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The causes of infertility can be complex and often both partners will require treatment. In fact, almost half of all infertile couples have a “male infertility component” making the semen analysis one of the most valuable fertility tests.
We discuss the major causes of infertility throughout the Web site. This page links to others with a more detailed description of each condition.
Reproduction requires that many complex processes occur, including:
- The male must produce sufficient sperm of acceptable quality to cause fertilization.
- The sperm must be ejaculated into the female’s vagina.
- Once ejaculated, the sperm must swim in the cervical mucus into the uterus and to the end of the fallopian tube where fertilization occurs.
- The male gametes (sperm) must be genetically “normal” and able to penetrate and fertilize an egg.
Abnormalities in any of the above processes can lead to male sub-fertility. Please read the section on "Male Infertility."
A complete evaluation of the female must be undertaken to rule out all potential causes of infertility. This is one of the best means to control infertility treatment costs.
- The female must produce
follicle stimulating hormone (FSH), which causes recruitment
of a follicle, which contains an egg.
- As healthy follicles develop they produce estrogen which helps prepare the endometrium.
- The hypothalamus most monitor hormone levels and produce gonadotropin releasing hormone (GnRH), which stimulates the pituitary to produce FSH.
- The lining of the uterus (endometrium) must thicken and become more vascular to accept a developing embryo.
- The uterus must be free of obstruction by fibroids and/or polyps.
- Progesterone is produced during the luteal phase of the cycle and is necessary to prepare the endometrium. It is first produced by the corpus luteum (the leftover follicle), and later by the placenta to help support a pregnancy.
- Once the follicles are mature, the hypothalamus must signal the pituitary to release a surge of luteinizing hormone (LH), which causes ovulation.
- The “ovulated egg” must travel unimpeded from the ovary to the end of the fallopian tube where fertilization occurs.
- The egg and sperm combine to produce an embryo. Both gametes must be “genetically normal”. When the eggs are "too old" our donor egg program is often the best option.
- Once an embryo is formed, it must implant in the endometrial lining.
- The implanted embryo is supported by the hormone progesterone produced by the placenta.
- The mother must be physically capable of carrying a pregnancy to term.
Failure of any one of these processes can lead to infertility. The major causes of infertility are categorized according to these biologic steps. Treatment for most infertility conditions does not include IVF, which is necessary in a small percentage of patients. When IVF is required our IVF success rates are among the highest.
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