If you’re struggling to get pregnant, you’re not alone. Millions of couples and individuals find themselves in the same situation, wondering why they’re unable to conceive.
Several factors can contribute to infertility in both men and women. About one-third of infertility problems are due to women, another one-third to men, and the remaining one-third can be attributed to a combination of male and female issues or unknown causes.
This article overviews some common causes of infertility and provides potential treatment options.
What is infertility?
Infertility is the inability to conceive after one year of trying (having regular, unprotected sexual intercourse). According to the American College of Obstetricians and Gynecologists (ACOG), an estimated 12% of reproductive-age individuals have difficulty getting pregnant or carrying a pregnancy to term.
Infertility in Men
Male factor infertility accounts for 30-35% of all infertility cases.
Some common causes of male factor infertility include:
- Oligospermia (low sperm count): This is the most common cause of male factor infertility. It means there aren’t enough sperm in the semen to fertilize an egg. A low sperm count is 15 million sperm (or fewer) per milliliter of semen. Several factors can contribute to low sperm count, including varicocele, hormonal imbalances, ejaculation problems, infection, and genetic factors.
- Asthenozoospermia (also known as asthenospermia or low sperm motility): Sperm motility refers to the ability of sperm to swim and move properly. Low sperm motility can make it difficult for sperm to reach and fertilize an egg. According to the World Health Organization (WHO), low sperm motility is total sperm motility of less than 40% and progressive sperm motility of less than 32% in a semen sample.
- Varicocele: A varicocele is a varicose vein in the scrotum. Varicose veins are veins that have become enlarged and twisted. Varicoceles are usually painless but can affect sperm production and quality, leading to infertility.
- Infections: Certain infections, such as sexually transmitted infections (STIs) like HIV, chlamydia, and gonorrhea, can cause infertility in men.
- Genetic disorders: Genetic disorders or chromosome defects such as Klinefelter’s syndrome can cause male infertility.
Other causes of male infertility include:
- Ejaculation issues: This can include retrograde ejaculation when sperm travel backward into the bladder instead of out of the penis.
- Tumors in the reproductive system: Tumors in the testicles, prostate, or other organs can damage sperm production or function.
- Hormone imbalances: Hypogonadism (low testosterone) or hyperthyroidism (high thyroid hormone levels) can affect sperm production.
- Undescended testicles: This is when one or both testicles do not descend into the scrotum during childhood. Undescended testicles can increase the risk of infertility.
- Tubule defects: These are problems with the tiny tubes in the testicles where sperm are produced.
- Erectile dysfunction: This is the inability to get or maintain an erection. Erectile dysfunction can make it difficult to ejaculate, which can affect fertility.
- Celiac disease: This is an autoimmune disorder that damages the small intestine. Celiac disease can affect sperm production and function.
- Certain medications: Some medications, such as cancer medications, anti-hypertensives and some ulcer drugs, can affect sperm production or function.
- Prior surgeries: Surgeries on the reproductive system, such as a vasectomy, can damage sperm production or function.
- Testicular trauma: Injury to the testicles can affect sperm production or function.
Infertility in Women
Some common causes of female infertility include:
- Ovulation disorders: Ovulation problems are the most common cause of female infertility. This is because, without ovulation, no eggs are available for fertilization. Common symptoms of ovulation disorders include irregular or absent menstrual periods. Polycystic ovary syndrome (PCOS), premature ovarian failure, and hormonal imbalances are examples of ovulation disorders.
- Endometriosis: This is a chronic, inflammatory condition in which endometrial-like tissue grows outside the uterus. Endometriosis can cause scarring, adhesions, and infertility.
- Tubal factor infertility: This occurs when the fallopian tubes are blocked or damaged, preventing sperm from reaching the egg.
- Pelvic inflammatory disease (PID): This is an infection of the female reproductive organs that can cause scarring and damage to the fallopian tubes, leading to infertility. According to the ACOG, about one in 10 people with PID become infertile.
- Uterine fibroids: These are noncancerous uterine growths that can sometimes interfere with conception.
- Asherman syndrome (intrauterine adhesions or intrauterine synechiae): This condition occurs when scar tissue forms in the uterus or the cervix, blocking the fallopian tubes or making it difficult for an egg to implant.
- Luteal phase defect: This condition is when the corpus luteum, which produces progesterone after ovulation, does not function properly. This can cause implantation failure and early pregnancy loss or miscarriage.
- Immunological factors: In some cases, the body’s immune system may attack sperm or the fertilized egg, preventing pregnancy.
- Genetic factors: Certain disorders, such as Fragile X syndrome (FXS) and Kallmann syndrome (KS), can increase the risk of female infertility.
Other causes of female infertility include:
- Age: A woman’s fertility declines in her mid-30s and drops rapidly after age 37.
- Blocked fallopian tubes: The fallopian tubes are the tubes that carry eggs from the ovaries to the uterus. If the fallopian tubes are blocked or damaged, it can prevent sperm from reaching the egg.
- Uterine problems: The uterus is the organ where the fetus grows. If the uterus is damaged or doesn’t form properly, it can prevent pregnancy.
- Hormonal imbalances: Hormonal imbalances, such as hypothyroidism (low thyroid hormone levels) and hyperandrogenism (high levels of male hormones), can affect ovulation and other aspects of fertility.
- Structural problems: Structural problems, such as a septum in the uterus, can make it difficult for an egg to implant or a pregnancy to develop normally.
- Infections: Infections, such as chlamydia and gonorrhea, can damage the fallopian tubes and other reproductive organs, leading to infertility.
- Surgery: Surgery, such as a hysterectomy or a tubal ligation, can damage the reproductive organs and lead to infertility.
- Radiation or chemotherapy: Radiation or chemotherapy, used to treat cancer, can damage the reproductive organs and lead to infertility.
Lifestyle choices and environmental factors can play a role in infertility for both men and women.
These include:
- excessive alcohol use
- smoking
- drug use
- exposure to toxic chemicals
- radiation exposure
- stress
- obesity
How does age affect fertility?
Age isn’t just a number when it comes to fertility. And contrary to popular belief, age can affect both a man’s and a woman’s ability to conceive.
Here are some of the ways that age can affect fertility in men and women:
Women
- Reduced quality of eggs: Women’s fertility begins to decline gradually after the age of 35. This is because the number and quality of eggs in the ovaries decline with age. By the time a woman reaches 40, her chances of conceiving are significantly lower than when she was younger.
Increased risk of chromosomal abnormalities: The eggs of older women are more likely to have chromosomal abnormalities, which can increase the time to pregnancy and increase the risk of miscarriage.
- Diminished ovarian reserve: The ovarian reserve is the number of eggs available for fertilization. As women age, their ovarian reserve decreases, and the chances of success with assisted reproductive technologies (ART) may be lower.
Men
- Reduced sperm production: In men >40-50 years old, sperm production may decrease. This means that there are fewer sperm available for fertilization.
- Increased sperm DNA damage: The DNA of sperm can become damaged with age. This can prevent fertilization and increase the risk of miscarriage or congenital disabilities.
- Reduced sperm motility: As men age, their sperm may become less motile. This can make it more difficult for sperm to reach and fertilize the egg.
What is secondary infertility?
Secondary infertility is the inability to conceive or carry a pregnancy to term after previously giving birth.
To be classified as secondary infertility, the previous birth(s) must have occurred naturally, without the use of ART, such as in vitro fertilization (IVF) or intrauterine insemination (IUI).
The length of time an individual or couple needs to try to conceive in order to be diagnosed with primary OR secondary infertility is the same – 12 months if you are less than 35 years old and six months if you are 35 or older.
What is the difference between primary infertility and secondary infertility?
Primary infertility is when a person or couple is unable to become pregnant after one year of having regular, unprotected sex. Secondary infertility is when a person or couple has been able to conceive at least once before but is unable to become pregnant again after trying for at least one year.
Secondary infertility affects approximately 11% of couples in the U.S.
Causes of Secondary Infertility
Secondary infertility can affect both female and male partners. In some cases, the cause of secondary infertility is unknown, but several factors contribute to this condition.
Here are some possible reasons for secondary infertility:
- Age: As women age, their fertility declines. This is because the number and quality of eggs decline with age.
- Medical conditions: Medical conditions, such as endometriosis, PCOS, and varicocele, can increase the risk of secondary infertility.
- Surgery: Certain surgeries, such as a hysterectomy or a tubal ligation, can damage the reproductive organs and lead to infertility.
- Infections: Certain infections, such as pelvic inflammatory disease (PID), can damage the fallopian tubes and other reproductive organs, leading to infertility.
- Environmental factors: Certain environmental factors, such as smoking, exposure to chemicals, and radiation, can damage the reproductive organs and lead to infertility.
- Lifestyle factors: Certain lifestyle factors, such as smoking, excessive alcohol use, increased BMI or obesity, and stress, can also contribute to secondary infertility.
Infertility Risk Factors
Primary and secondary infertility have overlapping risk factors, but secondary infertility often has identifiable, treatable, and preventable risk factors.
Some common risk factors for both primary and secondary infertility include:
- Age: As women age, their fertility declines. For example, people nearing 40 may experience ovarian insufficiency (a condition in which the ovaries do not produce enough eggs).
- Chronic diseases: Certain chronic diseases, such as lupus, diabetes, and hypertension, can increase the risk of infertility.
- History of sexually transmitted infections (STIs): STIs can damage the reproductive organs and lead to infertility.
- Hormone imbalances: Hormone imbalances, such as PCOS, can make it difficult to conceive.
- Previous pelvic surgeries: pelvic or abdominal surgeries can damage reproductive organs or lead to scar tissue that interferes with function of the fallopian tubes can lead to infertility.
- Uterine fibroids: Uterine fibroids are noncancerous growths that can develop in the uterus. They can block the fallopian tubes and make it difficult for an egg to implant in the uterus.
- Abnormalities in the uterus: Abnormalities in the uterus, such as a septum or a tilted uterus, can make it difficult for an egg to implant in the uterus.
- History of prostatitis: Prostatitis is an inflammation of the prostate gland. It can cause pain and inflammation in the reproductive organs, making it difficult to conceive.
- Hernia repair: Hernia repair surgery can damage the nerves and blood vessels that supply the reproductive organs, making it difficult to conceive.
- Undescended testicles: Undescended testicles are testicles that do not descend into the scrotum.
- Certain prescription medications: Certain medications, such as chemotherapy and steroids, can affect fertility.
- Genetic disorders: Certain genetic disorders, such as Turner syndrome and cystic fibrosis, can increase the risk of infertility.
People who’ve had PID or other sexually transmitted infections, irregular menstrual cycles, previous miscarriages, low sperm count, or hormonal imbalances may have a higher risk of experiencing difficulties in getting pregnant.
What’s an infertility evaluation?
An infertility evaluation is a series of fertility tests, blood tests, and examinations that specialists use to determine why a person or couple is having trouble getting pregnant. These evaluations can help identify any underlying issues or abnormalities contributing to infertility.
According to the ACOG, individuals or couples who’ve been trying to get pregnant for one year or longer without success should consider having an infertility evaluation. People 35 or older should also consider seeking an evaluation after six months of trying; people under 35 years old, after 12 months.
People 40 or older should speak with their fertility specialist or OBGYN before six months or whenever they decide they are ready to start trying to conceive to see what options are available for them.
The following tests and examinations may help fertility specialists identify abnormalities or blockages in the reproductive system.
- Blood tests: Blood tests can check hormone levels, thyroid function, and other factors affecting fertility.
- Transvaginal ultrasound: A transvaginal ultrasound uses sound waves to create images of the uterus, ovaries, and fallopian tubes.
- Hysterosalpingogram (HSG): An HSG uses dye to X-ray the uterus and fallopian tubes.
- Semen analysis: A semen analysis measures the number, motility, and morphology of sperm.
- Laparoscopy: A laparoscopy is a minimally invasive surgery that allows the doctor to view the inside of the abdomen and pelvis.
Infertility Treatment Options
There are several options available for couples and individuals with fertility problems. The specific treatment option will depend on the underlying cause of infertility.
Common infertility treatment options include:
Intrauterine insemination (IUI)
Intrauterine insemination (IUI) is a non-surgical fertility treatment that involves injecting sperm directly into the uterus to increase the chances of fertilization. IUI is often a first-line treatment for couples with unexplained infertility or mild male factor infertility.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is a more complex and advanced fertility treatment option. Specialists recommend IVF for couples who’ve tried other fertility treatments without success or individuals with certain medical conditions that may impact their ability to conceive naturally. IVF involves several steps, including:
- ovarian stimulation
- egg retrieval
- embryo culture
- embryo biopsy
- frozen embryo transfer
Ovulation Induction (OI)
Ovulation induction (OI) is a fertility treatment that uses medication to stimulate the ovaries to produce eggs. This can be helpful for women who have irregular or infrequent ovulation. Ovulation induction medications are typically taken orally or by injection.
Some common ovulation induction medications include clomiphene citrate (Clomid), letrozole (Femara), and gonadotropins.
Other Treatment Options for Infertility
Other treatment options for infertility include:
- Surgery: Surgery may be an option for individuals with blocked fallopian tubes or other structural abnormalities in the reproductive system.
- Endometriosis treatment: The gold standard for endometriosis treatment is excision surgery that removes all lesions.
- Male factor infertility treatment: Treatment options for male factor infertility include medication, surgery, and lifestyle changes.
When to Seek Help If You’re Having Trouble Conceiving
You may want to consult a gynecologist or fertility specialist if you are under 35 years old and have been trying without success for one year or longer. If you are 35 or older, seek help after 6 months.
A Word from RMA Network
At RMA, we understand how difficult it is to experience the frustration and heartache of struggling to get pregnant. Our team of experts can help you achieve your dream of parenthood.
If you’re struggling with infertility, we encourage you to contact us to learn more about our services. We’re happy to answer any questions and help you create the right treatment plan for you.
