16.10.2024.
Infertility is a significant issue that impacts millions worldwide, affecting about 1 in every 6 people of reproductive age, according to the World Health Organization. It can arise due to various factors, both in men and women. In men, infertility is often caused by issues such as low sperm count, poor sperm movement, or blockages in the reproductive system. For women, it can stem from problems with the ovaries, fallopian tubes, or hormonal imbalances.
- Infertility is not limited by socioeconomic status, as WHO data shows similar prevalence across high, middle, and low-income countries.
- Yet, access to fertility care remains a challenge, particularly in lower-income regions.
- The lack of prioritization in national health plans leaves many without access to treatments like IVF or other fertility services.
What causes infertility?
Infertility is caused by a range of factors, including lifestyle habits like smoking, excessive alcohol use, and obesity. Environmental toxins can also harm fertility in both men and women.
In the female reproductive system, infertility may be caused by:
- tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery;
- uterine disorders which could be inflammatory in nature (such as such endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids);
- disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders;
- disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus and the pituitary glands. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.
The relative importance of these causes of female infertility may differ from country to country, for example, due to differences in the background prevalence of STIs or differing ages of populations studied.
In the male reproductive system, infertility may be caused by:
- obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This blockage can occur in the tubes that carry semen (such as ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract;
- hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles – hormones such as testosterone regulate sperm production. Examples of disorders that result in hormonal imbalance include pituitary or testicular cancers;
- testicular failure to produce sperm, for example, due to varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy); and
- abnormal sperm function and quality. Conditions or situations that cause abnormal shape (morphology) and movement (motility) of the sperm negatively affect fertility. For example, the use of anabolic steroids can cause abnormal semen parameters such sperm count and shape.
Lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility. In addition, exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm), resulting in their decreased numbers and poor quality.
Why It’s essential to address infertility
Infertility isn’t just a medical issue—it can have profound social and emotional impacts, particularly on women. In some cultures, women often bear the blame for infertility, even when it’s not their condition, which can lead to emotional distress, social stigma, or even violence and divorce. Addressing infertility is crucial to promoting gender equality, mental health, and the basic human right to family planning.
WHO estimates show that around 17.5% of adults globally experience infertility, reinforcing the urgent need to widen access to fertility care. Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, stated,
Infertility does not discriminate,
emphasizing the need for fertility services to be included in health policies.
The way forward
Improving fertility care worldwide involves more than just offering treatments. Education and awareness are essential to prevent infertility and reduce the stigma around it. Ensuring equitable access to treatments like IVF and fertility counselling will help millions of people realize their dreams of parenthood, regardless of socioeconomic background. The WHO report urges policymakers to recognize infertility as a major health concern and integrate fertility care into national health coverage plans, ensuring safe, effective, and affordable treatments for everyone who needs them.
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