Are you having trouble getting pregnant? You’re not alone. In fact, one in six couples experiences infertility. The good news is that there are many possible causes of infertility, and most can be treated. Here are several possible reasons you may be struggling to conceive:
What is infertility and how common is it?
Infertility is a condition that affects both men and women when they are unable to conceive a child. For most couples, it is defined as the inability to become pregnant despite having frequent, unprotected sex for at least a year. In most cases, it is due to an unknown cause. However, it can also be caused by a variety of medical conditions that could be present with either you or your partner or a combination of factors that prevent pregnancy. Infertility is relatively common, affecting approximately one in six couples. Fortunately, thanks to medical enhancement, numerous safe and effective treatments are now available that can significantly increase your chances of becoming pregnant.
What are the causes of infertility in men and women?
There are many possible causes of infertility in both men and women.
Causes of female infertility:
In women, common causes of infertility include problems with ovulation, blocked fallopian tubes, endometriosis, and polycystic ovarian syndrome (PCOS). Other causes of infertility in women can include age, weight, and lifestyle factors.
- Ovulation disorders: this includes any problems with the release of the egg from the ovary. Most cases of infertility are caused by ovulating infrequently or not at all. This issue is mainly due to problems with the hypothalamus or pituitary gland’s regulation of reproductive hormones, as well as problems in the ovary itself. These include:
- Polycystic ovarian syndrome (PCOS): this is a hormonal disorder that can interfere with ovulation due to excess production of male sex hormones. Being the most common cause of infertility, this disorder causes insulin resistance, obesity, acne, and abnormal hair growth.
- Hypothalamic dysfunction: the hypothalamus is responsible for the production of gonadotropin-releasing hormone (GNRH), which controls the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. If it isn’t working properly, it can affect the entire menstrual cycle, preventing ovulation from occurring. Its disruption could be due to various factors such as emotional or physical stress. Sudden weight gain or loss is also another factor. In general, irregular or absent periods are usually the most common signs of this disorder.
- Hyperprolactinemia: high levels of prolactin, the hormone that stimulates milk production in breastfeeding mothers, can prevent ovulation from occurring due to reduced estrogen levels. It could be caused by a benign tumor on the pituitary gland or from certain medications.
- Primary ovarian insufficiency (early menopause): also known as premature ovarian failure; this is when the ovaries stop functioning before age 40, causing a sharp decline in estrogen levels and often leading to menopause symptoms. The cause is unknown but it may be due to genetic factors, autoimmune disease, chemotherapy, or certain infections. To put it into simpler words, it is when the ovary stops producing eggs.
- Uterine or cervical abnormalities: several uterine or cervical causes can disrupt egg implantation or increase the risk of miscarriage. These include:
- Congenital disorders: abnormalities with the cervix or the shape of the uterus can lead to infertility in some women.
- Cervical stenosis: the cervical opening is narrower than it should be and may be completely closed in severe cases. This can prevent sperm from reaching the egg and complicate fertility treatments.
- Noncancerous (benign) tumors in the uterine wall also known as uterine fibroids can block fallopian tubes or interfere with implantation, affecting fertility. However, it is important to note that many women with fibroids or polyps do eventually get pregnant.
- Fallopian tube damage or blockage: also known as tubal infertility, is when the eggs are unable to travel from the ovaries to the uterus or sperms cannot reach the egg due to blockage or damage in the fallopian tubes. This disorder can be due to a variety of reasons, including endometriosis, pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea, or other sexually transmitted infections. It could also be a result of a previous tubal surgery such as in the case of a previous ectopic pregnancy.
- Endometriosis: it is a condition where the tissue that normally lines the inside of the uterus grows outside of it. This extra tissue growth, as well as its surgical removal, can cause pain and scarring and make it difficult for an egg to travel through the fallopian tube and implant in the uterus. Endometriosis can also prevent a fertilized egg from implanting. The condition also appears to have an indirect effect on fertility, through sperm or egg damage.
- Pelvic adhesions: pelvic adhesion or scar tissue are a common cause of infertility. They could be due to different conditions, including but not limited to endometriosis, pelvic infection, and previous abdominal or pelvic surgery. This scar tissue can lead to decreased motility and function causing, as a result, infertility.
Causes of male infertility:
Initially, the development of male reproductive organs during puberty should be complete with at least one of the testes being functional. In addition, the right balance of testosterone and other hormones is needed to trigger and maintain correct sperm production.
In men, common causes of infertility include problems with sperm production or quality, blockages in the reproductive tract, and varicoceles (enlarged veins in the scrotum). Other causes of infertility in men can include age, weight, and lifestyle factors.
These usually lead to either
|Low sperm count
|Decreased sperm motility
|This is defined as fewer than 15 million sperm per milliliter of semen. If the number of sperm in your semen is low, then the chances of one of your sperm fertilizing your partner’s egg are reduced.
|If your sperm’s motility or function is abnormal, it may be unable to reach or penetrate your partner’s egg.
So, what are the causes?
- Abnormal sperm production or function: problems with sperm production or function can affect a man’s ability to father a child. Sperm are produced in the testicles, and they travel through the vas deferens (the tubes that carry sperm from the testicles) to be ejaculated. A variety of conditions can cause problems with sperm production or function, including:
- Klinefelter syndrome: this condition results when a boy is born with two x chromosomes and one y chromosome instead of the usual one x and one y. The extra x chromosome affects the development of the male reproductive organs as well as sperm production.
- Varicocele: this is an enlargement of veins in the scrotum, which may prevent normal cooling of the testicles. The result may be lower sperm production or function.
- Infections: mumps, HIV, and other infections can cause fertility problems in men.
- Blockages: a blockage in the man’s reproductive tract can prevent pregnancy from occurring. Blockages can be due to a vasectomy (a male form of birth control), injuries, or certain surgeries.
- Hormone imbalances: low levels of testosterone (the primary male sex hormone) may lead to fertility problems.
- Chromosomal defects: abnormalities in the number or structure of chromosomes can cause fertility problems. One example is Klinefelter syndrome (described above).
- Problems with the delivery of sperm: even if a man produces healthy sperm, they may not be able to reach the egg. This could be due to several reasons:
- Varicocele: again, we notice this enlargement of veins in the scrotum and is a common cause of infertility. The veins surrounding the testicle are critical for cooling the testicle and keeping the sperm healthy. When these veins become enlarged (a condition called varicocele), it can raise the temperature of the testicle and affect sperm production or function.
- Premature ejaculation: this occurs when a man reaches orgasm and ejaculates too soon after sexual intercourse.
- Retrograde ejaculation: this is when semen enters the bladder instead of emerging out of the tip of the penis during orgasm. Many health conditions can lead to retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery on the bladder, prostate, or urethra.
- Defects of tubules that transport sperm: sperm is transported in a variety of tubes. These tubes can become blocked for a variety of reasons. Some men are born with these blockages through abnormal development, such as with cystic fibrosis or other inherited conditions., while others develop them as a result of injuries or infections.
Other causes of infertility (in both males and females):
- Lifestyle and environmental factors: smoking, drinking alcohol, using recreational drugs, and being exposed to certain toxins can all impact fertility. In males, regular heat exposure, such as in saunas or hot tubs, can also raise body temperature and may affect sperm production.
- Medical conditions: certain medical conditions, such as diabetes, celiac disease, or thyroid disorders, can impact fertility.
- Tumors: cancers and nonmalignant tumors can directly affect both male and female reproductive organs, through hormonal glands such as the pituitary gland, or through other unknown causes. Cancers, particularly reproductive cancers can also affect fertility, as well as, chemotherapy, radiotherapy, and some surgeries.
- Age: after age 35, pregnancy becomes more challenging, and after age 40, it becomes much more difficult to conceive.
- Weight: both being underweight and being overweight can affect fertility.
- Surgeries: some surgeries can cause fertility problems in men, including those that remove the testicles or part of the reproductive tract.
- Unknown causes: in about 10 to 20 percent of couples who are unable to conceive, doctors can’t identify a specific cause. If both partners have any combination of minor fertility issues, this could result in unexplained issues with conceiving. However, these types of problems may eventually solve themselves.
Disclaimer: it is important to note that this information should not be used as a substitute for medical advice. Never self-diagnose yourself. If you think you have one of the above issues, see your doctor as soon as possible for an accurate diagnosis.
How is infertility diagnosed and treated?
If you are having trouble getting pregnant, it is important to visit your doctor. There could be an underlying medical condition causing your infertility. Your doctor will likely perform a series of tests to determine the cause of your infertility. These tests can include blood work, imaging tests such as an ultrasound or CT scan, and semen analysis for men.
Infertility treatment usually depends on the cause. Sometimes medications or surgery can help, while other times assisted reproductive technologies (ART) such as in vitro fertilization (IVF) are necessary.
What are the consequences of untreated infertility?
The consequences of untreated infertility can be significant for both you and your partner. Infertility can cause psychological stress, increased anxiety levels, decreased self-esteem, and can lead to problems in relationships. In couples who are unable to conceive, it can also lead to feelings of guilt, shame, and inadequacy. For women, untreated infertility can also lead to an increased risk of pregnancy complications, ovarian cancer, and other health problems later in life. In men, it can lead to an increased risk of prostate cancer and other health problems.
Always remember: if you are having trouble conceiving, it is important to visit your doctor to find out the cause and to get treatment. With proper medical care, many couples can conceive and have a healthy pregnancy.
How can you cope if you are struggling with infertility and where to find support?
If you are struggling with infertility, it can be difficult to cope. Here are some tips for managing your emotions:
- Talk to your partner about how you’re feeling. This can help to open up communication and support each other.
- Find a support group or online forum where you can share your experiences with others who are going through the same thing. This can help you feel not so alone.
- Seek out support from family members and friends who understand what you are going through.
- See a therapist. Infertility can cause a lot of emotional stress, and talking to a therapist can help you manage these feelings.
- Write in a journal. This can be a therapeutic way to express your thoughts and feelings.
Coping with infertility can be challenging, but with the right support, you can manage your emotions and feel better.
What are the success rates of fertility treatments?
The success rates of fertility treatments vary depending on the type of treatment used. However, most treatments have a relatively high success rate, with about 60-70% of couples conceiving after treatment. Statistics show that the success rates of fertility treatments are increasing as technology advances. The highest success rates were observed for IVF and other ART treatments. As of 2019, based on ART success rates by the center for disease control and prevention, the success rates for IVF are as follows:
- Fresh IVF cycle: 40-50%
- Frozen embryo transfer: 30-35%
- Donor egg IVF: 50-60%
- IVF with genetic testing of embryos: 65-85%
As you can see, the success rates of fertility treatments are quite high, so there is a good chance that you will be able to conceive after treatment. However, it is important to remember that every couple is different and that these success rates are only averages. Some couples may conceive after one treatment cycle, while others may need more than one cycle before they are successful.
What are the risks of fertility treatments?
Many couples who undergo fertility treatments are successful in conceiving a child. However, as with any medical procedure, there are risks associated with fertility treatments. The risks of fertility treatments vary depending on the type of treatment used. Some risks are common, such as mild discomfort during procedures or side effects from medications. Other risks are more serious, but rare such as infection or multiple births. Talk to your doctor about the risks of each treatment before starting any fertility treatment.
Some of the risks include:
- Risks associated with medications used in treatment, such as birth defects, pregnancy complications, and other health problems
- Risks associated with surgery, such as infection and bleeding
- Risks associated with assisted reproductive technologies (ART), such as pregnancy loss, birth defects, and multiple pregnancies (twins, triplets, etc.)
- Risks associated with embryo donation, such as pregnancy loss and birth defects
- Risks associated with surrogacy, such as pregnancy loss and complications, legal issues, and emotional challenges
It is important to talk to your doctor about the risks of fertility treatments before you begin any treatment. This way, you can make an informed decision about whether or not the benefits of treatment outweigh the risks.
What are the costs of fertility treatments?
The costs of fertility treatments vary depending on the type of treatment used. Some treatments, such as medication, are relatively inexpensive. Other treatments, such as in vitro fertilization (IVF), are more expensive. The costs of fertility treatments can range from a few hundred dollars to several thousand dollars.
Many couples use health insurance to cover some of the costs of treatment. Some insurance plans cover all or part of the costs of fertility treatments. Other insurance plans have very limited coverage or no coverage at all. Check with your insurance company to see what type of coverage you have for fertility treatments.
Some of the more common fertility treatments and their approximate costs are as follows (according to resolve; the national infertility association):
- Ovulation induction: $500-$1,500 per cycle
- Intrauterine insemination (IUI): $800-$2,000 per cycle
- In vitro fertilization (IVF): $10,000-$15,000 per cycle
- Donor egg IVF: $20,000-$30,000 per cycle
- Surrogacy: $30,000-$50,000+
Disclaimer: these are only approximate costs and may vary depending on your situation.
Are there any natural ways to improve fertility?
There are many natural ways to improve fertility. Some of these methods include:
- Eating a healthy diet: a healthy diet is important for both men and women who are trying to conceive. Eating plenty of fruits, vegetables, and whole grains can help improve fertility. It is also important to avoid processed foods and sugary drinks.
- Exercising regularly: exercising regularly can help improve fertility in both men and women. Regular exercise helps keep the body healthy and in shape, which can improve fertility.
- Staying hydrated: staying hydrated is important for overall health and can also improve fertility. Drinking plenty of water every day can help keep the body healthy and may boost fertility.
- Reducing stress: stress can negatively impact fertility. Reducing stress can help improve fertility in both men and women. Techniques such as yoga, meditation, and deep breathing can help reduce stress levels.
- Quit smoking: smoking can negatively impact fertility. Quitting smoking can improve fertility in both men and women.
- Avoiding alcohol: drinking alcohol can reduce fertility in both men and women. If you are trying to conceive, it is best to avoid alcohol altogether.
- Acupuncture: acupuncture is a traditional Chinese medicine technique that has been shown to improve fertility. Acupuncture can help improve fertility in both men and women.
- Herbal supplements: many herbal supplements claim to improve fertility. However, there is limited scientific evidence to support these claims. Speak with a doctor before taking any herbal supplement.
There are many other natural ways to improve fertility that vary depending on the individual. Speak to your doctor about other ways you can boost your fertility or a nutritionist about what dietary changes may be best for you, or try one of the many online resources available on improving fertility naturally.
If you are trying to get pregnant and haven’t been successful after a year of unprotected intercourse, it’s important to visit your doctor. There could be an underlying medical condition causing your infertility. By understanding the possible causes of infertility, you can be one step closer to getting the treatment you need to have a baby. Always remember, no matter what, know that you are not alone. Infertility is a common problem, but it’s also treatable in many cases. With today’s advances in fertility treatments, more couples than ever before can conceive and have healthy babies.
|CDC. What is infertility? Centers for Disease Control and Prevention. Published April 20, 2022. https://www.cdc.gov/reproductivehealth/features/what-is-infertility/index.html
|Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. afp. 2015;91(5):308-314. https://www.aafp.org/pubs/afp/issues/2015/0301/p308.html
|Overview | Fertility problems: assessment and treatment | Guidance | NICE. https://www.nice.org.uk/guidance/cg156
|Prepregnancy Counseling. Acog.org. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/prepregnancy-counseling
|Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ ASRM guideline. Asrm.org. Published 2020. https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/diagnosis-and-treatment-of-infertility-in-men-aua-asrm.pdf
|Infertility. Asrm.org. https://www.asrm.org/topics/topics-index/infertility/
|Infertility workup for the women’s health specialist: ACOG committee opinion summary, number 781. Obstet Gynecol. 2019;133(6):1294-1295. doi:10.1097/aog.0000000000003272