Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 31, 2016

Infertility is a reproductive condition that occurs in both men and women. Infertility is often a result of hormonal imbalances and problems in the anatomy or functioning of the male reproductive system or female reproductive system. Male infertility and female infertility sometimes necessitate the use of assisted reproductive technologies such as in vitro fertilization in order for conception to occur.


Definition & Facts 

Infertility is the inability to conceive despite attempts through sexual intercourse. It is considered a condition after attempts of at least a year. Studies by the Centers for Disease Control and Prevention show 11% of women who are of reproductive age (15-44) in the US have impaired fecundity (struggle conceiving) while 6% are infertile.

There is primary and secondary infertility. In primary infertility the patients have never conceived in their lifetime while secondary infertility affects men or women who have conceived before, but experience problems trying again.

Symptoms & Complaints

Many people realize they have infertility issues when they are not able to conceive. It is primarily the only evident sign without a diagnosis. There are other symptoms unique to either men or women of underlying conditions that cause infertility which should prompt medical diagnosis and treatment.

Women with infertility problems report changes in the menstrual cycle and ovulation. In most cases it is in the form of heavy menstrual bleeding or very light menstrual bleeding, shifting periods or no periods at all, and dysmenorrhea accompanied by pelvic pain and back pain.

When the cause of infertility is hormonal, women experience skin problems such as acne, fluctuating sex drive, hair loss and thinning of hair, weight gain, and for some women, facial hair growth.

Underlying causes of infertility that arise from the male may cause changes in sexual drive, lumps and swellings in the testicles, erection problems, and ejaculation problems. Hormonal causes for infertility may result in drastic hair growth and small, hard testicles.


Low sperm count, low sperm motility, and abnormal sperm shape are leading causes of infertility in men. They can be caused by problems such as genetic defects, testicular infections, surgeries, and undescended testicles. Enlarged blood vessels increase heat and blood flow to the testicles which may affect the shape of sperm. The form of the sperm is necessary for swimming to the egg for fertilization.

Problems in sperm delivery can cause infertility. Factors affecting sperm delivery include sexual problems such as premature ejaculation and retrograde ejaculation which is a situation where sperm enters the bladder during orgasm instead of coming out through the penis. Conditions such as cystic fibrosis and blockage of the epididymis may also impede sperm delivery.

Sperm quality is important when trying to conceive. Exposure to drugs, steroids, and high-temperature areas such as saunas compromise the quality of sperm. Cancer treatments also affect sperm quality due to radiation exposure.

Most cases of infertility in women are due to abnormalities of the reproductive system. Ovulatory disorders such as polycystic ovary syndrome prevent the release of eggs for fertilization. Abnormalities of the cervical mucus such as excessive viscosity or low production may contribute to infertility. Endometriosis and uterine fibroids may cause infertility.

Diagnosis & Tests

Correct infertility diagnosis comes from specific fertility testing carried out on both men and women depending upon the individual or couple looking to conceive. Semen analysis is the evaluation of the quality of sperm in a man. The test checks the semen for the sperm's motility, shape, and count among other characteristics. It is carried out on a sperm sample obtained after ejaculation.

Testosterone is the male sexual hormone crucial for production of sperm, and a hormone test establishes the levels of the hormone in the male body. Transrectal ultrasonography and transscrotal ultrasounds identify cases of retrograde ejaculation and blockages in the ducts delivering sperm. Genetic testing establishes infertility issues caused by genetic defects. Testicular biopsy looks for healthy sperm production by removing tissue samples from the testicles so as to rule out issues such as blockages. Biopsy may also rule out serious conditions like cancer.

Female infertility testing involves hormonal analysis and checking for structural deformities in the reproductive organs. Ovulation testing establishes the occurrence of ovulation by measuring hormone levels in the blood over a cycle. Hysterosalpingography is an X-ray test that evaluates the conditions of the fallopian tubes and uterus. Blockages in the fallopian tubes and/or the uterus can prevent fertilization of the eggs. Ovarian reserve testing determines the quality and quantity of eggs in a woman at a particular age.

Treatment & Therapy 

The cause of infertility determines treatments prescribed. Ovulation problems are treated using medicines such as clomifene, which stimulates ovulation. Women may also be prescribed hormone replacement therapy for estrogen in order to stabilize the menstrual cycle. Conditions such as polycystic ovary syndrome may be treated using metformin. Tubal surgery is carried out to repair blockage or damage in the fallopian tubes. Laparoscopic surgery removes endometrial tissue growth caused by endometriosis in the ovaries, uterus, and fallopian tubes, which is one of the leading causes of infertility in women.

When hormone therapies and corrective surgeries do not work, couples are encouraged to try assisted reproductive technology (ART). In vitro fertilization is an ART method in which a woman's egg is surrounded by many sperm in a petri dish prior to being placed into a woman’s uterus for implantation. Intracytoplasmic sperm injection is a type of in vitro fertilization that involves a doctor injecting one sperm into the egg. When fertilization occurs, the embryo is put into the uterus. Intracytoplasic sperm injection is particularly effective for cases of male infertility.

Prevention & Prophylaxis 

Men can help prevent infertility by proper care of the testicles and practices that do not lower sperm count and quality, while women can help prevent infertility by keeping their reproductive systems healthy and working with their health care providers to ensure that there is not a hormonal imbalance. Women should maintain a healthy weight as weight fluctuations affect the production of female hormones. Regular exercise can help reduce abnormal periods.

Men should avoid high temperatures in places such as hot tubs and steam baths. High temperature affects sperm motility. They should wear heavy protection when working in areas that expose them to chemicals. Illegal drugs and steroids can disrupt normal erectile function and decrease sperm count and should therefore be avoided. Earlier diagnosis and treatment of reversible conditions can prevent infertility.