In our previous blog we touched upon the statistics about infertility--- approximately 1 in 6 couples in the U.S. have issues pertaining to infertility. There can be many causes for infertility. The most common causes are listed below:
Advanced age of the female partner- A woman’s age has a profound impact on the chances of achieving a pregnancy. Women are born with a finite number of eggs and the egg number declines with increasing age along with a decrease in egg quality. Chances of pregnancy and live birth beyond age 43 are <1%. Lifestyle factors such as smoking can accelerate the decline in egg quality and quantity.
Anovulation – The lack of regular menstrual cycles is a sign of lack of appropriate ovulation. This is a very common cause of infertility. Many women with irregular cycles have polycystic ovary syndrome (PCOS). Other causes of cycle irregularity can be hormonal issues such as with thyroid or prolactin, diminished ovarian reserve, stress, hypothalamic causes, obesity, certain medications and some other conditions. The good news is that issues with ovulation are often easy to treat with simple medications such as the oral pill clomiphene citrate. If you have irregular cycles it is important to seek evaluation with your doctor.
Polycystic Ovarian Syndrome (PCOS) - This is one of the most common diseases responsible for infertility. There are several hormonal imbalances in this disorder, causing menstrual irregularities and anovulation. In many cases of PCOS, medication can help reverse this imbalance and help a woman achieve ovulation. Also, studies have shown that even an 8-10% reduction in body weight in obese women with PCOS can significantly improve metabolic parameters and response to treatment as well as chances of conception.
Blocked fallopian tubes – Tubal factor is another common cause of infertility. You may be ovulating normally and everything else checks out alright. However, a blockage in one or both of your uterine tubes can prevent sperm from reaching the egg. A blockage can be diagnosed with a hysterosalpingogram, or HSG. If tubal blockage is diagnosed, sometimes surgery can be undertaken to try and correct the anatomical abnormality, but often In-vitro fertilization is the best treatment.
Endometriosis - Endometriosis is the presence and growth of functioning endometrial tissue in places other than the uterus. Women with endometriosis have lower chances of conception per cycle than those without. However the chances of conception are significantly improved with fertility treatments. If you have a known diagnosis of endometriosis and have not conceived successfully after trying on your own (barring other issues) for 6 months, it is reasonable to request your doctor give a referral to see an infertility specialist.
Uterine abnormalities – There can be congenital or acquired abnormalities of the uterus such as a septum or intrauterine adhesions, fibroids, polyps etc which can hinder fertility or cause a miscarriage. These can be often diagnosed via an pelvic sonogram or hysterosalpingogram (HSG). Most infertility specialists will assess you for uterine abnormalities at the initial consultation and order testing as appropriate.
Male factor - About 30-40% of the time when a couple has infertility it is due to abnormalities with partner’s sperm. A semen analysis is a basic part of infertility evaluation and if abnormal treatment options can range form intrauterine insemination to in-vitro fertilization with intracytoplasmic sperm injection to donor sperm.
Unexplained infertility – Approximately 10% of couples have unexplained infertility where all the testing is negative. However the good news is that many couples are amenable to treatment and can achieve a successful pregnancy with some help.
The recommendations to seek care currently are that if a woman is under age 35 and has been trying for one year without success then it is best to seek an evaluation. In women over age 35, best to seek evaluation after 6 months of trying. Of course, if there are concerns prior to that time, it is always okay to see your obgyn or reproductive endocrinologist.
Rinku Mehta, M.D.
St. David's Women's Center of Texas