We divide the causes of infertility into ten categories:
Ovulatory Disorders and Infertility
Ovulation may not occur, or it may be irregular. These conditions are often treated with medications including Clomid, Femara or FSH. Ovulation is documented using ultrasound, progesterone levels, and other methods. PCOS is included in this category. Clomid may be a first line fertility drug to regulate ovulation. FSH (Gonal-F, Follistim, Repronex, Menopur, Bravelle) is usually the next treatment step.
Ovarian Failure and Infertility
Ovarian failure results when the eggs loose their ability to fertilize and develop normally, usually as a result of age. However, premature ovarian failure occurs in younger women. Oftentimes, our donor egg program is the only option for these women.
Tubal Disease Infertility
Tubal disease- The eggs must be able to pass through the fallopian tubes. If the tubes are damaged by endometriosis, infection, scarring from previous surgery, or other reasons, the eggs cannot make their passage. The fallopian tubes are evaluated using the hysterosalpingogram and/or laparoscopy.
Uterine Disease and Infertility
The developing embryo must embed in the endometrium and continue its growth as a fetus. If the uterus is abnormally shaped, or has large fibroids or polyps, the embryo may be unable to continue normal growth. A woman with a severely damaged uterus may have to use a surrogate mother. The uterus is often evaluated using hysteroscopy.
Cervical Factor Infertility
The sperm must be able to swim in the cervical mucus to make their passage to the uterus. If the mucus has poor consistency, the sperm will be unable to reach the eggs. Cervical mucus may also contain antisperm antibodies, which destroy sperm as if they were bacteria or viruses. The post coital test is used to evaluate the interaction of sperm with the cervical mucus.
Endometriosis and Infertility
Endometriosis is a very common cause of infertility. It can attach to the reproductive organs, including the ovaries, tubes, and uterus causing blockage, inflammation, and even organ penetration. An endometrial biopsy may be performed to evaluate endometrial development. Endometriosis may be treated with fertility drugs (Lupron) and/or laparoscopic surgery.
Luteal Phase Defect
The endometrium thickens and develops during the luteal phase of the cycle as a result of stimulation by progesterone and estrogen. If an endometrial biopsy shows the endometrium “to be out of phase” external progesterone may be administered.
Male Factor Infertility
The male must be able to produce enough sperm of adequate quality to cause fertilization. The semen analysis examines sperm for several characteristics including their number, shape, swimming ability, consistency of the semen, and other characteristics.
Miscarriage/Genetic Factors and Infertility
Sometimes, for reasons unknown, the egg and sperm will combine to yield an abnormal number of chromosomes in the embryo, known as aneuploidy, which can lead to miscarriage. The chromosomes may also be broken or have other abnormalities which can lead to miscarriage.
Unexplained Infertility
Sometimes all fertility tests performed on both partners are normal and no cause for their infertility can be found. There is certainly a cause, but science has not advanced to the point where it can be identified. This is typically termed unexplained infertility. We discusses in detail all of the causes of infertility and their treatments. The best news is that the majority of couples (>80%) who seek care from a fertility specialist, reproductive endocrinologist, will become pregnant.