In Hong Kong, approximately one in six couples faces infertility challenges. Infertility is defined as a couple's inability to conceive after one year of regular, unprotected intercourse. The causes of infertility can be attributed to both partners, with about 30-40% stemming from male factors, another 30-40% from female factors, 10% from combined issues, and around 20% remaining unexplained.
Causes of Male Infertility
Low Sperm Count: A normal male ejaculate should contain at least 20 million sperm per millilitre, with about 50% being motile and 50% having a normal shape.
Poor Sperm Motility: Non-motile sperm cannot reach the fallopian tubes to fertilise the egg.
Abnormal Sperm Morphology: Healthy sperm have an oval head and a long tail.
Obstruction of the Vas Deferens: This can hinder sperm transport.
Azoospermia: The absence of sperm in the ejaculate.
Varicocele: Enlarged veins in the scrotum can decrease sperm production, but surgical intervention can restore normal levels.
Testicular Dysfunction: Factors such as tight underwear or prolonged exposure to hot baths can elevate testicular temperature, reducing sperm count.
Sexual Dysfunction: Conditions like premature ejaculation or erectile dysfunction can be treated with medications like Viagra.
To address infertility, various approaches can be considered, such as timing intercourse, medication, or surgical treatments based on individual circumstances. If sperm count is low, assisted reproductive technologies may be utilised.
Method
Minimum Motile Sperm Count Required in the ejaculate
Coitus
10 million
IUI (Intrauterine Insemination)
1 million
GIFT (Gamete Intrafallopian Transfer)
100,000
IVF (In Vitro Fertilisation)
10,000
ICSI (Intracytoplasmic Sperm Injection)
1
TESE (Testicular Sperm Extraction)
None
DI (Donor Insemination)
Donor's sperm
Causes of Female Infertility
Advanced Age: Women over 35 years old.
Ovarian Insufficiency or Damaged Fallopian Tubes.
Menstrual Irregularities: Conditions like endometriosis, pelvic inflammatory disease, or uterine fibroids can affect fertility.
Cervical Issues: Inflammation or problems with cervical mucus can hinder sperm and egg interaction.
History of Ectopic Pregnancy or Recurrent Miscarriages.
Irregular or Anovulatory Cycles: Hormonal imbalances can disrupt normal ovulation, affected by factors like obesity, high stress, or hormonal disorders.
High FSH Levels: Indicates approaching menopause, suggesting a loss of fertility.
Ovulation Assessment
To determine if a woman has fertility issues, it is essential to assess ovulation. During ovulation, the cervix secretes mucus that helps sperm survive. Monitoring for egg white-like discharge can indicate ovulation; intercourse during this time increases the chances of conception. After the ovary releases an egg, it produces progesterone, and blood tests for progesterone can confirm normal ovulation. Ultrasound is the most direct method, as a visible follicle size of 2 cm indicates ovulation.
