Common Causes of Infertility

Polycyctic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a very common disorder that many women first learn about while seeking the cause of their infertility. PCOS affects 5-10% of women of reproductive age, making it one of the most common hormonal disorders in this age group. The exact cause of PCOS is not known. It is likely that a combination of factors leads to the development of PCOS. PCOS is thought to be a genetic trait and may run in families. Environmental factors such as the diet that one consumes are also thought to play a role in the development of PCOS.

For more information about causes and treatments, visit our Polycystic Ovary Syndrome (PCOS) page.

Secondary Infertility

 A diagnosis of secondary infertility may be rendered if:

• A couple who have already given birth without the use of medical support or fertility medications finds themselves unable to get pregnant or experiences recurrent miscarriages and
• They have been trying for one year if the woman is less than 35 or
• They have been trying for 6 months if the woman is older than 35

Whatever the underlying causes for a woman’s difficulty conceiving, talking with a specialist is the best way to untangle a web of confusing information and emotions; including the helpful “advice” from friends and family and the myriad ways people blame themselves when things don’t go as planned.

For more information about causes and treatments, visit our Secondary Infertility page.

Advanced Age

Fertility varies significantly with age. When a woman is born, she is born with all the eggs that she will ever have. In fact, the greatest number of eggs that a female has is actually during gestation (before she is even born). At puberty, a woman begins to release one egg each month at a particular time of the month. As a woman ages, the number of remaining eggs gradually decreases. The health of the remaining eggs also decreases. Therefore, a woman’s most fertile years are in her twenties. Once women reach the age of 30, for each cycle that a woman attempts pregnancy, only 20% of attempts will be successful (in other words, 1 out of 5 women will be pregnant). This number drops to 5% at the age of 40.  For this reason, we recommend that women over the age of 35 years who have been trying to conceive for 6 months without success come in for consultation.

To learn more read the ASRM Fact Sheets:

• “Age and Fertility” 
• “Does my age affect my fertility?” 

Related posts:

• Age & Fertility – You can’t change biology!
• Trying to get pregnant at 40?

Ectopic Pregnancy

A normal pregnancy occurs when an embryo implants inside the uterus. In situations when the embryo does not implant inside the uterus, we call these “ectopic” pregnancies, meaning that they are not in the correct location. Ectopic pregnancies most commonly occur in the fallopian tube, but can also occur in the ovary, the abdomen, or in cesarean section scars. It is important to recognize these pregnancies and treat them at an early stage, as they can be dangerous if untreated. Certain patients are at higher risk for ectopic pregnancies, such as patients who have had surgery on their tubes, those with a history of pelvic scarring or infections, or those with a prior ectopic pregnancy. Indeed, a common reason that patients are referred to fertility specialists is for damaged fallopian tubes. We are able to make recommendations for patients who are at risk for ectopic pregnancy and we are also able to closely follow our patients who have a history of ectopic pregnancy and are newly pregnant.

To learn more read the ASRM Fact Sheets:

• “Ectopic Pregnancy Booklet” 
• “Ectopic Pregnancy Fact Sheet” 

Endometriosis

What is Endometriosis?

Endometriosis is a common condition that can make it more difficult to achieve pregnancy. It is thought that endometriosis most likely results from shedding of the uterine lining (the endometrium) into the pelvis, rather than shed through the cervix and vagina as usually occurs with menstrual periods. This displaced endometrium can attach to tissue surfaces within the pelvis and begin to grow as nodules or lesions, resulting in pain and over time, scar tissue/adhesions. In patients with more advanced endometriosis, this scar tissue can disrupt the ability of the egg to be released from the ovary and enter the fallopian tube, leading to infertility. Some patients with endometriosis may have symptoms (such as painful menses or discomfort during intercourse), while others may be asymptomatic. In fact, some patients who seek care for fertility issues are found to have endometriosis during their evaluation, even though they had no signs or symptoms. As fertility specialists, we help to treat the symptoms of endometriosis and to help patients achieve pregnancy, if desired.

To learn more read the ASRM Fact Sheets:

• “Endometriosis (booklet)” 
• “Endometriosis and Infertility: Can Surgery Help?” 
• “Endometriosis: Does It Cause Infertility?” 

Click below to watch a video on Endometriosis from ARC Fertility

Fibroids

Fibroids are benign (noncancerous) growths that occur within the uterus (the womb). They are very common and will affect up to 70-80% of women by the time they reach menopause. Depending on their size and location, they can impact a woman’s ability to achieve pregnancy and they can cause symptoms such as pain, abnormal uterine bleeding, frequent urination, and difficulty with bowel movements. However, many women have no symptoms at all. Your physician will be able to determine if you have fibroids based on your office exam and ultrasound. If you are found to have fibroids, we will counsel you on whether the size and/or location of the fibroid(s) would affect your ability to become pregnant and maintain a healthy pregnancy. If indicated, we can discuss and perform surgical removal of fibroids to improve your chances of pregnancy.

Hyperprolactinemia

Hyperprolactinemia is an excess of brain hormone called “prolactin.” This is an essential hormone that helps to regulate milk production for women who are breastfeeding. However, the body can occasionally overproduce prolactin; this excess can lead to irregular ovulation and infrequent menstruation in women. As it is often an asymptomatic condition, we screen all women for hyperprolactinemia. If your levels are found to be high, we will often repeat the test when you are fasting (have not eaten anything). If the level is still high, we may recommend an MRI or CT of the brain to determine if there is a benign growth in the brain that is causing the excess prolactin. Hyperprolactinemia is generally treated with an oral medicine that helps to normalize the prolactin levels and decrease the risk for irregular ovulation/menstruation.

To learn more read the ASRM Fact Sheet “Hyperprolactinemia”

Hypothalamic Amenorrhea

This condition is commonly seen in patients who are avid athletes and engage in rigorous exercise. It can also been seen in patients who have anorexia, severe illnesses or those under considerable stress. Amenorrhea refers to a lack of menstrual periods. Regular menstrual cycles require proper signaling from the brain, specifically the hypothalamus and pituitary gland. A disruption in the proper signals prevents women from creating an egg follicle each month and ovulating. Without ovulation, a normal menstrual cycle cannot occur. Because there are multiple underlying causes for hypothalamic amenorrhea, treatment is tailored individually to each patient. The goal is the induce the brain to resume normal signaling or to mimic the signals of the brain to the uterus and ovaries.

Ovulatory Disorder

There are many conditions that can result in a disorder of ovulation, meaning that an egg does not develop properly or is not released properly from the ovary each month. It is a common reason for patients to seek help from a fertility specialist. There are many underlying conditions that can result in abnormal or absent ovulation such as disorders of the thyroid, hormonal imbalances, polycystic ovarian syndrome, eating disorders, etc. In some cases, we are able to identify an underlying cause but in some patients, the cause may be unknown. We can perform certain blood tests and ultrasounds in the office to determine if you are ovulating each month and tailor treatment based on our findings.

Pelvic Adhesive Disease & Tubal Disease

Patients are often referred to fertility specialists due to pelvic “adhesions,” which refers to scarring of tissue within the pelvis, or for damaged fallopian tubes. Adhesions can form due to underlying conditions (such as endometriosis or pelvic infections) or they can form after surgeries (such as cesarean sections or fibroid removals). In certain patients, the adhesions may be distorting the proper anatomy of the pelvis and interfering with the normal transport of the sperm and egg. Similarly, in the case of damaged fallopian tubes, sperm may have difficulty reaching the egg to fertilize it or a fertilized embryo (once egg and sperm meet) may have trouble traveling through the fallopian tube to reach the uterus and implant. A physical exam and radiographic tests, such as X-rays, can help to determine if adhesions are/or tubal disease present. In some situations, surgery may be indicated to verify if adhesions are present and to remove them. If the fallopian tubes contain fluid (referred to as “hydrosalpinx”), removal of the tubes may be warranted. If you have had multiple abdominal or pelvic surgeries or infections and are having trouble conceiving, seeing a fertility specialist may help to ascertain if adhesions are present and to discuss treatment options.

To learn more read the ASRM Fact Sheet “Adhesions: What Are They and How Can They Be Prevented?“

Premature Ovarian Failure

Premature ovarian failure (POF) refers to patients whose ovaries stop functioning properly prior to age 40. This means that the monthly release of an egg does not occur and menstrual cycles cease. Some women may develop POF as teenagers whereas other women may experience it later. Symptoms can be similar to those in menopause such as hot flashes, vaginal dryness, difficulty sleeping and mood changes. Certain women are at higher risk for POF, including patients with autoimmune disorders, particular chromosomal disorders, and those who have received chemotherapy and/or radiation. For women with POF, conceiving can be quite difficult with one’s own eggs and many women seek to achieve pregnancy using donor eggs. Women with POF also should be followed closely as they are at higher risk for early bone loss and heart disease. If you have been diagnosed with POF or are at risk, seeking the help of a fertility specialist may be beneficial for you.

To learn more read the ASRM Fact Sheet “Premature Ovarian Failure“

Unexplained Infertility

The evaluation for infertility includes both an assessment of the male and female partner using multiple modalities. In most situations, we will perform blood work on both partners to look for any underlying cause for the infertility. Several tests are available to see if the fallopian tubes are open and if there are any abnormalities of the uterus that may be contributing to fertility issues. We also recommend a semen analysis to ensure that there is healthy sperm present. In approximately one out of five couples, our multiple tests will reveal no abnormalities. We refer to this situation as “unexplained infertility.” It can be quite frustrating for couples since it is often easier to fix a known problem than to tackle an unknown problem. In truth, it may be that there is an underlying problem but that the present limitations of medical science do not allow us to identify it. Even if a cause for your infertility is not identified, we can still move forward and suggest treatments that can improve your chances for pregnancy.