What Causes Infertility?

Your path toward fertility

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Understanding infertility

 
  • Understanding infertility
  • Determining treatment
  • Questions to ask
  • Additional resources

Understanding what can cause infertility

Your fertility care team will assess your test results and medical history and create a personalized fertility plan designed for you. Your individualized treatment plan will be determined by what might be contributing to infertility and designed to address issues you or your partner may have.

Many factors can contribute to infertility in both female and male patients.

In female patients, potential factors include:

  • Polycystic ovary syndrome (PCOS)—a condition in which the ovaries produce higher than normal amounts of male hormones. PCOS is one of the most common causes of female infertility
  • Uterine fibroids—noncancerous growths that can form in and around the uterine wall
  • Endometriosis—occurs when tissue that normally lines the inside of the uterus is found in other places, like the fallopian tubes, and can cause scarring and blockages

In male patients, potential factors include:

  • Infection, such as gonorrhea or HIV
  • Injury, from surgery or trauma, which may cause anatomic changes or blockages
  • Toxin exposure, such as benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials, lead, or heavy metals
  • Hormone imbalances, such as disorders affecting the testicles themselves, or hypothalamus, pituitary, thyroid, or adrenal glands

Infertility can also arise from lifestyle factors such as drug, alcohol, and tobacco use, as well as being overweight or underweight.

Determining your treatment plan
Treatment plans will depend on the cause(s) and duration of infertility, as well as other factors, including your age, concerns, and preferences. Some treatment options may include:
A laparoscopic procedure

A laparoscopy is a minimally invasive surgery that allows a doctor to look internally at the pelvis, including reproductive organs, with a camera for the possible cause of infertility. In some cases, they may be able to repair abnormalities during the procedure.

Hormonal therapy

Exogenous hormone therapy

Exogenous hormone therapy involves providing your body with hormones, to help address any abnormalities.

Controlled ovarian stimulation, or COS

Controlled ovarian stimulation is a part of in vitro fertilization, or IVF. The goal of COS in IVF is to help multiple eggs (also known as oocytes) mature, prevent premature ovulation, and retrieve eggs for fertilization.

Intrauterine insemination, or IUI

Intrauterine insemination is a procedure in which healthy sperm is placed directly into the uterus around the time of ovulation.

  • Sperm can be from a partner or a donor
  • Sexual intercourse is not necessary

An IUI can be done in an office or a clinic.

Assisted reproductive technology, or ART

Assisted reproductive technology, or ART

Assisted reproductive technology involves using technology to manipulate both the egg and sperm before embryo transfer. In vitro fertilization, or IVF, is a form of ART.

IVF involves combining sperm and egg in a lab and implanting it in the uterus, which is known as an embryo transfer.

ICSI, or intracytoplasmic sperm injection, is another form of ART. With ICSI, a single sperm is injected directly into the center of an egg. Once fertilized, the embryo may be transferred into the uterus.

Preimplantation genetic testing, or PGT

Preimplantation genetic testing or screening (PGT or PGS) involves testing a small number of cells in embryos for genetic abnormalities. Once the eggs are fertilized, the lab retrieves a few cells to test the DNA.

PGD, or preimplantation genetic diagnosis, is a screening test similar to PGT or PGS that your reproductive team may suggest if you have a family history or previous history of genetic disease that might be passed on. PGD can screen for numerous genetic conditions.

Egg or embryo preservation

Egg freezing

Depending on where you are in your fertility experience, your team may suggest egg freezing. Egg freezing involves harvesting eggs from the ovaries and storing them, unfertilized, for later use.

These eggs can be thawed, combined with sperm, and implanted at a later date via IVF.

Embryo freezing, banking, and testing

Similar to egg freezing, embryo banking involves freezing, but in this case, it’s embryos. Your reproductive team will harvest your eggs or use donor eggs, and combine them with a partner or donor sperm. The embryos are then frozen for implantation at a later date.

Using a donor

Donor egg, sperm, or embryo

In some instances, individuals may use a donor egg, donor sperm, or a donated embryo as part of the fertility process. Donor eggs (retrieved from a donor female) and donor sperm (retrieved from a donor male) can be used in creating an embryo. A donor embryo is an embryo created with both donor sperm and a donor egg.

Donor sperm may be used for IUI or IVF, while donor eggs or donor embryos are used only in IVF.

Preimplantation genetic testing, or PGT

When using donor eggs or an embryo, it’s likely that you will do preimplantation genetic testing. This allows your fertility team to choose the most viable embryos for IVF.

Gestational carriers

For some people or couples, additional options are considered when looking to expand their family, including gestational carriers.

With gestational carriers, someone agrees to carry a baby physically for someone else. There are two types of gestational carriers—a typical gestational carrier who carries the embryo(s) from the intended parents, and a surrogate who provides the egg and carries the baby. Prior to working with a gestational carrier, all parties may be required to undergo additional screenings.

Keep in mind that everyone’s fertility journey is personal. Your plan of action and treatment options may look different than someone else’s.

Fertility Treatments and Options Vary With Each Person

Questions to ask about fertility treatments

Stay informed and consider these questions to ask

You may have a lot of questions about the treatment stage of your fertility journey. Here are some helpful questions to ask your fertility care team when discussing treatment options:

  • Will all my procedures be done here?
  • Are there differences in the success rates of various treatments?
  • What is an egg retrieval/embryo transfer?
  • What are the side effects of the treatments we’re discussing?
  • Will assisted reproductive technology, including in vitro fertilization (IVF), decrease my overall egg reserve?
  • What is the time commitment (eg, will I need to take time off work)?

Additional resources

Society for Assisted Reproductive Technology (SART)

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The American College of Obstetricians and Gynecologists (ACOG)

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Family Equality

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