Causes of Infertility

tubal disease

In some cases, the fallopian tubes become blocked or damaged, and this can prevent eggs from reaching the uterus or it can make it difficult for sperm to reach the egg. Tubal disease can be caused by a number of factors, such as infection, prior pelvic surgery, or endometriosis. In most cases, we can identify tubal issues with the help of an x-ray called HSG (Hysterosalpingogram). In some cases, a Laparoscopy is needed to repair or remove the damaged Fallopian tube.

In cases where the Fallopian tube is damaged beyond repair and dilated with a fluid collection (Hydrosalpinx), we recommend removal of the tube or what is blocking the tube pointing into the uterus (proximal tubal ligation). If a Hydrosalpinx is not treated, the fluid collection within the tube which is toxic to embryos, can leak into the uterine cavity and create a hostile environment for implantation. In Vitro Fertilization success rates are reduced by as much as 50% in such cases. A damaged Fallopian tube can also lead to pregnancies within the Fallopian tube (Ectopic Pregnancy).

Age

Reproductive success is diminished with age. The number of eggs in the ovaries decreases naturally and progressively through the process of atresia. The maximum complement of eggs is 6–7 million and exists at 20 weeks of gestation in the female fetus. The number of eggs decreases to approximately 1–2 million oocytes at birth; 300,000–500,000 at puberty; 25,000 at age 37 years; and 1,000 at age 51 years, the average age of menopause in the United States. The fertility of women decreases gradually but significantly decreases beginning around age 32 years and decreases more rapidly after age 37 years, reflecting primarily a decrease in egg quantity or egg reserve. This results in a gradual increase in the circulating level of follicle-stimulating hormone and decreases in circulating antimüllerian hormone leading to diminished ovarian reserve (DOR). To assess fertility potential and ovarian reserve, we suggest a consultation with one of our Fertility experts at AFS and a thorough evaluation of your ovarian reserve through hormonal testing ( E2/FSH, Anti Mullerian Hormone ) and ultrasound evaluation for Antral Follicle Count (AFC).

Sperm issues

In more than 40% of cases, infertility presents itself in males, usually in the form of sperm problems. There are a number of factors that can contribute to sperm problems, including smoking, problems with the brain or pituitary gland, systemic disease or other medical conditions, and congenital abnormalities resulting in an abnormal count, motility, and morphology. There are some patients who have no sperm (azoospermia), which could be due to a mechanical blockage in the tubes that store and transport sperm from the testes (vas deferens). In rare cases, genetic abnormalities can result in a perfectly healthy male with abnormal semen analysis and fertility issues.

Pelvic Factor

Uterine adhesions, pelvic adhesions, fibroids, endometrial polyps, endometriosis, pelvic inflammatory disease (PID) can all contribute to infertility.

Unexplained Infertility

When a couple fails to conceive after one year of unprotected intercourse and there is no apparent cause for this infertility (such as ovulation problems or sperm problems), we often refer to the situation as unexplained infertility. The experts at AFS make every attempt to determine the cause of your infertility, which could be caused by any number of factors, such as inefficient fertilization of eggs or lack of fertilization, poor development embryos, thickened outer shell (zona pellucida) of the egg, or implantation failure.

If you have been told that your inability to conceive is the result of unexplained infertility, we may be able to help you determine the cause or causes of infertility that pertains to your unique situation.

Genetic Abnormality

Chromosome abnormalities (karyotype issues) or specific gene disorders like Fragile X, can lead to depletion of ovarian reserve, recurrent pregnancy loss and fertility problems.

Medical problems

Medical conditions associated with infertility include many diseases like thyroid issues, gastrointestinal issues (eg. Celiac disease, Crohn’s, ulcerative colitis, IBS), prolactin abnormalities, cancers, etc. Many medical conditions affect fertility through loss of a balance needed in the body to become pregnant or carry a healthy pregnancy. A complete medical history is important to determine any other possible causes other than the most common and obvious ones.

Obesity

Pregnancy rates decrease with an increase in BMI (body mass index) above 30. BMI abnormalities being extremely high or low can also affect fertility. Normal BMI is between 18-25.

Ovulation Problems

There are a number of factors that can contribute to ovulation problems, and they may include stress, eating habits, nutritional supplements, thyroid disease or other medical conditions such as tumors or growths in the brain.

Polycystic Ovarian Syndrome (PCOS)

PCOS is a syndrome in which the ovaries are enlarged and have several small, painless cysts. PCOS can affect more than fertility: it can have an impact on menstrual cycles, hormone levels, and appearance in the form of acne, facial hair, and hair loss.

Symptoms of PCOS can vary widely from woman to woman and can be mild or severe. A woman with PCOS may experience one or more of the following symptoms:

– Acne
– Alopecia (hair loss)
– Excess facial and/or body hair (hirsutism)
– High cholesterol levels or high blood pressure
– Infertility
– Irregular or absent periods
– Obesity

Other Issues

Some sexual dysfunction such as premature or retrograde ejaculation decreased libido, painful intercourse, or over exposure to certain environmental factors such as pesticides, toxins, chemotherapy or radiation can lead to infertility.