Top Causes of Infertility and the Tests That Detect Them

Hormonal Imbalances

Both men and women face a common cause of infertility, which is hormonal issues. These imbalances can lead to disruptions in ovulation, sperm production, and overall reproductive health. Tests to unveil these issues at Pantai Hospitals can offer some answers to what causes infertility.

Blood tests for hormone levels

These tests measure important hormones such as follicle-stimulating hormone (FSH), luteinising hormone (LH), oestrogen, progesterone, and testosterone. Unusual levels can indicate issues like polycystic ovary syndrome (PCOS) or low testosterone levels.

Thyroid function tests

Thyroid disorders can disrupt women's ovulation, leading to infertility, and affect male sperm production. Hypothyroidism or hyperthyroidism can be identified through testing for thyroid-stimulating hormone (TSH) levels.

Prolactin tests

Elevated prolactin levels can lead to suppression of ovulation and inconsistent menstrual cycles.

Resolving these imbalances with personalised treatments like hormone therapy or lifestyle adjustments can notably improve fertility results.

What are Some Diagnostic Tests to Take for Structural Abnormalities?

Structural issues within the reproductive system can hamper conception as well. Diagnostic tests for structural issues include:

Laparoscopy

A minimally invasive surgical procedure to identify endometriosis, adhesions, or other pelvic abnormalities.

These tests aid in the diagnosis of physical barriers to conception, many of which can be treated surgically or through the use of assisted reproductive technologies such as in vitro fertilisation (IVF) (Thaker et al., 2023).

What are the Factors for Male Infertility?

Infertility impacts both men and women equally, yet male infertility is constantly overlooked. Thorough testing for male factor infertility includes:

What is Unexplained Infertility?

For about 10-20% of couples, standard fertility tests like hormone checks, tube tests, and sperm analysis may come back normal, yet pregnancy remains difficult to achieve. This condition is described as unexplained infertility. In these cases, more advanced diagnostic tools can help unveil hidden factors leading to infertility and offer important information for tailored treatment strategies. These specialised tests include:

Genetic Screening

Genetic factors can indirectly affect fertility without resulting in obvious medical conditions. Genetic screening entails analysing the chromosomes and specific gene mutations of both partners to identify anomalies that may compromise egg or sperm quality. Conditions like balanced translocations, single-gene mutations, or mitochondrial DNA defects may damage the development of the embryo, leading to implantation failure or elevating the risk of miscarriage. Identifying these abnormalities can help clinicians to recommend suitable interventions, including preimplantation genetic testing (PGT) during IVF cycles.

Reproductive Immunology Testing

The immune system may play a hidden role in unexplained infertility in certain instances. Reproductive immunology testing assesses whether autoimmune or alloimmune reactions are present, which may prevent embryo implantation or result in repeated miscarriages. Conditions such as antiphospholipid syndrome, higher natural killer (NK) cell activity, or the presence of anti-thyroid antibodies may cause failed pregnancies. Detecting these immune factors allows fertility specialists to include immunomodulatory treatments like corticosteroids, intralipids, or anticoagulants to enhance the chances of a successful pregnancy.

Endometrial Receptivity Analysis (ERA)

A receptive endometrium is important for effective embryo implantation. However, the peak timing for implantation (the "window of implantation") can vary even in healthy women. ERA involves a biopsy of the endometrial lining, where its gene expression patterns are examined for signs of receptivity. Clinicians can adjust the timing of the embryo transfer during an IVF cycle to match the personalised implantation window if the window is displaced, notably improving implantation and pregnancy rates in women with unexplained infertility.

Advanced Semen Analysis

Conventional semen analysis mainly emphasizes sperm concentration, motility, and morphology. However, sperm DNA integrity, which is vital to embryo growth and viability, is not always reflected by these parameters. Advanced semen testing includes DNA fragmentation analysis, which evaluates the extent of genetic damage within the sperm. Elevated levels of DNA fragmentation have been connected to poor fertilisation, poor embryo quality, and constant miscarriage. Detecting this issue can initiate recommendations for lifestyle adjustments, antioxidant therapies, or assisted reproductive techniques such as ICSI (intracytoplasmic sperm injection) to improve results.

These advanced diagnostic options offer valuable insights that are constantly missed by standard evaluations. By unveiling underlying genetic, immunological, endometrial, or sperm-related issues, fertility specialists can tailor more personalised treatment plans, elevating the possibility of achieving a successful pregnancy, even in cases labelled as “unexplained” previously (Practice Committee of the American Society for Reproductive Medicine, 2020).

Schedule an Appointment at Pantai Hospitals

Infertility can be a journey that is emotionally and physically challenging to both men and women, but the correct diagnostic tests can unveil hidden causes and forge the path for successful treatments. Pantai Hospitals provide state-of-the-art facilities and a compassionate team of specialists to help you through every step of your fertility journey. Schedule an appointment today to take the first step towards achieving your dream of parenthood, or you may also book an appointment via our website or download our My Health 360 application, which can be obtained from the Google Play Store or Apple App Store. 

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.