Most infertility experts agree that infertility is the appropriate diagnosis when pregnancy has not occurred after a full year of unprotected intercourse. Many couples turn to the woman’s obstetrician/gynecologist for answers regarding their problem and are then referred to a fertility specialist when appropriate. Other couples who suspect a problem sometimes self-refer to a fertility expert.
Causes of Infertility
In general, 50 percent of couples having difficulty conceiving have factors involving the female partner, another 35 percent involve the male partner, and the remaining 15 percent have both male and female factors that together prevent conception.
The Female Partner
Common factors related to the female partner:
Problems with the ovaries or lack of regular ovulation, which is the development or release of a healthy egg. These may be caused by endocrine disorders such as Polycystic Ovarian Syndrome (PCOS) that can result in irregular menstrual cycles including prolonged, infrequent or lack of periods; infertility; or recurrent miscarriages.
Problems with the fallopian tubes, the uterus, or other pelvic organs.
- Damage to the fallopian tubes that affects the movement of the egg into the uterus.
- Endometriosis, where tissue normally found on the inside of the uterus is found on the outside of the uterus and can cause scarring and anatomical abnormalities that disrupt the menstrual cycle.
- Fibroids, or uterine tumors, forming the muscle of the uterus and distorting the uterine cavity and interfere with conception.
- Hormonal abnormalities, where certain imbalances can affect the ability to produce a healthy egg.
- The woman’s age. Experts now believe that a woman’s ability to conceive begins to decrease approximately 10 years before the onset of menopause, which varies from woman to woman, but in general starts at age 35.
The Male Partner
Common factors related to the male partner:
- Anatomic abnormalities, which obstruct the passage of sperm into the ejaculate; or lack of proper development of the internal reproductive organs
- Hormonal abnormalities, where certain imbalances can affect the ability to produce sperm
- Abnormal dilation, or expansion, of the veins in the testicle; also known as a varicocele, this abnormality is found in approximately 25-35 percent of infertile males during a physical examination.
Recurrent Pregnancy Loss (Repeated Miscarriages)
Although recurrent pregnancy loss may sound like a different problem than infertility, women who have had two or more consecutive miscarriages before the 20th week of pregnancy should be tested by a fertility specialist to determine the cause of the miscarriages. Some causes are bacterial infections, specific toxins, an abnormality of the uterus, a clotting abnormality, a progesterone deficiency or immune factor. Even after several miscarriages, women can be treated and can have a successful pregnancy.