Infertility Causes and Diagnosis

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

Finally, for the pregnancy to continue to full-term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

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Causes of Infertility

No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20% of cases, is unexplained.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease, or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How Infertility Is Diagnosed

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse; however, there are several reasons why a work-up should be performed earlier. Women over the age of 35 may also benefit from seeking the care of a specialist after no more than 6 months without conceiving. After a thorough history and evaluation by one of our physicians, more specific tests may be recommended. For women, these include hormone testing and ultrasound to assess the function of the ovaries, and imaging studies to evaluate the uterus and fallopian tubes. For men, initial testing is focused on a semen analysis.

Portions of this information have been adapted from the American Society for Reproductive Medicine (ASRM).