Infertility can be due to a problem in either the male or female partner or both. When there is an inability to conceive despite regular attempts for a period of 1 year, the first step is to identify the possible cause.
To become pregnant, each of the following factors is essential:
Problems with ovulation are common causes of infertility, accounting for approximately 25% of all infertility cases. Ovulation involves the release of a mature egg from one of your ovaries. If you have regular menstrual cycles, you are probably ovulating. Cycle lengths of approximately 24 to 34 days (from the beginning of one period to the beginning of the next period) are usually ovulatory. If you only have a period every few months or not at all, you are probably not ovulating or are ovulating infrequently.
These can be caused by hormonal problems either in the hypothalamus or the pituitary gland, or by problems in the ovary itself.
When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth and the surgical removal of it can cause scarring, which may obstruct the tube and keep the egg and sperm from uniting. It can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage.
In some instances, all tests appear normal and an apparent cause for infertility is never found. It’s possible that a combination of several minor factors in both partners underlie these unexplained fertility problems.
In approximately 40% of infertile couples, the male partner is either the sole or a contributing cause of infertility. Therefore, a semen analysis is important in the initial evaluation.
A semen analysis determines the volume (amount), sperm count, motility (movement), and morphology (appearance and shape) of the sperm. In general, two or three semen analyses may be recommended over two to six months, since sperm quality can vary over time. Other hormonal, imaging and genetic tests may be recommended as well depending on the type and severity of abnormalities found.
Delaying marriage and subsequent pregnancy is a common choice for today’s modern urban women. The number of women attempting pregnancy and having babies in their 30s and 40s has increased in the last decade.
All women must be aware of the normal aging process of the ovaries. Your fertility begins to decline significantly in your mid 30s and accelerates in your late 30s. Some women even begin to experience a decline in their fertility in their late 20s and early 30s.
Fertility declines with age because fewer eggs remain in your ovaries, and the quality of the eggs remaining is lower than when you were younger.
This decline in fertility with age is in itself a major contributor to reduced fertility. Moreover older women do not respond very well to treatment methods and treatment success reduces as age advances. (for more information please read the section on age and fertility)