Question 7: What are typical causes of infertility?

Being a fertility specialist is a bit like being a detective. You gather the evidence and then work on a hypothesis. Once you have the hypothesis, then you can test it out and see if the problem is resolved. Today I saw a new patient that was very frustrated with her situation and the response that she had gotten from her previous physicians. I listened carefully to her story and then explained carefully what I thought explained her particular problem. We now have a plan to test my hypothesis. If I am right then we will all be very happy, but I think that even if I am wrong then at least the couple understood how I approached the problem in a logical fashion.

Ultimately there are not that many fertility issues and common things are common. But every patient has their own story to tell and we need to listen in order to make sound decisions. So what types of problems do we deal with? Good question and the topic of today's Question of the Day from the upcoming 2nd Edition of 100 Questions and Answers about Infertility.


7. 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 leaving us to rely upon the descriptive components of the semen analysis. A complete semen analysis should include the total number of sperm (concentration), the percentage of those sperm that are moving (motility), and the shape of those 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 major fertility factor is reproductive aging. Peak fertility occurs when a woman is in her twenties, and it declines significantly during her thirties and forties. The rate of decline increases after the age of 35 as is evident in decreased IVF pregnancy rates and decreased embryo implantation rates in this age group.