Curious about fertility
Under 35 and trying to get pregnant
Ready to talk to a fertility specialist
Common reasons for infertility
Concerned that something is wrong?
Maybe you and your partner are wondering if something is wrong. After all, you may have been trying to conceive for a while without any luck. It may be helpful to review some basic biology of fertility and conception. Or maybe you're not having intercourse at the right time during the female partner's reproductive cycle. Monitoring the basal body temperature (BBT) or cervical mucous changes will help to estimate ovulation times.
On the other hand, something physical may be wrong. What follows is an overview of conditions that may negatively affect the fertility of males and females. As you read, don't jump to conclusions and self-diagnose. If you suspect something, you should talk to your health care provider or a fertility specialist.
Seek help (find a fertility clinic near you) if:
When it comes to fertility, the hormonal control of the menstrual cycle can be extremely complex. Below is a short list of conditions that can cause fertility problems. If you're concerned that one of them may affect you, seek help from a fertility specialist. The good news is that treatments may be available for many of these conditions.
Approximately 33% to 50% of all infertile women have problems with ovulation. The normal ovarian cycle is so complex that even small changes may disrupt the cycle and prevent ovulation.
In the majority of cases, the problem is caused by hormonal imbalances (e.g., not having enough of a certain hormone or not releasing a hormone at the right time). Often this may be caused by improper communication between the hypothalamus in the brain and the pituitary gland. Sometimes, abnormal ovulation may also be associated with extremely low body weight or with being overweight, as well as any significant change in weight (loss or gain).
A woman's fertility naturally declines as she gets older.
If you're 35 or older, and you've been unable to conceive after 6 months of unprotected, regular intercourse, seek help from a fertility specialist (use the clinic locator to find a fertility clinic near you). Women over 37 do not need to wait 6 months before seeing a doctor because waiting too long to seek help could harm their chances of conceiving.
Adhesions in the pelvic cavity may occur following pelvic surgery for treatment of fibroids, ovarian cysts, or anatomical problems with reproductive organs. Adhesions can also be associated with endometriosis.
Intrauterine adhesions may be caused by trauma to the uterine cavity, such as dilation and curettage (scraping away of tissue or growth, sometimes because of a previous abortion). They may also be caused by prolonged use of an IUD and infections of the endometrium, although these causes are less common.
Blocked fallopian tubes
Treatment of tubal problems or pelvic scarring may require specialized surgery, depending upon a woman's situation. To determine whether the fallopian tubes are blocked, doctors can use a hysterosalpingogram (HSG). In this procedure, X-rays are taken after a radiopaque dye is injected through the cervix. The dye outlines the interior of the uterus and fallopian tubes. This procedure is performed shortly after a woman's menstrual period ends.
Cervical mucus problems
The cervical mucus may also be hostile to sperm: Some women have substances called antibodies (produced by the immune system) within their cervical mucus that kill sperm. Infections of the cervix can also make the mucus hostile to sperm. If your doctor thinks cervical mucus problems may be an issue, you may be asked to undergo a post-coital test. This test, which is done after intercourse around the time of ovulation, looks at the cervical mucus to see if it is too thick or if it is hostile to sperm. If so, your doctor may recommend intrauterine insemination (IUI), a procedure that inserts the sperm directly into the uterus so that they don't have to cross the cervical mucus.
Although fibroids are common, only about 3% of infertility is caused by fibroids. Most fibroids are very small and don't have an effect on the ability to conceive. In some cases, they can cause no symptoms. In others, they can cause abnormal menstrual patterns or difficulty with conceiving.
When fibroids push into the cavity of the uterus, they can make it problematic for the embryo to implant in the uterine wall.
Polycystic ovarian syndrome (PCOS)
There are different types of congenital (condition you are born with) uterine malformations. Many uterine malformations can be traced all the way back to the fetus. Early in a pregnancy, a female fetus develops a tubular system called Müllerian ducts. These ducts are supposed to fuse together to form a uterus in the fetus. If this fails to happen, the female can be born with a malformed uterus.
A bicornuate uterus is the most common congenital uterine malformation. The uterus, instead of being pear-shaped, is formed like a heart. Inside, there's a wall that gives the embryo less space to grow than in a normally shaped uterus. A septate uterus is a uterus that is divided by a wall on the inside. In some cases, this wall can extend the entire length of the uterine cavity to the cervix.
Depending upon the location of treatment and the medication and dosage used, chemotherapy and radiation can contribute to difficulty conceiving. If you are diagnosed with cancer and are interested in understanding options in fertility preservation, speak to your oncologist or contact a fertility specialist right away.
Learn more about how your lifestyle could affect your fertility.
There are many reasons why a man may have difficulty with fertility. Fortunately, once diagnosed, some of these causes may be treatable.
If you have any concerns about your health or about any of the following conditions, you should talk to your health care provider or a fertility specialist as soon as possible.
Many fertility problems can be related to sperm disorder. Of the millions of sperm normally deposited into the vagina, only a few hundred will get close to the egg and have a chance to fertilize it. Several factors play a role in determining whether or not the sperm will succeed:
A deficiency in any of these factors may cause fertility difficulties. Although sperm count is important, sperm motility and forward progression appear to be even more crucial in determining the likelihood of sperm fertilizing the egg. Despite a low sperm count, many men with high-quality sperm may still be fertile. A simple semen analysis can be done at your doctor's office to determine sperm quality.
A variety of conditions can play a role in causing sperm disorders.
Sexually transmitted infections (STIs)
Medical conditions, lifestyle, and environmental factors
Retrograde ejaculation may be a side effect of medications used to relax the muscles of the urinary tract for various purposes. These medications may cause the bladder sphincter to relax as well and to fail to contract fully. Other types of medications that may be associated with this side effect include antidepressants and antipsychotics.
Retrograde ejaculation can also be a complication of diabetes, especially for people with long-term poor blood sugar control. This is due to damage of the nerve supplying the bladder sphincter.
Retrograde ejaculation may cause a couple to experience infertility, as most sperm do not get to the vagina and the rest of the female reproductive system.
Erectile dysfunction (ED)
ED may be treatable at any age, and awareness of this fact has been growing. Many men have sought help and returned to normal sexual activity after speaking to their doctor and finding an appropriate treatment.
Lifestyle and environmental factors
Diseases, drug use, and medications
Smoking, alcohol, and drug use may also have a negative effect on man's fertility.
Learn more about how your lifestyle could affect your fertility.
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