How Gonadal Failure Can Affect Fertility

Underactive Ovaries or Testes

Doctor with teenage patient
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The gonads are the male and female primary reproductive organs. In males, the gonads are the testes and, in females, the gonads are the ovaries. These organs are necessary for sexual reproduction, as they are responsible for the production of sperm and eggs. These are the male and female gametes (a cell that fuses with another cell during fertilization).

Gonads also produce the sex hormones needed for the growth and development of your primary and secondary reproductive organs and structures. In women, estrogen and progesterone are secreted by the ovaries and act during the menstrual cycle to prepare the uterus for pregnancy or menstruation. In men, the testes produce testosterone which stimulates sperm production. In both females and males, these hormones maintain secondary sexual characteristics such as breast development and beard growth.

What Happens When Things Go Wrong?

Gonadal failure, also known as hypogonadism, is what occurs when the gonads cease functioning as efficiently as they once did. They may produce only a small amount of hormones or none at all. This diminished functioning may result in low androgen (testosterone) and estrogen levels, in addition to a decrease in other hormones produced by the gonads. Sperm production (in males) and ovulation (in females) may be impaired, and this may then result in partial or complete infertility. This deficiency of the sex hormones can also result in defective sexual development, or in withdrawal effects (premature menopause) in adults.

How Will I Know I'm Experiencing Gonadal Failure?

This condition usually becomes evident during puberty. Women will fail to menstruate, which may affect their height and breast development. The onset of gonadal failure in women after puberty causes the cessation of menstruation, lowered libido, loss of body hair, and hot flashes.

In men, gonadal failure can cause impaired muscle and beard development and reduced height. It can also cause reduced body hair, enlarged breasts, the loss of muscle, and sexual difficulties.

Laboratory tests to determine gonadal failure include blood tests for estrogen, follicle stimulating hormone, and luteinizing hormone in women and testosterone in men. A sperm count and genetic tests may also be done.

What Causes Gonadal Failure?

This failure of the gonads may be caused by both congenital and developmental disorders, infections, trauma, surgery, toxic exposure, alcohol, drugs, and cancer treatments such as chemotherapy and radiation. Severe diseases in the liver or kidneys, certain infections, sickle cell anemia, and some cancers also affect the gonads.

More specifically, the childhood disease known as mumps, if acquired after puberty, can infect and destroy the testicles—a disease called viral orchitis.

Sometimes the pituitary develops a tumor that destroys it. Failure of the pituitary is called hypopituitarism, and it leaves the gonads with no stimulation to produce hormones.

Treatment

Hormone replacement therapy is sometimes an option, but this treatment can carry other health risks. Women and girls can take estrogen and progesterone as a pill or skin patch. Men and boys can take testosterone as a skin patch, skin gel, or by injection.

To improve fertility, some women can use injections or medications that stimulate ovulation despite hypogonadism. Men may have increased sperm production with injections of pituitary hormone.

View Article Sources
  • Hypogonadism. MedlinePlus. https://medlineplus.gov/ency/article/001195.htm.