There are a number of potential causes of infertility, and here at the Center for Reproductive Health & Gynecology, we understand that discovering the cause of your infertility is the first step to helping you on your way to achieving your dream of growing your family. Among the most common causes of infertility we see at our center are ovulation problems such as polycystic ovarian syndrome (PCOS), tubal disease, sperm problems, unexplained infertility, and endometriosis. For more information on these and other causes of infertility, we encourage you to read on. Then, contact the Center for Reproductive Health & Gynecology to schedule an infertility consultation.
Reproductive success is diminished with age. Women seem to have fewer chances of pregnancy above age 30. After age 30 the fertility potential decreases significantly and is very diminished above the age of 45.
Diminished Ovarian Reserve
It would be logical to assume that with age fertility rates are reduced, but even in some young women fertility rates diminish prior to age 30. To assess fertility potential and ovarian reserve, we suggest a thorough evaluation through hormonal testing ( E2/FSH, Inhibin B, Anti Mullerian Hormone ) and ultrasound evaluation for Antral Follicle Count (AFC) .
In more than 30% of cases, infertility presents itself in males, usually in the form of sperm problems. There are a number of factors that can contribute to sperm problems, including problems with the brain or pituitary gland, systemic disease or other medical conditions, and congenital abnormalities resulting in an abnormal count, motility, and morphology. There are some patients who have no sperm (azoospermia), which could be due to a mechanical blockage in the tubes that store and transport sperm from the testes (vas deferens). In rare cases, genetic abnormalities can result in a perfectly healthy male with abnormal semen analysis and fertility issues. Some men with genetic abnormality can present with no sperm.
Uterine adhesions, pelvic adhesions, fibroids, endometrial polyps, endometriosis, pelvic inflammatory disease (PID) can all contribute to infertility.
In some cases, the fallopian tubes become blocked or damaged, and this can prevent eggs from reaching the uterus or it can make it difficult for sperm to reach the egg. Tubal disease can be caused by a number of factors, such as infection, prior pelvic surgery, or endometriosis. In most cases, we can identify tubal issues with the help of an x-ray called HSG (Hysterosalpingogram). In some cases, a Laparoscopy is needed to repair or remove the damaged Fallopian tube.
In cases where the Fallopian tube is damaged beyond repair and dilated with a fluid collection (Hydrosalpinx), we recommend removal of the tube or what is blocking the tube pointing into the uterus (proximal tubal ligation). If a Hydrosalpinx is not treated, the fluid collection within the tube which is toxic to embryos, can leak into the uterine cavity and create a hostile environment for implantation. In Vitro Fertilization success rates are reduced by as much as 50% in such cases. A damaged Fallopian tube can also lead to pregnancies within the Fallopian tube (Ectopic Pregnancy).
When a couple fails to conceive after one year of unprotected intercourse and there is no apparent cause for this infertility (such as ovulation problems or sperm problems), we often refer to the situation as unexplained infertility.
At the Center for Reproductive Health and Gynecology in Los Angeles, we make every attempt to determine the cause of unexplained infertility, which could be caused by any number of factors, such as inefficient fertilization of eggs or lack of fertilization, slow division or stopped division of embryos, thick outer shell (zona pellucida) of the egg, or implantation failure. For more information about thickened outer shell (zona pellucida) and treatment, please visit the assisted hatching section of our website.
If you have been told that your inability to conceive is the result of unexplained infertility, we may be able to help you determine the cause or causes of infertility that pertains to your unique situation.
Chromosome abnormalities (karyotype issues) or specific gene disorders like Fragile X, can lead to depletion of ovarian reserve and fertility problems. These abnormalities can result in low fertility or increased risk of recurrent pregnancy loss and even the increased risk of affected babies (Mental Retardation and anomalies).
Medical conditions associated with infertility include many diseases like thyroid issues, gastrointestinal issues (eg. Celiac disease, Crohn's, ulcerative colitis, IBS), prolactin abnormalities, cancers, etc.
Many medical conditions affect fertility through loss of a balance needed in the body to become pregnant or carry a healthy pregnancy. A complete medical history is important to determine any other possible causes other than the most common and obvious ones.
Pregnancy rates decrease with an increase in BMI (body mass index) above 30. BMI abnormalities being extremely high or low can also affect fertility.
BMI = Weight in kilograms divided by height in meter) squared or to use pounds (lb) and feet instead of kilograms and meters, use the same formula, but multiply the weight by 4.88.
Normal BMI is between 18-25.
A healthy balanced diet is a requirement for a fully functional reproductive system. Anorexia or Bulimia patients do experience health and fertility issues.
Stress is one of the results of infertility, but in many cases can contribute to the condition. Patients need to recognize this fact and work with their fertility specialist to determine if therapy should be part of their total treatment.
There are a number of factors that can contribute to ovulation problems, and they may include stress, eating habits, nutritional supplements, thyroid disease or other medical conditions such as tumors or growths in the brain.
Polycystic Ovarian Syndrome (PCOS)
PCOS is a syndrome in which the ovaries are enlarged and have several small, painless cysts. PCOS can affect more than fertility: it can have an impact on menstrual cycles, hormone levels, and appearance in the form of acne, facial hair, and hair loss.
Symptoms of PCOS can vary widely from woman to woman and can be mild or severe. A woman with PCOS may experience one or more of the following symptoms:
- Alopecia (pattern hair loss)
- Excess facial and/or body hair (hirsutism)
- High cholesterol levels or high blood pressure
- Irregular or absent periods
- Ovarian cysts
- Skin tag
Some sexual dysfunction such as premature or retrograde ejaculation decreased libido, painful intercourse, or over exposure to certain environmental factors such as pesticides, toxins, chemotherapy or radiation can lead to infertility.
If you have been trying to have a child for more than one year with no success, it may be time to work with a specialist. Our team of infertility specialists have the experience and dedication necessary to get the answers you need. There are a number of options available to many couples who struggle with infertility. To learn more about the possible causes of infertility affecting you, contact the Center for Reproductive Health & Gynecology in Los Angeles to schedule a confidential consultation.