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Infertility 101

April 21- 27, 2019 is National Infertility Awareness week.

The topic of infertility is a very real matter for an estimated 6.1 million people, or 15% of couples, in the United States. Infertility is a condition of the reproductive system where there is an inability to achieve pregnancy after 12 months of regular, unprotected intercourse. For women over the age of 35, the number is reduced to 6 months of regular, unprotected intercourse. Recent statistics indicate that 1 in 8 women are challenged by infertility.  

Leading Causes in Women

The following is a brief synopsis of infertility causes found in women.

Reduction of Egg Quantity and Quality.

This process is also referred to as Diminished Ovarian Reserve. It means that the number of eggs that a woman has that are free from chromosomal defects are few. Many times, these defects are responsible for infertility, miscarriage, or congenital disorders. 


This is a disorder of the uterine lining (endometrium). The disorder causes endometrial tissue to grow on other parts of the reproductive system. This leads to the potential for cysts and/or other barriers to chances of fertility.

Ovulation/Glandular Disorders.

This category includes Polycystic Ovarian Syndrome (PCOS), a well-publicized hormonal disorder that causes irregular ovulation. Other disorders include problems with the hypothalamus, pituitary gland, and adrenal gland (such as Cushing’s syndrome or congenital adrenal hyperplasia).

Structural Issues.

Many benign growths, such as uterine fibroids and polyps, can be a culprit. Fibroids are fairly common; approximately 40% of women may have them. Submucosal fibroids are strongly correlated with reduced pregnancy rates. In some cases, removal of a submucosal fibroid/s solves infertility. Moreover, removal of polyps is also known to dramatically improve chances of fertility. Additionally, blocked or damaged fallopian tubes, abnormal anatomy of the cervix or uterus, and scar tissue can all also cause issues within the reproductive structure.

Additional Causes.

  1. Thyroid disorders

  2. Hormonal issues

  3. Certain Acute and Chronic diseases (e.g., Sickle cell disease, Kidney disease, Celiac disease, Diabetes)

  4. Poor diet

  5. Athletic overtraining

  6. Stress

  7. Over exposure to certain chemicals and toxins (e.g., tobacco smoke, alcohol, marijuana, pesticides, radiation, and chemotherapy)

  8. Certain medications

  9. Unexplained infertility

Leading Causes in Men

The following is a synopsis of the reproductive aspects that may affect sperm count or cause abnormal sperm function. These include:

  1. Undescended testicles

  2. Genetic defects/DNA damage

  3. Diabetes

  4. Prior bacterial or viral infections such as mumps or adenovirus

  5. Trauma or prior surgeries on the testicles or inguinal region

  6. Enlarged veins (varicoceles) in the testes that can increase blood flow and heat, both of which affect the number and shape of the sperm

  7. Exposure to chemicals like pesticides, radiation, and chemotherapy

  8. Alcohol use, marijuana use, and tobacco smoke

  9. Steroid use

  10. Overexposure to heat (such as in saunas and hot tubs)

  11. Surgical removal of one of the testicles due to cancer

Beginning Treatment

Treatment begins with fertility evaluations,  including a personal history and physical examination. For women, your doctor may also opt for a transvaginal ultrasound in order to evaluate the structure of your uterus, tubes, and ovaries. The ultrasound can detect uterine abnormalities, such as fibroids, polyps, distal fallopian tube occlusion, and ovarian cysts. Additionally, transvaginal ultrasounds provides your doctors with the opportunity to assess the approximate number of available eggs.

Other treatment may include laboratory testing to asses various hormone levels, such as:

  1. Estradiol or FSH: Related to ovarian function and overall egg numbers.

  2. TSH: assesses thyroid function.

  3. Prolactin: a hormone that can affect menstrual function, if elevated.

For men, a semen analysis is the main evaluation conducted to establish the quality of sperm. The analysis consists of four parameters: semen volume, sperm concentration, sperm motility or movement, and morphology or shape.

For questions or if you are seeking support during your fertility/reproductive journey, please contact the Amy Wine Counseling Center at (832) 421-8714.


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