Contents
What Is Infertility?
Basics of Human Reproduction
Common Causes of Infertility
Medical Help for Infertility
Low-Tech Fertility Treatments
High-Tech Fertility Treatments
Third-Party Reproductive Help
Alternative Fertility Treatments
How to Decide on a Fertility Treatment
How to Pay for Fertility Treatment
Other Options for Dealing with Infertility
How to Cope with Infertility
Infertility Resources
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Common Causes of Infertility
About 30–40% of infertility cases are diagnosed as female factor infertility, meaning that a problem can be traced back to the woman. Another 30–40% are diagnosed as male factor infertility. (Couples may have both female and male factors at play in their infertility diagnosis.) About 10–20% of all cases remain unexplained, meaning that doctors are unsure of what is causing the infertility.
Common Causes of Female Factor Infertility
There are many causes of female infertility. The following are the most common reasons.
Hormonal Issues
Hormonal problems are at the root of many female factor infertility issues. The female reproductive system depends on a complex interaction between hormones, and it can be difficult to conceive or to maintain a pregnancy if hormones are not properly balanced. Common causes of hormonal problems include:
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Polycystic ovarian syndrome (PCOS): This condition affects between 5–10% of women and is the most common hormonal reproductive problem in women of childbearing age. Women with PCOS don’t ovulate because their ovaries don’t make all the hormones needed for their eggs to mature.
- PCOS causes a cluster of symptoms, including irregular menstrual periods, weight gain or difficulty losing weight, excess facial hair, pelvic pain, male-pattern baldness, thinning hair, acne, oily skin, and dandruff.
- Doctors diagnose PCOS by talking with patients and performing physical exams. This condition can’t be cured, but it can be managed with a variety of medications, and many women who get treated for PCOS go on to have healthy babies.
- Thyroid problems: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can interrupt the menstrual cycle and cause infertility.
- Weight issues: Women who are very thin may cease to have menstrual cycles—a condition known as amenorrhea. Overweight women may find their cycles disrupted as well, leading to infertility.
- Luteal phase defect (LPD): If the second half of a woman’s ovulatory cycle, the luteal phase, doesn’t provide the hormonal support to maintain a healthy uterine environment, she won’t be able to sustain a pregnancy. LPD may exist due to other issues, such as PCOS or hypothyroidism.
Fallopian Tube Damage
Certain conditions, such as chlamydia, can cause inflammation in the fallopian tube. When a fallopian tube becomes damaged and scarred, a fertilized egg can have difficulty moving through the tube and into the uterus, leading to infertility problems.
Pelvic Adhesions
Pelvic adhesions are bands of scar tissue that can form in the abdomen and pelvis after pelvic infection, appendicitis, or surgery. These adhesions connect organs and tissue that are normally separated, which can affect the ovaries, fallopian tubes, and uterus, and can lead to infertility.
Endometriosis
Endometriosis occurs when the tissue that makes up the lining of the uterus grows outside the uterus, such as in the ovaries, intestines, or fallopian tubes. Endometriosis can cause painful periods and may sometimes cause other conditions that contribute to infertility, such as:
- Ovarian cysts: Endometriosis can sometimes cause ovarian cysts, called endometriomas, that are often associated with reduced fertility. These cysts can be treated with surgery.
- Scar tissue: Endometriosis can cause scar tissue to form among the uterus, ovaries, and fallopian tubes. This scar tissue can prevent the egg from moving to the fallopian tube.
Premature Ovarian Failure
Premature ovarian failure (POF), sometimes called early menopause, occurs when a woman’s ovaries stop releasing eggs and she stops menstruating before she turns 40. The cause of POF is often unknown, but it can be caused by genetics, chemotherapy, radiation treatments, or an
immune disorder.
Age
As a woman ages, her ovarian reserve diminishes, and her hormonal system may become disrupted. She may also be at greater risk for miscarriage.
Uterine Anomalies
Due to genetic or environmental factors, some women are born with uterine abnormalities, including:
- Bicornuate uterus: This uterus is heart-shaped instead of pear-shaped; some physicians call this a “double-horned” uterus.
- Septate uterus: A septate uterus has a wall, or septum, dividing the uterus into chambers.
- Unicornuate uterus: A unicornuate uterus has a single “horn” and is about half the size of a normal uterus.
These uterine anomalies may make it difficult for a fertilized egg to implant or may increase the risk of miscarriage.
Common Causes of Male Infertility
Male infertility can be caused by a number of factors that affect that sperm and its ability to fertilize the egg.
Problems with Sperm
Most cases of male infertility are related to problems with sperm. Hormonal problems, exposure to toxic chemicals, autoimmune disorders, and even too many hot baths can cause sperm abnormalities. Because new sperm are constantly being made by the male reproductive system, some issues can be reversed through treatment or even through different lifestyle choices. For example, wearing boxers instead of briefs may increase sperm count in some men. Problems with sperm include:
- Low sperm count: A normal sperm count is at least 20 million sperm per milliliter of semen. A lower sperm count means that there are fewer opportunities for the egg to be fertilized; a count of 10 million or fewer sperm per milliliter indicates potential infertility.
- Impaired motility: Sperm must be able to move quickly and accurately. Slow or wandering sperm can have trouble reaching their destination and fertilizing the egg. Infections can sometimes temporarily affect sperm motility.
- Abnormal morphology: Healthy sperm have oval heads to help them penetrate the surface of the egg and long tails to help propel them. Misshapen sperm are not as effective at fertilization.
Structural Problems
Though not nearly as common as problems with sperm itself, some men have conditions that prevent the sperm from getting to the egg.
- Varicocele: A varicocele is a varicose vein in the scrotum that can prevent normal cooling of the testicle, leading to a raised testicular temperature, which prevents sperm from surviving. Varicoceles are common and do not always influence fertility.
- Blockages: Blockages in the male reproductive tract can lead to a low sperm count (oligospermia) or even a zero sperm count (azoospermia). In addition, sexually transmitted diseases such as chlamydia can cause scarring, resulting in blocked sperm passage.
- Retrograde ejaculation: This condition occurs when semen enters the bladder rather then going out through the penis. Bladder, prostate, or urethral surgery; diabetes; and the use of psychiatric or antihypertensive drugs can cause this condition.
- Undescended testicle: In some men, one or both testicles fail to descend from the abdomen into the scrotum. Undescended testicles are exposed to the higher internal body temperature, which can impair sperm production.
Unexplained Infertility
Many cases of infertility have no explanations and no discovered causes. It can be frustrating to go through countless diagnostic tests and yet still be unsure of what is causing the infertility. It is important to remember that even when doctors are unable to discover the cause of infertility, successful treatment may be possible. Many fertility treatments bypass or boost the natural reproduction process regardless of specific fertility issues.
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