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Infertility: Causes and Diagnosis

Infertility can be a challenging problem for many women.  The good news is that with the proper diagnosis and treatment there is hope for many couples who may currently have difficulty having children.

Infertility can be defined as a failure to achieve pregnancy after twelve months of unprotected intercourse or intrauterine insemination in women under 35 or for 6 months in women over 35.  

There are several probable causes of infertility.  These include: male infertility, a decreased ovarian reserve, ovulatory dysfunction, tubal factors, and uterine factors.  

How is Infertility Diagnosed?

First, medical providers want to understand where the infertility comes from, so diagnoses typically start by examining men and women. 

To understand whether male infertility is the cause, a doctor or other medical provider will conduct a basic medical history and do a semen analysis at the beginning of the work up.  This is something that can be done either by the woman’s OBGYN or the man’s treating medical provider. 

Diagnosing Male Infertility

This basic medical history for men typically includes: 

  • determining if the man has fathered any previous children (and when)
  • a history of childhood illnesses and other medical illnesses
  • a history of erectile/ejaculation issues
  • a history of prior surgery or prior trauma
  • a history of sexually transmitted diseases
  • a family history.  

Understanding these things can help the doctor make a decision among the available options. 

Diagnosing Female Infertility

The woman’s medical exam consists of: 

  • obtaining a weight
  • BMI
  • blood pressure
  • Pulse
  • determining a Tanner Stage (sexual maturity rating)
  • looking for signs of androgen excess
  • a pelvic exam with cultures
  • a thyroid exam  

There are some things that doctors and other medical providers used to do early on when determining causes of infertility which are no longer recommended as places to start.  Examples of these tests include: laparoscopy; advanced sperm function testing; postcoital testing; thrombophilia testing; immunologic testing; karyotyping (looking for chromosomal abnormalities); endometrial biopsies; and checking prolactin levels.  

Common Causes of Infertility in Women

A woman’s ovarian reserve declines with age. In fact, this decline is quite pronounced after the age of 35.  This means there are fewer eggs available.

Ovulatory dysfunction is the number one cause of infertility. Ovulatory dysfunction means ovaries are not working properly and producing eggs. The most common type of ovulatory dysfunction is Polycystic ovary syndrome (PCS). Your doctor or medical provider will run tests to determine if you have ovulatory dysfunction and possibly prescribe medications that may help.

Tubal factors can also contribute to infertility. Tubes can become blocked which means the eggs are not able to reach the uterus. Your doctor or medical provider can run tests, including a hysterosalpingogram, to determine if there is a tubal blockage and if so, recommend treatment options.

Finally, uterine factors can also contribute to infertility. Your doctor or medical provider may order tests like a pelvic ultrasound when looking for uterine problems. Some of the things your doctor or medical provider may test for include: endometrial polyps, adhesions or scar tissue within the uterus, uterine anomalies, and fibroids. Based on the results of these tests your doctor or medical provider will review available treatment options.

Ultimately 30% of infertile couples have no identifiable reason for the infertility.

Addressing Infertility

The good news is there are treatments for infertility.  Two of the most common ones are the medications Clomid and Letrozole.  These drugs help the ovaries produce and send eggs through the fallopian tubes to the uterus. Your OGA doctor or Nurse Practitioner can help you understand the possible causes of and treatments for infertility. Please call us at 208-888-0909 to schedule an appointment.  


*** This article is not intended to be medical advice and should not replace the advice of your treating medical professional.