011 568 3865 info@centrocmrtorino.it 09:00 - 13:00 | 14:00 - 18:00


When a man and/or woman are unable to contribute to conception

When a man and/or woman are irreversibly unable to contribute to conception, we talk about sterility; when we speak of infertility on the other hand, we mean the inability of a couple to procreate in the absence of irreversible sterility factors.

Often, even in medical circles, the two terms are confused.

The International Council on Infertility Information Dissemination (INCIID) defines a couple as sterile if they fail to conceive after one year of attempts (time reduced to six months in the case of a woman over thirty-seven).

Male and female sterility can be defined as primary when referring to people who have never been able to conceive, while secondary sterility is when the difficultyconcerns the conception of a second or additional child, after having conceived and/or carried a normal pregnancy to term.

Female fertility is at its peak around the age of 23, slowly declining until the age of 30, then decreasing rapidly from the age of 30 to 35, at later ages progressively plummeting until the age of 45.

According to the Istituto Superiore di Sanità, a body of the Ministry of Health, in a report on medically assisted reproduction in April 2017, the following infertility factors were identified:

Percentage Infertility Factors


Medically speaking (and in order of frequency), female infertility/infertility can be divided into the following forms:

Endocrine sterility/infertility
It accounts for about 6% of female sterility/infertility cases and means that the woman has alterations in her ovulatory cycle.

Tubal sterility/infertility
It represents 9% of all female causes of sterility/infertility, and relates to the lack of anatomical and/or functional integrity of the fallopian tube, a prerequisite for its proper functioning. This case represents one of the main indications for an in vitro fertilisation (IVF) cycle.

Cervical sterility/infertility
Linked to the poor quality of cervical mucous, which should be permeable to sperm just before ovulation, acting, on the other hand, as a barrier to the passage of sperm and germs outside the ovulatory period. One possible solution is intrauterine insemination (IUI).

Uterine sterility/infertility
It accounts for about 5% - 10% of cases, and consists of congenital abnormalities, adhesions from previous curettage, fibroid or polyp growth and, more rarely, infections.

Vaginal sterility/infertility
It depends on changes in the vagina and basically recognises three causes:

  • Malformations
  • Dyspareunia
  • Psychic vaginismus

In these particular cases, it is essentially due to obstructed sexual intercourse or abnormal deposition of semen in the vagina.

Immunological sterility/infertility
This is caused by the presence of anti-spermatozoa antibodies that are able to interfere with fertility by immobilising them and preventing them from entering the cervical canal. A solution to this problem can be intrauterine insemination (IUI).


Male sterility occurs when the sperm is unable to fertilise the oocyte; it can be divided into three categories:

They mainly concern pathologies affecting the hypothalamus and pituitary gland, resulting in a deficiency in gonadotropin secretion, leading to a failure to develop sexual characteristics. If this occurs after puberty, it can lead to testicular hypotrophy.

Pre-testicular causes are:

  • Endocrine problems, e.g. diabetes mellitus, Cushing's syndrome, thyroid disorders
  • Hypothalamic disorders, e.g. Kallmann's syndrome
  • Hyperprolactinemia
  • Hypopituitarism
  • Hypogonadism in various degrees
  • Cryptorchidism
  • Psychological causes
  • Intoxication by drugs, alcohol, chemicals, use of certain medication (SSRI antidepressants, neuroleptics...)
  • Vitamin deficiencies (particularly folic acid deficiency)
  • Irradiation with x-rays or gamma rays
  • Heat sources that raise testicular temperature constantly and continuously

These are congenital or acquired disorders of the testicles and affect the production of sperm inside the testicles.

Testicular damage can be caused by:

  • Varicocele
  • Cryptorchidism
  • Orchitis
  • Torsions of the funiculus
  • Genetic abnormalities
  • Testicular cancer
  • Environmental factors
  • Germ cell aplasia
  • Lifestyle

    Post-testicular and penile causes are:
    They include malformations, acquired or congenital, of the seminal tract and attached glands and concern the transportation of sperm from the testicles to outside the body.

    Post-testicular and penile causes are:

    • Obstruction of the vas deferens
    • Infection, e.g. prostatitis
    • Retrograde ejaculation
    • Hypospadias
    • Erectile dysfunction (impotentia coeundi)
    • Penile dysfunctions or malformations

    The main examination to be performed is the spermiogram. This analysis mainly includes counting the sperm, measuring their motility and their morphology under the microscope.

    The production of a low quantity of sperm is called oligospermia, the absence of sperm altogether is azoospermia.

    A quantitatively sufficient production but with poor motility is called asthenozoospermia.

    Sperm production with morphological characteristics below normal is called teratozoospermia.

    “Impotentia generandi” refers to the inability to procreate despite being able to have normal sexual intercourse, while “impotentia coeundi” refers to the inability to complete coitus. In this case, however, the man is able to generate offspring through assisted fertilisation techniques.