Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of frequent unprotected intercourse, about 90 percent of couples will become pregnant. The majority of couples will eventually conceive, with or without treatment.

The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms.

Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. Fortunately, there are many safe and effective therapies for overcoming infertility.

When to see a doctor

In general, you may consider seeing a doctor about infertility if you and your partner have been trying regularly to conceive for at least one year.

Infertility problems can be present from birth (congenital) or something can go wrong along the way that results in infertility.

The reasons for infertility can involve one or both partners. In general:

  • In about one-third of cases, the cause of infertility involves only the male.
  • In about one-third of cases, the cause of infertility involves only the female.
  • In the remaining cases, the cause of infertility involves both the male and female, or no cause can be identified.

In order to undertstand the caues of infertility, we need to understand how the normal pregnancy happens.

unprotected vaginal intercourse, during which a man successfuly ejaculates sperm into the vagina or sometimes at the vulva. The sperm can then travel up through the cervix, into the uterus, and, if an egg is present, the sperm may fertilize it.  

So, the Causes of male infertility may include:

  • Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region. Enlarged veins in the testes can increase blood flow and heat, affecting the number and shape of sperm.
  • Problems with the delivery of sperm due to sexual problems, such as premature ejaculation, semen entering the bladder instead of emerging through the penis during orgasm (retrograde ejaculation), certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the part of the testicle that contains sperm (epididymis), or damage or injury to the reproductive organs. Men who have previously undergone a vasectomy and desire a return of fertility will also need to either have the vasectomy reversed (see ‘vasectomy reversal’ below) or have sperm retrieved through a surgical procedure for use in assisted reproductive techniques.
  • Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, marijuana, and steroids (including testosterone). In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate the testicular temperature, impairing sperm production.
  • Damage related to cancer and its treatment, Treatment for cancer and removal of one testicle due to cancer also may affect male fertility.

Causes of female infertility may include:

  • Ovulation disorders, due to hormonal disorders such as polycystic ovary syndrome, a condition that might relate to your ovaries producing too much of the male hormone testosterone, and hyperprolactinemia, when you have too much prolactin — the hormone that stimulates breast milk production.
  • Primary ovarian insufficiency, also called early menopause, when the ovaries stop working and menstruation ends before age 40.
  • Uterine or cervical abnormalities, including problems with the opening of the cervix or cervical mucus, or abnormalities in the shape or cavity of the uterus. Benign tumors in the wall of the uterus that are common in women (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids may distort the uterine cavity interfering with implantation of the fertilized egg.
  • Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, usually caused by sexually transmitted infection, endometriosis or adhesions.
  • Endometriosis, which occurs when endometrial tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
  • Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.

Other causes in women include:

  • Thyroid problems. Disorders of the thyroid gland can interrupt the menstrual cycle or cause infertility.
  • Cancer and its treatment. female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman’s ability to reproduce.
  • Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, Cushing’s disease, sickle cell disease, kidney disease or diabetes, can affect a woman’s fertility. Also genetic abnormalities can make conception and pregnancy less likely.
  • Certain medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped.

Risk factors

Many of the risk factors for both male and female infertility are the same. They include:

  • Age. Over age 40 women and men will become less fertile.
  • Tobacco use. A couple’s chance of achieving a pregnancy is reduced if either partner uses tobacco. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and low sperm count in men.
  • Alcohol use. Alcohol use increases the risk of birth defects, and it may also make it more difficult to become pregnant. For men, heavy alcohol use can decrease sperm count and motility.
  • Being overweight. an inactive lifestyle and being overweight may increase the risk of infertility for both men and women.
  • Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
  • Exercise issues. Lack of or not enough exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

Tests and treatment trial periods for infertility may extend over several months and can be expensive and uncomfortable. And there’s no guarantee — even after all the testing and counseling — that conception will occur.

Tests for men

You may have a general physical exam. This includes an examination of your genitals. Specific fertility tests may include:

  • Semen analysis. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container.
  • Hormone testing. A blood test to determine the level of testosterone and other male hormones is common.
  • Transrectal and scrotal ultrasound. Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.
  • Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
  • Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy will tell if sperm production is normal.
  • Other testing. In some cases, other blood or semen tests may be recommended to try to determine why the sperm may not be able to effectively fertilize the egg.

Tests for women

For a woman to be fertile, her ovaries must release healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and allow the sperm to join the egg for fertilization. The fertilized egg must travel on to the uterus and implant in the lining. Tests for female infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam. This includes a regular gynecological exam. Specific fertility tests may include:

  • Ovulation testing. A blood test is performed to measure hormone levels to determine whether you’re ovulating,
  • Other hormone tests check levels of ovulatory hormones, as well as thyroid and pituitary hormones that control reproductive processes.
  • Imaging tests. Pelvic ultrasound can be also done to check for fibroids for example
  • Hysterosalpingography evaluates the condition of your uterus and fallopian tubes. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal. Blockage or other problems often can be located.
  • Ovarian reserve testing. is done to determine the quality and quantity of the eggs available for ovulation.
  • Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. Laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
  • Genetic testing. Genetic testing helps determine whether there’s a genetic defect causing infertility.

Not everyone needs to have all of these tests before the cause of infertility is found. Which tests are used and their sequence depend on your case.

I wish you the best of health!

Alyaa Gad