Infertility has traditionally been diagnosed when a couple has been trying to conceive without contraception for one year. Reasons to seek a fertility consultation prior to trying for a year include known or suspected problems with fertility, such as a known problem with the male partner’s sperm, irregular or anovulatory menstrual cycles, or to follow the recommendation that patients over 35 years of age should be seen for a workup after six months of trying.
There are many possible causes of infertility, but the primary causes include ovulation dysfunction, in which the woman does not release an egg every month in the normal time frame. Cycles that are over 35 days in length, irregular cycles or no cycles at all resulting in no menstrual periods fall into the category of ovulation dysfunction. The most common cause of ovulation dysfunction is Polycystic Ovary Syndrome or PCOS, but other causes include hormonal abnormalities such as thyroid disease and over- production of prolactin. Also women who are thin, exercise heavily, or are under a lot of stress may develop ovulation dysfunction. The workup and treatment of ovulation dysfunction will be discussed further in the website in the section on fertility workup and ovulation induction.
Tubal factor is another common cause of infertility in which one or both fallopian tubes are blocked or damaged. The fallopian tubes are responsible for picking up the egg that is released from the ovary at ovulation, and it is the site where the egg is fertilized by the sperm. The fertilized egg or embryo is then transported by the fallopian tube into the uterine cavity, where it can implant and form a normal pregnancy. If the tubes are blocked or damaged, the normal pick-up, fertilization or transportation process can be obstructed, leading to either infertility or ectopic (tubal) pregnancy. The most common causes of damage to the tubes include infections such as chlamydia and gonorrhea, as well as, endometriosis, a common disorder in which uterine lining tissue flows back through the fallopian tubes and implants behind the uterus, on the ovaries or the tubes. Inflammation from endometriosis can cause scarring or adhesions around the tubes or can result in the complete blockage of one or both tubes. Additionally, any prior pelvic surgery can cause tubal adhesions or blockage. The workup and treatment of tubal factor is discussed further in this website in the sections on the workup of infertility.
Male factor refers to when the sperm count, motility (percent swimming), or morphology (percent normal shape), prevent sufficient sperm from getting to the fallopian tubes and fertilizing the egg. Up to 35% of couples with infertility suffer from some degree of male factor. Male factor is determined by the evaluation of a semen analysis or sperm count. If abnormal, an examination with an urologist is often advised. Treatments including intra-uterine insemination (IUI), in which sperm is concentrated and placed into the uterus through a simple vaginal exam, or Intra-cytoplasmic sperm injection (ICSI), an IVF procedure in which a single sperm is injected into an egg will successfully treat nearly all cases of male factor infertility. Details are discussed further in the sections on the workup and treatments offered for infertility.
Unexplained Infertility is the fourth main category of infertility causes. Unexplained infertility is assigned when all the initial testing for ovulation, tubal patency, and male factor return as normal. Unexplained infertility does not mean that there is no cause of the infertility. In fact, some of the most common occurrences associated with infertility would fall into this category, such as diminished ovarian reserve (low number of eggs), advancing reproductive age and endometriosis. Fertility treatment is quite successful for unexplained infertility, and the approach is often directed by the women’s age, ovarian reserve testing, and how long the couple has been trying to conceive. Common treatments include clomiphene citrate and IUI, letrazole and IUI, FSH injections and IUI, as well as, in vitro fertilization. All these treatments are reviewed in detail in the appropriate section on what we offer to patients.