Dr. mom explores Difficulty 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 still not pregnant. Like many women, my friends and I worried about our fertility when we started approaching our late 20s. We started to believe our parents when they said our “biological clocks are ticking!” 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 and having difficulty conceiving.  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 Men first include a semen analysis. Genetic testing, hormone evaluation, and a scrotal ultrasound might also be ordered.

Investigations for infertility for someone usually start with tracking their menstrual cycles. You may also be sent for 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).

There is an unfounded stigma surrounding infertility. Many people struggle with conception and there is nothing to be ashamed of. You are not broken. However, there are many options for couples and individuals to try to have a biological child. If that isn’t possible or isn’t for you, there is also adoption. Many children need loving homes, and giving them the opportunity to be loved and cared for is something to be proud of. There are many different paths to building a family, it just matters which one is right for you.

Learn more from Doctor Mom
What to know about the abdominal and pelvis muscles during pregnancy
The importance of Folic Acid in Pregnancy
Postpartum depression and the baby blues
Postpartum Exercise

References:
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.

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

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