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Pregnancy and Conceiving: What are the Causes of Infertility

Before medical school I thought I was going to have all of my children before the age of 30. Then real life happened. Studying, residency, work, and soon I was 29 years old and not pregnant. My Mom’s comments about my “biological clock ticking” were now driving me bonkers!

I was very blessed and able to conceive Madi within a year, however, there are many couples and individuals that are struggling to get pregnant.  In those cases, there are investigations for infertility that your doctor might order to determine the cause of your infertility. This is some information that i provide to my patients that request more information about the causes and investigations for infertility:

What is infertility?

Infertility is medically defined by the inability to get pregnant after 12 months of regular, unprotected sexual intercourse.

What are the Causes of Infertility?

There are many different factors that play into a couple having troubles conceiving, both regarding the female and male reproductive system.

Male causes of infertility include:

  • Low sperm count.
  • Sperm not functioning properly.
  • The tubes that carry sperm (ductus deferens) are blocked or were never formed properly during development.
  • Ejaculatory issues.
  • Hormonal imbalances.
  • Genetic problems.

Female causes of infertility include:

  • Ovaries failing to release an egg during the menstrual cycle.
  • Damage to the fallopian tubes (which prevents an egg from travelling from the ovary, through the fallopian tubes to the uterus).
  • Endometriosis (a condition where uterine tissue grows outside the uterus), or other unexplained issues.

Investigations for Infertility

When infertility has been diagnosed there are many tests that both men and women can undergo to determine the underlying cause.

Investigations for Infertility for males first include a semen analysis. Genetic testing, hormone evaluation, and a scrotal ultrasound might also be ordered.

Investigations for infertility for females typically starts with tracking their menstrual cycles. Additional tests include blood work to test for hormone levels, which help determine if eggs are being released by the ovary during the menstrual cycle. Females can also undergo a test known as a “hysterosalpingogram”, which is a tubal dye test to see whether there are problems in the uterus or fallopian tubes.

Treatment of Infertility

Some lifestyle changes may help couples with infertility, like quitting smoking, decreasing marijuana use, reducing alcohol and caffeine intake, and increasing exercise. Hormone replacement and/or other medications can be used to stimulate ovulation or increase sperm count, depending on the specific cause of the infertility. Some couples find success with procedural interventions such as assisted reproductive technologies, intrauterine insemination (where sperm is placed in a woman’s uterus), or in vitro fertilization (where an embryo is made outside of the uterus and then placed in the woman’s uterus).

Please contact your health care provider to discuss investigations and management options if you are struggling with getting pregnant.

This article was co-authored with Megan Crosby, Dr. Sabrina Merali, Dr. David Chapman

Kuohung, W and M Hornstein (2018) Evaluation of female infertility. In:UpToDate, Eckler, K (Ed). UpToDate, Waltham, MA.
Anawalt B and S Page (2018) Approach to the male with infertility. In:UpToDate, Martin, K (Ed). UpToDate, Waltham, MA.

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