Infertility

Ovulation disorders disrupt menstrual cycles, preventing you from ovulating entirely or interrupting the frequency with which you ovulate. They include:

• Polycystic ovary syndrome (PCOS): The most common cause of infertility in women, PCOS can disrupt the development or release of eggs.
• Hyperprolactinemia: Often related to hypothyroidism, this condition is when the body produces too much prolactin, a hormone that, at high levels, can disrupt ovulation.
• Hypothalamic dysfunction: The hypothalamus is a part of your brain that controls the pituitary gland, which controls the ovaries. It can cause missed periods.
• Primary ovarian insufficiency (POI): If you have POI, your ovaries stop functioning normally before age 40, and you may miss or have irregular periods.

Eggs from the ovaries travel through the fallopian tubes to reach the uterus. A man’s sperm fertilizes the egg inside the fallopian tubes. These tubes can become blocked or damaged for many reasons, including:

• Pelvic inflammatory disease (PID) or pelvic infection: PID occurs when a bacterial infection, such as chlamydia or gonorrhea, affects one of the reproductive organs, such as the fallopian tubes.
• Previous surgery: Abdominal surgeries, such as those to remove uterine fibroids or treat endometriosis, can create scar tissue that can cause infertility.

Endometriosis occurs when tissue resembling the uterine lining grows outside the uterus. It can affect fertility in many ways, including causing inflammation, creating scar tissue on the fallopian tubes, affecting hormones and limiting the ability of an egg to implant.

Many different genetic conditions can affect fertility. They might impact the structure of your reproductive system, disrupt ovulation, prevent an embryo from implanting or cause a miscarriage.

Turner syndrome, for example, is a genetic disorder that causes a missing X chromosome. It’s related to problems in the pituitary gland or the hypothalamus that limit sex hormones produced by the ovaries. It’s also linked to a genetic disorder that prevents the ovaries from developing properly.

Conditions that cause inflammation, scarring or structural problems in the uterus or cervix can prevent eggs from implanting or block the fallopian tubes. They include:

• Fibroids: Fibroids are tumors (typically noncancerous) that grow in your uterine walls.
• Intrauterine adhesions: Adhesions are bands of scar tissue that result from surgery or infections. They can develop in the uterus and cervix.
• Adenomyosis: This condition occurs when the lining of your uterus (endometrium) grows into the muscular uterine wall (myometrium).
• Congenital anomalies: Some females are born with missing or malformed reproductive organs. These conditions may not be diagnosed until a woman tries to conceive.

Issues with making, growing and delivering sperm are the most common causes of male infertility. Sperm disorders can affect the quantity of sperm as well as the quality. These disorders can result in:

• Azoospermia: This is a condition in which there are no sperm in a man’s semen, either due to a blockage or because the testes don’t produce enough sperm.
• Oligozoospermia: This is the medical term for low sperm count. Often, doctors can’t find a cause, but it can be related to various health conditions.
• Abnormally structured sperm: Sperm that are not shaped correctly may have a harder time penetrating the egg to fertilize it.

A common cause of infertility, varicoceles are swollen veins in the scrotum (the pouch of skin behind the penis that holds the testicles). While experts don’t fully understand the link between varicoceles and infertility, it’s possible that the buildup of blood in the veins can raise the temperature inside the scrotum, negatively impacting sperm production or count in the testicles.

Retrograde ejaculation occurs when semen travels backward into the bladder during ejaculation instead of going forward out of the penis. As a result, sperm cannot reach the egg. While uncommon, retrograde ejaculation can occur due to diabetes, certain medications and bladder or prostate surgery. Symptoms include low or no semen count during ejaculation.

Ejaculatory ducts typically empty sperm mixed with seminal fluid into the urethra and out of the body when you ejaculate. Blockages in these ducts can prevent the delivery of sperm. This condition is called ejaculatory duct obstruction, and it can exist at birth or develop due to cysts, scar tissue from pelvic surgery or damage to the urethra.

Ejaculatory duct obstruction is different from a vasectomy, which is a procedure that blocks the vas deferens, the tubes that carry sperm to the ejaculatory ducts, preventing sperm from entering the semen.

The hypothalamus and pituitary glands are hormone-producing (endocrine) glands in the brain. When they don’t function properly, you can develop a low sperm count or no sperm. These endocrine disorders and hormone imbalances include cancerous pituitary tumors, inherited disorders of the adrenal gland, exposure to too much estrogen or testosterone and Cushing’s syndrome. Men who use hormones such as testosterone often have reduced sperm production.

Certain health conditions can contribute to infertility, including:

• Diabetes: When your blood sugar levels are too high, you can develop testicular failure. Several studies have shown an association between diabetes and infertility in men.
• Cystic fibrosis: This inherited condition affects breathing and digestion. However, most males with cystic fibrosis are born without the vas deferens.

Genetic disorders that can cause low or no sperm production and abnormal development of the male reproductive organs include:

• Klinefelter syndrome: Males with this condition have an additional X chromosome, leading to low testosterone production.
• Y-chromosome microdeletion: Changes or deletions of genes in the Y chromosome affect sperm production and cause male infertility.
• Myotonic dystrophy: An inherited disorder that causes progressive muscle weakness, myotonic dystrophy can cause male hormonal changes that impact fertility.

Certain medications and treatments for cancer, epilepsy, depression, ulcerative colitis and other health conditions can affect male fertility.

• Testosterone replacement: While often used to treat hypogonadism (low testosterone levels), testosterone replacement therapy can lead to infertility.
• Chemotherapy: All chemotherapy drugs can damage the cells that produce sperm and can cause azoospermia, which can be temporary or permanent.
• Radiation therapy: Male fertility can decline with exposure to radiation.
• Surgeries: Procedures related to testicular and rectal cancers and those to treat prostate conditions may lead to the inability to ejaculate semen.

Your doctor will begin by asking about your health and sexual history. They will want to know about any medical conditions you have that could cause infertility, whether you’ve had any past pregnancies or miscarriages, and whether you’ve had any unusual menstrual symptoms. Tell your doctor when you started attempting to get pregnant and how often you’ve been trying.

Your doctor will examine you to assess your physical health. In addition to a standard physical exam, they may conduct a pelvic exam to check your uterus, ovaries and other reproductive organs for signs of problems.

Analysis of blood samples can measure the levels of hormones involved in reproduction and gauge your egg supply, among other functions.

During laparoscopy, your doctor will make a small incision in your lower belly and insert a scope that allows them to see your reproductive organs. They can check for damage, blockages in the fallopian tubes, endometriosis and other problems. Laparoscopy is often reserved for women who have difficulty getting pregnant and have pelvic pain and/or abnormal imaging tests.

During a hysteroscopy, your doctor will send a camera-equipped scope inside your vagina to examine your uterus.

Imaging tests provide additional insight into reproductive health and can help your doctor narrow the number of reasons why you’re struggling to get pregnant. Tests you may need include:

• Transvaginal ultrasound: This imaging test uses sound waves to create pictures of your pelvic organs. An ultrasound can show potential causes of infertility, such as uterine fibroids, polyps or reproductive organ abnormalities.
• Sonohysterography: Another type of ultrasound, this test uses saline, which your doctor injects into your uterus, to view problems, such as polyps or fibroids.
• Hysterosalpingography: Your doctor will use an X-ray machine to watch as contrast dye moves through your fallopian tubes. The test can show blockages that could affect fertility.

Also called a sperm count, a semen analysis can help determine if a problem with semen or sperm is the cause of infertility. You typically provide a sample by masturbating and collecting the semen in a container. The lab will then measure the quantity and quality of your semen and sperm.

Blood tests can measure your hormone levels, including testosterone, which can lead to reduced sperm production. Because hyperthyroidism is associated with low sperm count, your care provider may also order a thyroid-stimulating hormone test to measure the thyroid hormone level in your blood. Genetic testing using blood samples can also look for any abnormalities in your genes or chromosomes.

Often used to diagnose retrograde ejaculation, this test can check for sperm in urine.

A small tissue sample from the testicle can help determine how well it produces sperm.

Imaging tests can help evaluate male reproductive organs to determine potential causes of fertility issues. Tests you may need include:

• Scrotal ultrasound: Also known as a testicular ultrasound, this noninvasive test uses sound waves to look at the scrotum. It can help detect varicoceles and other issues affecting the testicles.
• Transrectal ultrasound: A small, lubricated rod is inserted into the rectum to look for any obstructions in the ejaculatory ducts that can cause infertility.