HIV and Fertility Q & A with Dr Matabese

30 Nov, 2012


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I had the awesome opportunity of having a Q&A session with Dr Matabese of the Cape Fertility Clinic who has a state of the art HIV lab to help couples who are HIV positive realising their goal of having babies of their own. I have learnt a lot about this issue and I can only thank Dr Matebese for her information. I’m sure many HIV patients will be helped with this information.

GET PREGNANT Q&A with Dr Nomathamsanqa (Tamtam) Matebese, Specialist in Reproductive Medicine at the Cape Fertility Clinic


TOPIC – Assisted conception for HIV positive patients


1. I often get emails from HIV positive couples who are scared to call just any fertility clinic for help, for fear of being rejected or judged. Do you know which clinics are able to help?

We are definitely able to help at the Cape Fertility Clinic, as we have a dedicated lab for the treatment of fertility in HIV positive patients.

2. What would you tell an HIV positive couple to reassure them?

Modern technology allows HIV positive patients to realise their dream of having HIV negative children. While the thought of receiving treatment may seem very daunting, by seeking consultation with a reputable fertility clinic, that specialises in treating HIV positive patients, couples can rest assured that their treatment is in the hands of an expert doctor.

3. Are all fertility clinics required to help?

According to international guidelines, a clinic must have a dedicated HIV lab in order to offer assisted reproduction to couples who are HIV positive. This means that a separate set of equipment is used for patients with infectious diseases like HIV/AIDS. The equipment is very expensive and this might be a deciding factor for some clinics, as to whether or not they offer such treatments.

HIV positive patients who are not able to receive treatment from some clinics should not think that they’re being rejected because of their status. The reality is that many clinics to not have the equipment needed to help them, and this would probably apply to most of the public hospitals.

4. Is it possible for a HIV positive couple to conceive and give birth to a HIV negative baby?

Absolutely! If the mother is on antiretroviral drugs during the pregnancy then the risk of transmission to the baby is very low.

5. Is there a guarantee that the baby will be HIV negative?

Unfortunately there are no guarantees. However, if the mother is on ARV’s and her viral load is non-detectable, she has a 98% chance of delivering a HIV negative baby.

6. What procedure is used when the male partner is HIV positive?

It’s important to know that it’s not the sperm that carries the virus, but rather the semen in which the sperm survives. A procedure of sperm washing is therefore done to remove the HIV virus from the sperm. The sample then undergoes viral testing to determine whether or not the virus has been successfully removed. If the sample is negative, the sperm is then inseminated directly into the woman’s uterus.

Another option is for the couple to use donor sperm. With this option, the risk of the female partner getting HIV is eliminated completely.

A third option is IVF/ICSI. With ICIS (an intracytoplasmic sperm injection), the sperm is washed and then injected directly into the egg. This reduces the chance of transmission to the partner.

7. What procedure is used when the female partner is HIV positive?

We can inseminate the HIV negative sperm directly into the woman’s uterus so that there is no risk of unprotected intercourse for the male partner. The couple can also consider the option of surrogacy.

8. What procedure is used when both partners are HIV postive?

The couple can choose to have artificial insemination or IVF depending on other clinical criteria such as the age of the female partner and whether or not her he fallopian tubes are blocked.

Blocked fallopian tubes are quite common in patients who are HIV positive as they are prone to pelvic infection. If the fallopian tubes are blocked, then artificial insemination will not work. IVF and preferably ICSI (mentioned above) will reduce the risk of transmission.

9. How would a HIV positive mother give birth, without infecting the baby?

There is enough medical evidence to show that if a HIV positive mother is on antiretroviral treatment with a non-detectable viral load, she has a 98% chance of delivering a HIV negative baby. Under these circumstances there is no longer enough medical evidence to show that an elective caesarean section is necessary. Certain precautions are however necessary. The mother’s membrane, for example, must not be ruptured until she’s close to delivering the baby. In other words, the mothers’ waters must not be artificially broken. If her waters break spontaneously and it is estimated that she will NOT deliver the baby within 4 hours, then she will require a caesarean section. During natural childbirth, cutting of the perenium should be avoided. The use of forceps and vacuum should also be avoided. All procedures that put the baby at risk of coming into contact with the mother’s blood should be avoided.

10. What happened after the birth? Are there any ARV’s the baby has to take?

Yes, the baby is given antiretroviral medication in a syrup form for the first 6 weeks. In most cases exclusive bottle feeding is advised.

11. Are there special precautions to make sure the baby remains HIV negative?

Exclusive bottle feeding is the best. However, if no safe clean water is available or the couple cannot afford the formula then exclusive breastfeeding for six weeks has been shown to reduce the chances of the baby getting HIV from breast milk.

12. Will baby have to go for regular blood tests?

The baby will have an HIV-PCR test at six weeks and if test comes back negative, then it confirms that the baby is HIV negative.

13. Many people would wonder if both parents are HIV positive and they give birth to a HIV negative baby and by some unfortunate circumstances they both die an early death and the baby is left orphaned. What would you say to those people?

If someone is HIV positive, takes their ARV medication properly, has a healthy immune system on blood tests and has a good HIV physician looking after them, they can expect to live a long normal healthy life. It is really the same as living with any other long term well controlled illness e.g. Diabetes or asthma. There is no reason why they should not consider having children as well.

14. Can ARV therapy affect fertility?

There is no definite scientific evidence for this. There are a few papers however, which show that some antiretroviral drugs have a negative effect on the sperm.

15. Are ARV’s safe to use during pregnancy?

Most ARV’s are safe in pregnancy. Only Efavirenz is contra-indicated in pregnancy due to the increased chance of getting abnormalities in the baby if on this drug during pregnancy.

16. Would mommy be able to breastfeed?

Exclusive bottle feeding is the best.

Myths about Infertility

27 Nov, 2012


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I recently received some wonderful insights from Mandy Rodrigues (Clinical Psychologist)  who so generously agreed to write the following article on Male Infertility.


Male Infertility

By Clinical Psychologist, Mandy Rodrigues

Infertility is a universal problem that impacts many people across the world. It is also a growing problem in spite of medical science developing new methods daily for improving treatment. There are some common myths, shared by men and women alike about male infertility. These myths seem to transgress cultural boundaries, and appear to be universal.

Myth 1: Infertility is a female problem

While this belief is widely held, it has no factual basis. One too easily assumes that infertility is a female problem. However, in nearly a third of all infertility cases, a male factor is the main cause. The most well-known causes of male infertility include: damage to the testicals from infections like mumps, genetic problems, failure of the testicles to properly descend, damage caused by chemotherapy and radiation, or the loss of a testicle due to torsion or trauma. Further possible complications include the tube from the testicles carrying the sperm, being blocked due to a sexually transmitted group of infections, and in some instances, men are actually born without the vas deferens tube.

Myth 2: The more we have intercourse, the higher our chances

Baby and father sleeping

One assumes that the more one has intercourse around time of ovulation, the more sperm, and the higher the chance of a pregnancy. However, having intercourse every day can lower the sperm count significantly. Every other day is probably a better option. Similarly, abstaining for long periods of time, does not improve the store of sperm. In fact, after three days the quality of the sperm starts decreasing somewhat.

Myth 3: If I am producing semen, then I must have sperm

This is a common perception. However, one must not confuse semen with sperm. Semen is the fluid in which the sperm swims. The white thick creamy fluid is just a vehicle for the sperm to survive in until they reach the egg. A healthy male has millions of microscopic sperm in each drop of semen. To have spontaneous conception the sperm count should typically be more than 10 million and the sperm motility should be more than 40%. In instances where a man has no viable sperm in their ejaculated sample, a fertility specialist will proceed with a testicular biopsy procedure to extract a small amount of tissue from one testicle, which can be used to fertilise the egg.

Myth 4: I cannot have a vasectomy reversed

A vasectomy is considered a form of permanent birth control. During the procedure, each testicle is cut or sealed to prevent the release of sperm. Fortunately, a reversal can be effective in a huge number of cases. And if a reversal is not possible, there are other more invasive options available. One would need to consult with a specialist urologist to ask about further options.

Myth 5: If I am battling to have children, I am not a man

It is sad when virility and fertility are placed on the same continuum. Even though there is a common perception that one’s ability to have children is linked to one’s masculinity, fertility and sexual function; fertility and sexual function are not related. There are certain rare instances where this might be the case, as with severe hormone deficiencies, physical injury or drug usage. But these are very rare.

Myth 6: If my wife just relaxed, she would fall pregnant

Father and baby sleeping

When you tell someone to relax, it is impossible to obey. The relationship between stress and fertility exists, but it is not as simple as that, or as direct as that. Infertility is a disease, and has a physical component as well as an emotional component. To tell someone to relax, will simply stress them more and be counter productive. Support and empathy help; as well as a plan forward with some hope. If she is struggling, let her go speak to someone. There is help and courses are available; as well as therapists who specialise in the management of infertility.

Myth 7: It’s so easy for other couples to conceive

While you are going through the process of trying to have a child and battling, it does feel like everyone else is falling pregnant easily. The fact is that one in 10 people are battling to conceive, and even when a couple is absolutely healthy, they only have a 25% chance every month of conceiving.

Myth 8: Does going to a fertility clinic means we have to do invasive treatment like IVF?

This is a common misperception. Firstly, just because a couple has been struggling for only a few months, it doesn’t mean they can’t go seek a specialised opinion. By seeking this opinion in the beginning, the basics can put right so that conception happens quicker. Medical assistance should be considered in couples under 35 who have been trying to conceive for over a year without success, or after six months in women over 35. There are very few clinics that only do IVF, and most have a variety of less invasive options that they start off with and if conception difficulties are not identified, then more involved tests are done.

Myth 9: Fertility treatment will cause marital difficulties.

This myth is closely related to the idea that if intercourse is timed, a couple’s sex life will dwindle. Fertility treatment does not cause marriage problems. A marriage that is already vulnerable and then discovers a fertility problem is at risk for developing difficulties regardless. In many instances, couples report feeling closer to one another during fertility treatment, as they become more intent on trying to preserve the strength of their marriage through a period that would really test the strength of their love and commitment. A major challenge that couples do face is that the male partner will expect a quick solution and will want to fix things; while all the female partner wants is somebody with whom she can talk. She doesn’t expect a quick solution. When the two are not on the same page, they withdraw from one another and this is not a unique problem. Fertility treatment need not cause marital difficulties but rather a time of closer intimacy. Couples are encouraged to seek some professional help if need be.

Myth 10: Men can have children no matter what age they are

Baby feet in hand

Even though Charlie Chaplin fathered a child in his seventies, and we see many older men fathering children with their second younger wives, men also have a biological clock. Not only does the genetic DNA start showing more problems such as in birth defects but the longer one lives, the more one is exposed to the environment and lifestyle factors. Recent research is showing strong evidence for lifestyle factors contributing to male factor infertility such as smoking, obesity and stress. However, the good news is that these can be managed.

Infertility is a journey for both parties, even when the problem lies only with one individual. Women tend to think men are indifferent to the process ahead, and disinterested. But in reality, they are just less likely to discuss their concerns with their wives for fear of causing unnecessary upset. A strategy of independent coping develops, and the couple tries to cope individually with a problem that is easier to deal with when shared.

Hopefully the debunking of some of these myths creates a more accurate depiction of the issue.

BIRTH RIGHT: Ante-Natal Exercise and Relaxation classes now being run at Fourways Health Centre

23 Oct, 2012


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First time moms often approach the birth and initial care of their babies with mixed emotions. Overwhelmed by questions, fears and uncertainties, expecting a first child can be a daunting experience. Ante-Natal exercise classes can however help moms prepare for their new arrival, by calming the worry and demystifying the birth process.

Ante-natal exercise classes prepare women for labour and birth. They’re also a great place to meet and share experiences

Pregnant Belly

with other moms-to-be. The classes also include information on good eating habits, smooth post-partum adjustment and impart skills for coping with the stress of labour and general stress management during pregnancy.

“It’s very important for pregnant women to remain as relaxed as possible during their pregnancy,” says Justine Hunt, a

“During birth, another hormone called oxytocin is released to facilitate uterine surges and cervix dilation,” continues Hunt. “Most women in labour experience some sort of fear, tension and anxiety and this in turn also leads to a large release of adrenaline which counteracts the effects of the oxytocin. When this happens, moms to be usually experience short, agitated breathing which reduces good oxygenation to the baby through the umbilical cord.” registered physiotherapist and cranio-sacral therapist practicing at The Centre for Holistic Health in Fourways. “During pregnancy, a woman’s body releases a hormone called relaxin which allows the ligaments in her hips to stretch so that the pelvis can widen in preparation for birth. If a mom is under strain, the stress hormone adrenaline is released countering the effects of the relaxin and this may in turn cause stress to the unborn baby.

Hunt, who gave birth to her first baby just under a year ago, understands the importance of including relaxation techniques in a birth preparation class in order to facilitate stress release. She also values the role that gentle exercise and posture support play in improving and maintaining pelvic floor and core stability strength, so as to prevent back pain and loss of bladder control pre- and post-natal.
Mom holding baby“Ante-natal exercise classes are a great way to preserve and enhance the general fitness and flexibility of pregnant women, and this should be coupled with advice and education about the different stages of labour, optimal birth positioning and breathe awareness exercises, so that the mind and body is prepared for the birth,” concludes Hunt.
With so many magazines and books out there, the enormity of pregnancy can be very overwhelming for even the most prepared mom-to-be. Attending ante-natal exercise and relaxation classes should provide some peace of mind, while the rest is up to motherly instinct.

Justine Hunt is a qualified physiotherapist and cranio-sacral therapist with a special interest in ante-natal care, birth preparation and post-natal care.


Based at the Centre for Holistic Health in Kingfisher Drive, Fourways, her classes are fun, relaxing, and empowering for new moms-to-be.

For more information contact the Centre for Holistic Health on 011 467-7022.

The benefits of a sperm friendly lubricant like Pre-Seed.

23 Aug, 2012


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The Benefits of a Sperm Friendly Lubricant Like PreSeed.

Having to have intercourse during the woman’s fertile time can lead to stress and increased vaginal dryness.

Women who are trying to conceive are also aware of the quality of their fertile fluids also known as cervical mucous. Normally, during ovulation, the cervical mucous is made by the woman’s body to support sperm on their journey through the cervix to meet the egg. Fluid volumes increase, and they become more slippery (like egg whites), with a rise in fluid pH to protect sperm. As women age, or if they have hormone imbalances, these normal fertile fluid changes don’t occur, making it difficult for the sperm to swim through the cervix.

Safe for use by couples trying to conceivePreSeed is the first lubricant ever allowed to make this statement. The safety of PreSeed for sperm is supported by independent, published studies.

Woman Sperm Physiologist Dr. Joanna Ellington (Dr. E) invented this ‘fertility-friendly’ isotonic formula specifically to meet the need for safe lubrication when trying to get pregnant.

Pre-Seed comes with applicators to deposit the unique lubricant inside, where it can coat the vagina and external cervix and best mimic your own natural fluids in an optimal environment for sperm.

  • 82% of users felt that PreSeed provided just the “right amount of lubrication”
  • 52% of women used PreSeed to supplement inadequate fertile secretions

When you are trying to conceive, know the facts about vaginal lubricants. A number of medical studies report that leading “nonspermicidal” lubricants damage sperm and should be avoided if you want to optimize your chances for a baby.

Pre-Seed was developed specifically to match a woman’s fertile fluids and to provide safe lubrication for use when trying to conceive a baby!

  • Balanced to match fertile cervical mucus.
  • Applying Pre-Seed inside mimics and supplements natural body fluids.
  • Recommended by leading fertility and women’s clinics.

Published studies also show that Pre-Seed’s isotonic formula is less irritating to the sensitive tissues of intimacy than other leading lubricants. Pre-Seed is safe enough to make a baby, but it also provides natural feeling mild lubrication for anyone at any time. Pre-Seed is made in America and has been trusted by TTC couples since 2002.

How to get the most out of your Ovulation tests

12 Jun, 2012


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Most people fall pregnant without giving it a second thought. But what do you do when it’s just not happening for you quick enough? That’s where Ovulation Predictor Kits (OPK’s) come in.

OPK’s are a very popular method in predicting ovulation. It can help you determine your most fertile window. It’s a quick, easy and accurate way to predict ovulation in advance.

How does OPK’s work?

Lets look at how ovulation happens: Firstly the follicle stimulating hormone (FSH) starts the follicles growing, as the follicles grow oestrogen is produced to thicken your endometrium which is where the possible embryo may implant, then when everything is right another hormone, Luteinizing hormone, surges to trigger the release of the egg which happens within around 36 hours.

Luteinizing hormone is what the OPK picks up. As soon as your OPK shows a strong positive (bear in mind that a weak 2nd line is considered a negative) you will ovulate within 36 hours. This is your most fertile time. Although sperm can survive for up to 5 days with an average of 48 hours, so intercourse before this time can yield conception as well.

Sometimes it happens that you use your OPK’s as prescribed and you still get a negative, then you can look at making a few changes, for example:

  • Never use first morning urine (FMU). Although this will give you a strong postive, it is possible that the LH concentrates in your urine overnight.
  • Always use your second morning urine.
  • Test 4 hours after you last emptied your bladder. So avoid using the bathroom for 4 hours before you test. But if you are bursting then test as soon as you empty your bladder.
  • Limit your water intake: We don’t want you to become dehydrated, but if you’re consuming large amounts of liquid in the hours before testing your urine may become diluted and you will have a negative and miss your LH surge.
  • Test more than once a day. Generally your LH spike lasts briefly, and you might miss the surge altogether and maybe miss out on conception that month.

The test line as has to be the same shade or darker than the control line: The reason for this is because as women we always have a small amount of LH in our systems, and we will ovulate only when the LH surge happens and this is what the OPK’s pick up.


You may want to chart your basal temperatures while using your OPK’s. By looking at previous charts you can easily determine when to start using your ovulation tests.

Try to test at the same times each day.

If you do not see a surge within the five days recommended by the manufacturers, test until you see a surge or until your temperatures have risen and stayed elevated for three days on your BBT Chart.

Recommended products:

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Our top 10 tips to falling pregnant

23 May, 2012


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1. Have sex more often.

By having sex 3 times a week you have a better chance of not missing out on your fertile window. Most women do not know when they ovulate, so by having regular sex you are sure to fall pregnant very quickly.

2. Use Ovulation Predictor Kits.

Using an ovulation kit) to predict when you are ovulating will improve your chances of getting pregnant. Ovulation prediction kits work by reading LH surges prior to ovulation. They are relatively easy to use and are generally accurate for predicting ovulation.

3. Have sex before ovulation.

After ovulation a woman’s egg will survive for approximately 24 hours. A man’s sperm live up to three to five days, so having the sperm waiting in the fallopian tubes to meet the egg will increase your chances of falling pregnant.

4. Don’t rely on the calendar method to fall pregnant.

Having a 28 day cycle doesn’t necessarily mean that you will ovulate in day 14 of your cycle, some women ovulate earlier or later and by having sex in the middle of your cycle could mean that you miss out on your fertile window. By using Ovulation Predictor Kits and watching for other signs that you are about to ovulate will help you to better time your intercourse.

5. Don’t rely on fertility charting alone to predict ovulation.

I love Fertility Charting and I am an ardent advocate of the BBT thermometer, but by the time you can see your ovulation on your chart it is too late. Using ovulation predictor kits with your BBT charting is ideal, this way you’ll be able to predict your most fertile window with the ovulation kits and then check on your chart to see that you have timed things right. Fertility Charting is also very helpful in tracking your cycles, getting to know your other fertility signs and checking to see that you ovulate at the same time each month.

6. Go for a check-up.

It is very important to make sure that you are in good health before starting on your trying to conceive journey. Sexually transmitted diseases, untreated infection and poor health can affect your fertility. It’s also good to start taking prenatal vitamins including Folic Acid.

7. Change your lifestyle

Living a healthy lifestyle will dramatically increase your fertility, you should also stop smoking, stop using drugs and alcohol as these substances can cause severe abnormalities in your unborn child. As well as cause problems such as blocked fallopian tubes, increased risk of ectopic pregnancy, lower quality eggs as well as damaged eggs and in increased risk of miscarriage.
Also make sure you are eating enough fruit and vegetable and getting in adequate water and ample exercise. You are about to carry the most precious cargo ever!

8. Watch your weight.

Being overweight impacts on your fertility, but you do not have to lose all the weight to start seeing a positive effect. By just losing 10-15% of your total body weight, researchers have found that women with previously anovulatory cycles, started ovulating again. Being underweight can also affect your fertility.

9. Check your mucus.

Fertile cervical mucus is slippery and very stretchy. You’ll notice a change in your cervical mucus when you approach ovulation. When cervical mucus is sticky or dry you are most likely not in your fertile window. Fertile cervical mucus is the ideal environment for sperm to stay alive and swim up into your fallopian tubes. As soon as you start to notice the change in your mucus make a note of it on your BBT chart and start having sex! You are more likely to conceive.

10. Ditch the lubricants.

Your body makes its own lubricant. But we all know that there are days when we need a little extra help. Normal lubrications are detrimental to sperm, the slow sperm down and can even kill or damage them. There is a great sperm friendly lubricant on the market called Pre~seed .





23 May, 2012


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Infertility is something none of us want to consider, but sadly it is becoming more and more prevalent in today’s society. If you have been trying for longer than a year to fall pregnant you might want to ask your OB/GYN for a basic check-up.
The WHO defines infertility as follows:

Infertility is the inability to conceive a child. A couple may be considered infertile if, after two years of regular sexual intercourse, without contraception, the woman has not become pregnant (and there is no other reason, such as breastfeeding or postpartum amenorrhoea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause.

Prevalence of infertility varies depending on the definition, i.e. on the time span involved in the failure to conceive.


  • Some estimates suggest that worldwide “between three and seven per cent of all couples or women have an unresolved problem of infertility.
  • Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.
  • Fertility problems affect one in seven couples in the UK. Most couples (about 84 out of every 100) who have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get pregnant within a year.
  • About 92 out of 100 couples who are trying to get pregnant do so within 2 years.
  • Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men’s fertility is less clear.
  • In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. However, about one in five cases of infertility has no clear diagnosed cause.
  • In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other.
  • In Sweden, approximately 10% of couples wanting children are infertile. In approximately one third of these cases the man is the factor, in one third the woman is the factor, and in the remaining third the infertility is a product of factors on both parts.

What causes infertility?

Causes in either sex.

Factors that can cause male as well as female infertility are:

  • Genetic factors
  • A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.
  • General factors
  • Diabetes mellitus, thyroid disorders, adrenal disease
  • Hypothalamic-pituitary factors
  • Hyperprolactinemia
  • Hypopituitarism
  • The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1.5 and 95% confidence interval of 1.1–2.0.
  • Environmental factors
  • Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides. Tobacco smokers are 60% more likely to be infertile than non-smokers.
  • German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility, though it is otherwise not harmful. Mutation that alters human DNA adversely can cause infertility, the human body thus preventing the tainted DNA from being passed on.

Female Infertility Causes:

  • Hypothalamic-pituitary factors
  • Hypothalamic dysfunction
  • Hyperprolactinemia
  • Ovarian factors
  • Polycystic ovary syndrome.
  • Anovulation. Female infertility caused by anovulation is called “anovulatory infertility”, as opposed to “ovulatory infertility” in which ovulation is present.
  • Diminished ovarian reserve, also see Poor Ovarian Reserve
  • Premature menopause
  • Menopause
  • Luteal dysfunction
  • Gonadal dysgenesis (Turner syndrome)
  • Ovarian cancer

Tubal (ectopic)/peritoneal factors:

  • Endometriosis. Endometriosis can lead to anatomical distortions and adhesions (the fibrous bands that form between tissues and organs following recovery from an injury). However, the link between infertility and endometriosis remains enigmatic when the extent of endometriosis is limited. It has been suggested that endometriotic lesions release factors which are detrimental to gametes or embryos, or, alternatively, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon; for this reason it is preferable to speak of endometriosis-associated infertility in such cases.
  • Pelvic adhesions
  • Pelvic inflammatory disease (PID, usually due to chlamydia)
  • Tubal occlusion
  • Tubal dysfunction

Uterine factors

  • Uterine malformations
  • Uterine fibroids (leiomyoma)
  • Asherman’s Syndrome

Cervical factors

  • Cervical stenosis
  • Antisperm antibodies
  • Non-receptive cervical mucus

Vaginal factors

  • Vaginismus
  • Vaginal obstruction

Male Infertility Causes:

Pre-testicular causes

Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:

  • Hypogonadotropic hypogonadism due to various causes
  • Obesity increases the risk of hypogonadotropic hypogonadism. Animal models indicate that obesity causes leptin insensitivity in the hypothalamus, leading to decreased Kiss1 expression, which, in turn, alters the release of gonadotropin-releasing hormone (GnRH).
  • Drugs, alcohol
  • Strenuous riding (bicycle riding, horseback riding)
  • Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin; those that decrease sperm motility such as sulfasalazine and nitrofurantoin
  • Genetic abnormalities such as a Robertsonian translocation
  • Tobacco smoking
  • Male smokers also have approximately 30% higher odds of infertility. There is increasing evidence that the harmful products of tobacco smoking kill sperm cells. Therefore, some governments require manufacturers to put warnings on packets. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.

Testicular factors

Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:

  • Age
  • Genetic defects on the Y chromosome
  • Y chromosome microdeletions
  • Abnormal set of chromosomes
  • Klinefelter syndrome
  • Neoplasm, e.g. seminoma
  • Idiopathic failure
  • Cryptorchidism
  • Varicocele (14% in one study)
  • Trauma
  • Hydrocele
  • Mumps
  • Malaria
  • Testicular cancer
  • Defects in USP26 in some cases
  • Acrosomal defects affecting egg penetration
  • Idiopathic oligospermia – unexplained sperm deficiencies account for 30 % of male infertility.
  • Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.

Post-testicular causes

Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:

  • Vas deferens obstruction
  • Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
  • Infection, e.g. prostatitis
  • Retrograde ejaculation
  • Ejaculatory duct obstruction
  • Hypospadias
  • Impotence

New beginnings

23 May, 2012


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Hello world!

It’s been ages since I’ve been here. For those who still have me listed on your readers, this is just a short note to say that I will be using this blog as a means to add fertility related articles to my website. I will no longer be using this space to journal my own trying to conceive journey, so you may now unsubscribe me, unless you’re interested in the information that I’m about to start posting here.