossibility of pregnancy can be attributed to 50% of the female sex, while andrological causes account for 30%.
Andrologic causes of infertility
Already the physical examination of the infertility by consideration of the secondary sex characteristics (eg extent of the hair growth) and the Palpation of the testicle allow first conclusions on possible wrong developments. An objective, laboratory examination of male fertility is done by creating a spermiogram.
This allows for significant information on the quality of the ejaculate and the sperm in it. Here the ejacut volume (norm: more than 2ml), their pH (norm: 7, 2-7, 8) and the sperm concentration (norm: more than 20 million / ml) are raised.
The total sperm count must be more than 40 million per ejaculate. These rough parameters are not enough to classify the man as fertile. The nature of the sperm provides further indications of the quality of the sperm. The motility (mobility) and the morphology (shape) of the sperm plays an essential role. More than half of the sperm must have a forward mobility. In addition, less than a third should have atypical forms and more than half must be vital.
The causes of female infertility are based on the anatomy of the female reproductive organs and the physiology of the fertilization process.
a) Ovarian infertility (frequency of 30%)
Here it is important to mention the disturbance of the hypothalamic-pituitary axis. Hypothalamus and pituitary gland are members of a chain that stimulates the ovary by gonadotropins ( sex hormones ) to form follicles and ovulate. If one of these limbs fails, gonadotropins such as follicle stimulating hormone (FSH) are not formed. Functioning of the ovary stops and follicles can not mature. The cause of the susceptibility of the hypothalamic-pituitary axis is psychological stress and high-performance sport.
b) Tubar-related infertility (frequency of 30%)
Inflammatory changes in the fallopian tube have an effect on the transport of the ovary ovarian to the uterus, which can lead to infertility. Because the mucous membrane can be changed so that it can come to the closure of the fallopian tube. These changes are often triggered by bacteria such as chlamydia. Inflammatory events in the area of the small pelvis attach to the tube, which reduces its mobility. The trapping mechanism of the fallopian tube funnel can no longer be guaranteed. Because during ovulation, the egg cell must be picked up from the funnel and then transported further in the fallopian tube.
c) uterine conditional infertility (frequency of 5%)
Malformations of the uterus in the form of uterine septa are an obstacle to the implantation of the fertilized egg. Damage to the mucous membrane in the uterus, the endometrium, also impedes implantation. The endometrium undergoes negative changes due to frequent curettage (scraping) or endometritis.
d) cervical sterility (frequency of 5%)
Cervical tears or inflammation are responsible for sperm patency. In particular, the property of cervical mucus at the time of fertilization of the woman may be so altered by a lack of estrogens that the sperm is prevented from further ascent of the vagina towards the uterus.
e) vaginal infertility (frequency of 5%)
Abnormalities or stenoses prevent sexual intercourse. Inflammatory processes such as colitis favor premature birth.