Why are we not getting pregnant?

What is the problem? That question is at the heart of most of our initial consultations and yet sometimes even after extensive testing we still are not sure why a couple is infertile. Overall, it is important to remember that infertility is a disease of couples. Often the male partner is less than enthusiastic about his role in the testing process but more than half the time male factor infertility plays a role in the couple’s situation. I always tell the wives to check with their other half and inquire if obtaining a sperm sample is painful. Because if it is, then perhaps they had better see a urologist. In 11 years of practice I have never heard back that it was…

So what are we looking for in terms of causes? Well that is the Question of the Day from 100 Questions and Answers about Infertility, the book that makes a great holiday gift.

8. What are typical causes of infertility?


The causes of infertility are wide ranging but can be examined in light of the reproductive cycle described in Question 1. (See Table 1.)


In general, the causes of infertility can be equally divided between the male and female partners in a couple. Half of all infertility cases, therefore, involve problems with the sperm of the male partner. Unfortunately, functional tests for sperm competence (the ability of sperm to fertilize an egg) are not available. Thus, when assessing male-related fertility issues, a semen analysis determines the total number of sperm (concentration), the percentage of those sperm that are moving (motility), and the shape of the sperm (morphology). Many factors can reduce the female partner’s ability to conceive. For example, a woman may have anatomical problems related to the fallopian tubes, uterus, and peritoneal structures within the pelvis such as adhesions or endometriosis. Problems with ovulation are very common in infertile patients, and women with irregular periods may suffer from a common disorder such as polycystic ovarian syndrome (PCOS). Another factor often found in conjunction with infertility is reproductive aging. A woman’s peak years of fertility occur when she is in her twenties. A woman’s fertility declines significantly during her thirties and forties, with an especially rapid decline in fertility occurring after she passes age 35.