Ovulatory disorders, ovarian failure, endometriosis, blockage of the fallopian tube(s), cervical mucous problems, uterine abnormalities, miscarriage, genetic diseases, and male factor are the most common causes of infertility. Links to more detailed information are included at the bottom of the page.
Ovulatory disorders are a common cause of infertility. They include irregular ovulation (oligoovulation) and ovulatory failure (anovulation). Anovulation is evidenced by the lack of menses.
Polycystic ovarian syndrome (PCOS) is a frequent cause of ovulatory problems. Patients with PCOS often have chronically elevated levels of androgens that prevent "good" ovulation.
Chronically elevated levels of prolactin, the hormone responsible for breast milk production in pregnancy, abnormal levels of thyroid hormones, excessive exercise, stress, being severely underweight or obese are also causes. Ovulatory disorders can also result for unexplained reasons.
Older women (thirties) may experience reduced ovarian reserve or ovarian failure leading to few or no viable eggs. Some women choose to freeze their eggs while young for use later when they are ready to have a child.
In most cases, ovulatory disorders can be treated with fertility drugs and/or lifestyle changes. Women with very low ovarian reserve, congenital abnormalities of the ovaries, or ovaries that were damaged by cancer treatments are usually candidates for donor egg IVF.
Endometriosis affects 5-10% of women in the general population. Endometriosis causes pelvic pain, severe cramping with menses, painful urination, painful and possibly bloody bowel movements, and pain during intercourse, and infertility. Endometriosis can damage or block the fallopian tubes, and it can attach to the ovaries and other organs. It can also create an inflammatory environment in the pelvis.
Male infertility is present in up to 50% of infertile couples. This fact makes the semen analysis one of the most important fertility tests. Sperm are sensitive to temperature and in order to control the temperature of the testicles, the scrotum expands or contracts to move them closer to or further from the body.
Hots tubs or tight clothing can sometimes damage sperm by raising testicular temperature. Varicoceles are a mass of varicose veins in the spermatic cord that can also interfere with testicular cooling.
Smoking, excessive drinking, exposure to heavy metals, marijuana, chemotherapy, and radiation can also lead to male infertility.
Cervical Factor Infertility
In the past, the cervical mucus was evaluated using the post coital test to determine if it had the correct consistency for sperm passage. Research has shown that this test is not a viable predictor of fertility and it is not recommended.
Tubal disease can be caused by endometriosis and severe pelvic infections. A woman may be born without one, or both, of her tubes but this is rare. In vitro fertilization (IVF) is usually the ‘treatment of first choice” for tubal disease. IVF or tubal reversal surgery are treatment options for women who had their tubes tied.
Miscarriage is one of the most difficult situations couples have to face and it is magnified in those who have recurrent miscarriages, also known as spontaneous abortions. Recurrent miscarriage is typically defined as three or more consecutive pregnancy losses that occur prior to 24 weeks of gestation. First trimester losses are the most common and occur prior to 12 weeks of gestation.
Factors influencing the chance of miscarriage include having a previous miscarriage, female age, presence of a condition such as PCOS, genetic abnormalities. When a couple has had two or more miscarriages the chances for future miscarriage is increased.