When a couple is struggling with infertility, the most urgent question on their minds is why. Infertility as a diagnosis is determined by the length of time you have been attempting to get pregnant. Primary infertility is diagnosed when a couple has failed to conceive after a year of unprotected sex. Secondary infertility is diagnosed when a couple is unable to conceive again after previously having one or two children.

“Infertility” is a broad concept, however, and answering the specific “why” in your case will require looking a little deeper at the underlying factors. There are many medical conditions and diseases that can impact fertility in both men and women. It is important to know that you are not alone. Problems with fertility affect about one in six men and women of reproductive age. Contemporary infertility medicine has a good understanding of most of these conditions, and there are some highly effective treatments and interventions available which can help most couples eventually conceive.

What are the common causes of male infertility?

While infertility has historically been considered a female concern, we now know that up to a third of cases involve male-factor infertility. Most male infertility is caused by a problem with the sperm, though physical issues that affect the process of ejaculation may also be an impediment to conception. The most common fertility issues faced by men are:

• Azoospermia: Defined as the complete absence of sperm in the semen/ejaculate, azoospermia is a condition that affects about 5% of infertile men. It can mean that no sperm is produced at all, but more commonly it is caused by an obstruction or blockage in the vas deferens which prevents the sperm from reaching the ejaculate.
• Oligospermia: Also known as a “low sperm count,” oligospermia means that few sperm cells are found in the ejaculate. Again, it may mean that few sperm are produced, or it could be caused by a partial blockage.
• Congenital absence of the vas deferens: Sometimes the tubes that transport sperm to the penis for ejaculation fail to develop before birth. Men with this condition may be producing sperm in the testes, but because it has no way to travel to the ejaculate, pregnancy is prevented.
• Varicocele: These enlarged varicose veins in the scrotum can prevent normal function in a number of ways, affecting sperm production, quality, and transport.
• Previous vasectomy: A many who has undergone a vasectomy who now wishes to conceive will need have the procedure reversed.

What are the common causes of female infertility?

There are many possible factors which can contribute to female infertility, and some women may deal with more than one at the same time. A patient may have problems conceiving at all, or may be dealing with recurrent pregnancy loss. Some of the most common infertility issues women struggle with are:

• Age: A woman’s age has a huge impact on her ability to achieve a healthy and successful pregnancy. Some experts would consider this the single most important determining factor. Around age 35 a woman’s egg quality and quantity begin to decline rapidly. She may be ovulating and menstruating regularly, but she still may be incapable of getting or staying pregnant.
• Menstruation problems/Infrequent ovulation: An irregular cycle can have a drastic impact on a woman’s ability to conceive. Ovulation is the release of a mature egg from the ovary, and it must occur for there to be a chance of pregnancy. Less frequent ovulation means less chances to get pregnant.
• Endometriosis: This painful chronic disease affects more than 5.5 million women in North America. Endometriosis is when the endometrial tissue which lines the uterus is found growing outside the uterus. These endometrial growths grow and bleed along with a woman’s menstrual cycle, causing pain and scarring. They are usually discovered inside the peritoneal cavity on the ovaries, fallopian tubes, uterus, bowels and bladder. The scar tissue that builds up through this condition can affect fertility by blocking the fallopian tubes, damaging the ovaries, or making it difficult for the body to maintain a pregnancy.
• Fallopian tube blockage/tubal disease: This issue is usually the result of scarring. As mentioned a condition like endometriosis can contribute to this issue. It can also be caused by a pelvic infection or an STD such as chlamydia, especially if the original infection was not properly treated. A history of an ectopic pregnancy, or of surgeries such as an appendectomy or the removal of removal of ovarian cysts can also be a factor.
• Fibroids or polyps: These are benign growths in the uterus. While generally harmless to the health of the woman, they can end up blocking the fallopian tubes. Fibroids can also lead to infertility by making it difficult for an embryo to implant in the uterus, and may cause repeated miscarriages.
• Polycystic Ovarian Syndrome (PCOS): This common hormonal imbalance affects 5 million women in America. It affects the development and release of eggs from the ovaries, and when left untreated it can result in irregular periods and a lack of ovulation.
• Premature Ovarian Failure (POF): This condition is diagnosed in women 40 years old or younger whose ovaries no longer function properly. It may be caused by chromosomal defects, certain cancer treatments, or unknown causes. A woman dealing with POF is unable to ovulate/release eggs and could potentially lose her reproductive capabilities

What should you do?

If you are worried about your ability to conceive, the best thing you can do is to be aware of the risks, and seek help early. If meet the following conditions, you should visit an infertility specialist:

• If you are a woman under 35 years of age and have been unsuccessful getting pregnant after one year of unprotected sexual intercourse.
• You are a woman over 35 and have been trying to conceive for over six months.
• You have undergone two or more miscarriages.
• You or your male partner have been diagnosed with a medical condition listed above.

Being diagnosed with infertility can be devastating, but it is only the first step towards getting help and finding out what is actually going on. Arriving at an answer will often require an in-depth investigation and careful testing. Information is power. Once the underlying issues are identified, there is cause for hope: your team will be able to use that information to put together a plan for action and move you towards your goal of bringing a baby home.