Patient's question:
Hello, I would like to consult about infertility issues. My wife has been pregnant twice, but both times the pregnancy did not develop properly and stopped developing. I would like to know which aspects need to be checked. Thank you.Doctor's answer:
The extent of infertility among modern men and women has risen dramatically to an unprecedented level, clearly becoming a modern ailment. Currently, there are many classifications of factors or causes of infertility in men and women, such as sexually transmitted diseases, diabetes, and other disease-related factors, as well as personal psychological factors. The increase in environmental and industrial toxins can affect the reproductive systems of both men and women, particularly severely damaging sperm-producing cells, leading to a decline in sperm quantity and quality. Additionally, prolonged exposure to high-intensity radiation can cause infertility. Generally, if a couple does not conceive within a year of marriage, it should warrant attention, and they should seek medical examination for infertility factors or causes.Suggestions:
One of the important purposes of marriage is to have offspring, and carrying a child is a very happy event. However, certain factors or causes make it difficult for some couples to fulfill their dream of having children, with half of these factors or causes being related to female infertility. There are 10 potential factors that may lead to female infertility—let’s identify them.
1. Vaginal Factors
Congenital conditions such as vaginal atresia or septum can cause sexual intercourse difficulties or barriers, thereby affecting sperm entry into the female reproductive tract. Furthermore, infections like candidiasis, trichomoniasis, or gonorrhea can lead to vaginal inflammation, altering the biochemical environment and reducing sperm motility and survival, thus impacting fertility.
2. Cervical Factors
Conditions such as cervical stenosis, polyps, tumors, or adhesions can hinder sperm passage. Cervical erosion, with its inflammatory secretions, has a spermicidal effect. The presence of antisperm antibodies in cervical mucus is unfavorable for sperm penetration or complete loss of sperm motility. Notably, cervical adhesions caused by induced abortion in unmarried women, especially after repeated procedures, can severely obstruct sperm from entering the cervix.
Congenital abnormalities of the cervical canal are often accompanied by menstrual irregularities or dysmenorrhea, prompting medical examination after menarche. Cervicitis caused by pathogens like gonorrhea typically leads to cervical canal obstruction or stenosis.
Cervical incompetence is a common cause of habitual late miscarriage and infertility. When the gestational sac grows beyond the cervix’s capacity, the canal dilates, the sac protrudes, and water breaks, followed by the expulsion of the fetus and placenta, usually occurring after 3 months of pregnancy.
3. Uterine Factors
Developmental abnormalities or malformations such as congenital absence of the uterus, immature uterus, or solid non-cavitary uterus can impair female fertility. Posterior uterine position or severe retroflexion, endometrial inflammation, or uterine adhesions are also factors contributing to infertility.
Approximately 75% of endometriosis patients have a history of infertility, as it can cause posterior uterine adhesions, reduced mobility, and tubal adhesions leading to decreased peristalsis. The ectopic endometrium can act as an autoimmune antigen, triggering hyperimmunity in women, such as the production of anti-endometrial antibodies. It can also produce more prostaglandins, causing strong contractions of uterine and tubal muscles, disrupting sperm and egg movement and implantation, thus causing infertility.
Uterine fibroids are the most common benign tumors in women, with an infertility rate of 30–40%, significantly higher than the general population. Submucosal fibroids can obstruct sperm passage and embryo implantation, while intramural fibroids not only hinder conception but also frequently cause miscarriage or preterm birth. Even if pregnancy occurs, abnormal uterine contractions during the late stage may lead to preterm labor, delivery obstruction, or postpartum hemorrhage.
4. Tubal Factors
Conditions such as excessively long or narrow fallopian tubes, tubal inflammation leading to obstruction, hydrops, or adhesions can impede the movement of sperm, eggs, or fertilized eggs. Tubal diseases account for 25% of female infertility and are a significant cause, with inflammatory conditions including tuberculosis, endometriosis, trichomoniasis, gonorrhea, and other infections. Blocked fallopian tubes can be restored through fluid irrigation or microsurgical repair, or assisted reproductive technologies like in vitro fertilization and embryo transfer (IVF-ET) can be used to help patients achieve pregnancy.
5. Ovarian Factors
Factors affecting follicular development or ovulation, such as incomplete follicular development, failure to ovulate and form a corpus luteum, premature ovarian failure, polycystic ovaries, or ovarian tumors, can cause infertility. For example, a mature follicle may fail to rupture, preventing ovulation, with normal basal body temperature and hormonal levels, a condition known as luteinized unruptured follicle syndrome.
Luteal phase defect, characterized by insufficient progesterone secretion, is often associated with hyperprolactinemia, impairing endometrial secretion and hindering embryo implantation. Even if implantation occurs, insufficient progesterone may lead to miscarriage.
Polycystic ovary syndrome (PCOS) is characterized by anovulation and is not a single disease but a group of clinical and physical symptoms, including menstrual disorders (oligomenorrhea or amenorrhea), infertility, bilateral ovarian enlargement, thickened capsules, and polycystic changes; hirsutism, obesity, and hypersexuality. Infertility is caused by endocrine and menstrual disorders.
6. Endocrine Factors
Incomplete maturation of the hypothalamus or delayed maturation of the hypothalamic cycle center can disrupt the regulation between the hypothalamus-pituitary-ovary axis, leading to anovulatory menstruation, amenorrhea, or luteal dysfunction—all potential causes of infertility. Additionally, hyperthyroidism or hypothyroidism, as well as hyper- or hypofunction of the adrenal cortex, can affect ovarian function and hinder ovulation.
7. Congenital Factors
Severe congenital reproductive system abnormalities, often accompanied by primary amenorrhea. Sex chromosome abnormalities, such as Turner syndrome or true hermaphroditism. Habitual miscarriage caused by chromosomal abnormalities.
8. Systemic Factors
Nutritional disorders, metabolic diseases, chronic wasting diseases, simple obesity, etc. Exposure to toxic cottonseed oil, harmful chemicals, radiation, microwaves, and other physical factors.
9. Psychoneural Factors
Dysfunction of the vegetative nervous system, mental illness, environmental amenorrhea, neurogenic anorexia, pseudopregnancy, etc.
10. Other Factors
Immune infertility, blood type incompatibility (e.g., habitual miscarriage or stillbirth caused by Rh or ABO hemolysis).
It is recommended that you take your wife to a specific department in the hospital for consultation, which will be more targeted.