Medically reviewed by Amanda Kallen, MD — By Yvette Brazier — Updated on February 14, 2023.
Doctors generally define infertility as not conceiving after 12 months of regular sexual intercourse without birth control. Possible causes include a low sperm count in males and ovulation disorders in females.
What is infertility?
Infertility is when a male or female cannot conceive due to a problem with the reproductive system of either partner.
Infertility can be primary or secondary. Primary infertility is when someone is not able to conceive at all. Secondary infertility is when someone has previously conceived but is no longer able to.
This article explains infertility’s causes, types, and treatment, as well as other things a person may wish to know about infertility in both sexes.
Infertility is defined as the inability to get pregnant after 12 months of trying. Any person of either sex who fits this definition is experiencing infertility.
Causes in males
The following are common causes of infertility in males:
Problems with semen and sperm
Semen is the milky fluid that the penis releases during ejaculation and consists of fluid and sperm. The fluid comes from the prostate gland, the seminal vesicle, and other sex glands. The sperm is produced in the testicles. When the ejaculate comes out of the penis, semen helps transport the sperm toward the egg.
Things that can make it more difficult for sperm to fertilize the egg include having a sperm count below 15 million, low sperm motility, or sperm that have an unusual shape and a harder time fertilizing the egg.
About 2% of males may have these types of issues with their sperm. They can result from:
A medical condition: This could be a testicular infection, cancer, or a surgery.
Overheated testicles: Causes include an undescended testicle, a varicocele, a varicose vein in the scrotum, the use of saunas or hot tubs, wearing tight clothes, and working in hot environments.
Ejaculation disorders: If the ejaculatory ducts are blocked, semen may be ejaculated into the bladder.
Hormonal imbalance: Hypogonadism, for example, can lead to a testosterone deficiency.
Other causes may include :
Genetic factors: A male should have an X and Y chromosome. If a person has two X chromosomes and one Y chromosome, as in Klinefelter syndrome, the testicles will develop abnormally, and there will be low testosterone and a low sperm count or no sperm.
Mumps: If this occurs after puberty, inflammation of the testicles may affect sperm production.
Hypospadias: With this congenital anomaly, the urethral opening is under the penis instead of at its tip. Doctors usually surgically correct this condition during infancy. If the correction is not done, it may be harder for the sperm to reach the female’s cervix. Hypospadias affects about 1 in every 200 newborn boysTrusted Source in the United States.
Cystic fibrosis: This is a chronic disease that results in the creation of sticky mucus. This mucus mainly affects the lungs, but males may also have an absent vas deferens. The vas deferens carries sperm from the epididymis to the ejaculatory duct and the urethra.
Radiation therapy or chemotherapy: These treatments can both impair sperm production. In the case of radiation therapy, the severity usually depends on how near to the testicles the radiation occurred.
Other diseases: Conditions that are sometimes linked to lower fertility in males are anemia, Cushing’s syndrome, diabetes, and thyroid disease.
Medications: Some medications increase the risk of fertility problems in males. These include sulfasalazine (Azulfidine) and anabolic steroids.
Causes in females
Infertility in females can also have a range of causes.
Problems with ovulation
Ovulation disorders make up about 25% of infertility cases in females. Ovulation is the monthly release of an egg. The eggs may never be released, or they may only be released in some cycles.
Ovulation disorders can occur due to:
Hyperprolactinemia: If prolactin levels are high and the female is not pregnant or breastfeeding, it may affect ovulation and fertility.
Thyroid problems: An overactive or underactive thyroid gland can lead to a hormonal imbalance that interferes with ovulation.
Polycystic ovary syndrome (PCOS): This is a hormonal condition that can cause frequent or prolonged menstruation and can interfere with ovulation.
Problems in the uterus or fallopian tubes can also prevent the egg from traveling from the ovary to the uterus, or womb. If the egg does not travel, it can be harder to conceive naturally.
Other causes include:
Chronic conditions: These include AIDS or cancer.
Primary ovarian insufficiency (POI): The ovaries stop working normally before the age of 40 years.
Poor egg quality: The quality of the eggs may interfere with conception. As a female ages, the number and quality of the eggs declines. Eggs that are damaged or develop genetic abnormalities may also not be able to sustain a pregnancy. The older a female is, the higher the risk.
Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
Submucosal fibroids: Benign or noncancerous tumors occur in the muscular wall of the uterus. They can interfere with implantation or block the fallopian tube, preventing sperm from fertilizing the egg.
Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body.
Tubal ligation: In females who have chosen to have their fallopian tubes blocked, the process can be reversed, but the chances of becoming fertile again are not high.
There are certain risk factors that can increase the chance of infertility for both sexes. These include:
Smoking: Smoking significantly increases the risk of infertility in both sexes, and it may undermine the effects of fertility treatment. Smoking during pregnancy increases the chance of pregnancy loss. Passive smoking has also been linked to lower fertility.
Chemotherapy: Some chemotherapy drugs can result in ovarian failure or significantly reduce sperm count.
Radiation: If this is aimed near the reproductive organs, it can increase the risk of fertility problems.
Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a female and cause inflammation in a male’s scrotum. Some other STIs may also cause infertility.
Age: The female’s ability to conceive may start to fall gradually before or around the age of 35 years while male fertility starts to fall after the age of 40 years.
In addition, other factors may also be associated with infertility, though in many cases, the research is still insufficient. These include:
Narcotics: Consumption of drugs such as cannabis or cocaine can lower the sperm count. Some females who use cannabis or cocaine may also have fertility problems.
Exposure to certain chemicals: Some pesticides, herbicides, metals (such as lead), detergents, and solvents have been linked to fertility problems in both sexes.
Obesity: This may reduce the chance of conceiving for both sexes.
Stress: Stress can be a factor, especially if it leads to reduced sexual activity. It can also affect female ovulation and male sperm production.
Exercise: Too much and too little exercise can lead to fertility problems in both sexes. In males, it can affect the sperm count.
Nutrition: An unhealthy diet can impact fertility in males and females. If an eating disorder leads to serious weight loss, fertility problems may also arise.
Alcohol misuse: Excessive alcohol consumption may reduce sperm count. It may also interfere with the success of in vitro fertilization (IVF) treatments.
Treatment to help a person conceive naturally will depend on many factors, including the age of the person who wishes to conceive, how long infertility has lasted, personal preferences, and their general state of health.
Frequency of intercourse
The first strategy a couple trying to conceive may wish to try is having sexual intercourse more often around the time of ovulation.
Typically the menstrual cycle lasts for about 28 –32 days. Counting from the first day of the last period, a female will usually ovulate anywhere between day 11 and day 21.
Any person whose cycle is shorter than 21 days or longer than 35 days should see their doctor for an evaluation.
However, timing intercourse may not be sufficient on its own to help a couple conceive. Treatments will depend on the underlying cause of infertility.
In males, this can include medications for erectile dysfunction. Surgery may include a procedure to remove a varicose vein in the scrotum or repair a blocked epididymis.
In females, doctors can prescribe fertility drugs to regulate or induce ovulation. These can include clomiphene (Clomid, Serophene), letrozole (Femara), dopamine agonist medications, and a variety of hormonal drugs.
If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through. A person may also be advised to undergo IVF.
Doctors may also treat endometriosis with laparoscopic surgery. They make a small incision in the abdomen and insert a thin, flexible microscope with a light at the end, called a laparoscope. The surgeon can then remove implants and scar tissue, which may reduce pain and aid fertility.
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