Infertility: Causes, Symptoms, Diagnosis, Treatment and When to See a Doctor

Infertility can be an emotional and confusing experience, especially when you have been trying to conceive without success. You may wonder, “Why am I not getting pregnant?”, “Could there be a problem with my fertility?” or “When should I see a doctor?”

The good news is that infertility is common, and many couples can achieve pregnancy with the right evaluation and treatment. Infertility can affect women, men, or both partners, so it is important that both partners are considered during a fertility evaluation.

What Is Infertility?

Infertility is the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse.

For women aged 35 or older, it is generally advisable to seek an evaluation after 6 months of trying to conceive, because fertility can decline with age.

Infertility may be:

• Primary infertility: Pregnancy has never occurred.
• Secondary infertility: You have been pregnant before but are now having difficulty conceiving.

Infertility does not necessarily mean that pregnancy is impossible. In many cases, a specific cause can be identified and treated, while in other cases, fertility treatment can help improve the chances of pregnancy.

How Common Is Infertility?

Infertility is more common than many people realize. It can affect couples of all ages and backgrounds.

Importantly, infertility is not only a female problem. Male factors contribute to infertility in a substantial proportion of couples, while in some cases both partners have factors that may affect fertility.

This is why a fertility evaluation should usually consider both the woman and the man rather than assuming that the problem is related to one partner.

What Causes Infertility?

There are many possible causes of infertility. Some affect ovulation or egg quality, while others affect sperm production, sperm movement, the reproductive organs, or the ability of the sperm and egg to meet.

Sometimes, no obvious cause is found even after appropriate testing. This is sometimes called unexplained infertility.

Common Causes of Female Infertility

Female infertility can be caused by problems involving ovulation, the fallopian tubes, uterus, ovaries, or hormones.

Common causes include:

• Ovulation problems
• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Blocked or damaged fallopian tubes
• Fibroids or certain uterine problems
• Reduced ovarian reserve
• Age-related decline in fertility
• Hormonal disorders
• Previous pelvic infections or surgery
• Certain medical conditions and medications

Problems with ovulation are particularly important because an egg needs to be released for fertilization to occur.

For example, women with PCOS may have irregular or infrequent ovulation, which can make it more difficult to become pregnant.

Common Causes of Male Infertility

Male infertility can occur when there is a problem with sperm production, sperm quality, sperm movement, or the delivery of sperm.

Possible causes include:

• Low sperm count
• Poor sperm motility
• Abnormal sperm morphology
• Varicocele
• Hormonal problems
• Certain infections
• Problems affecting the testicles
• Previous surgery or injury
• Some medications
• Smoking and excessive alcohol use
• Certain lifestyle and environmental factors

A semen analysis is one of the most important initial tests used to evaluate male fertility.

What Are the Symptoms of Infertility?

Infertility often does not have obvious symptoms. The main sign is simply difficulty becoming pregnant despite regular, unprotected sex.

However, some symptoms may suggest an underlying fertility problem.

In women, these may include:

• Irregular or absent periods
• Very painful periods
• Symptoms associated with endometriosis
• Signs of hormonal imbalance
• A history of pelvic infection
• Previous problems with the reproductive organs

In men, possible warning signs include:

• Problems with sexual function
• Low libido
• Problems with ejaculation
• Pain or swelling around the testicles
• A history of testicular problems
• Previous reproductive or hormonal conditions

Having these symptoms does not necessarily mean that you are infertile. However, they may be reasons to discuss your fertility with a doctor.

When Should You See a Doctor for Infertility?

Knowing when to seek help can prevent unnecessary delays in diagnosis and treatment.

You should generally consider a fertility evaluation if:

• You have been trying to conceive for 12 months without pregnancy.
• You are 35 or older and have been trying for about 6 months.
• You are over 40 and want to become pregnant.
• Your periods are irregular or absent.
• You have a known condition such as PCOS or endometriosis.
• You have had previous pelvic or reproductive problems.
• You or your partner has a known fertility-related condition.
• There is a history of testicular problems, surgery, or other conditions that may affect sperm production.

You do not always need to wait 6 or 12 months if there is already a known reason to be concerned about fertility.

How Is Infertility Diagnosed?

Infertility diagnosis begins with a detailed medical and reproductive history.

Your doctor may ask about:

• Your menstrual cycle
• Previous pregnancies
• How long you have been trying to conceive
• Previous surgeries or infections
• Medical conditions
• Medications
• Lifestyle factors
• Sexual history
• Previous fertility treatments

Both partners may be evaluated because infertility can have female, male, combined, or unexplained causes.

Common Infertility Tests for Women

Depending on your medical history, your doctor may recommend:

• Blood tests to assess hormones
• Tests to determine whether ovulation is occurring
• AMH testing to help assess ovarian reserve
• Pelvic ultrasound
• Evaluation of the uterus and ovaries
• Hysterosalpingography (HSG) to check whether the fallopian tubes are open
• Other tests when indicated

Not every woman needs every fertility test. Your doctor will decide which investigations are appropriate based on your age, symptoms, medical history, and fertility goals.

Common Infertility Tests for Men

The initial evaluation often includes a semen analysis.

This test assesses important characteristics of sperm, such as:

• Sperm count
• Sperm movement or motility
• Sperm shape or morphology
• Other features of the semen

Additional blood tests, imaging, or specialist evaluation may be recommended depending on the results.

How Is Infertility Treated?

Infertility treatment depends on the underlying cause, the age of the woman, the duration of infertility, test results, and the couple's preferences.

There is no single treatment that works for everyone.

Treatment may include:

Lifestyle Changes

In some situations, improving lifestyle habits may support reproductive health.

This can include:

• Maintaining a healthy weight
• Eating a balanced diet
• Exercising regularly
• Avoiding smoking
• Limiting alcohol
• Managing stress
• Getting adequate sleep
• Reviewing medications with your doctor

Lifestyle changes alone cannot treat every cause of infertility, but they can form an important part of overall fertility care.

Medicines for Infertility

Fertility medicines may be recommended when ovulation is irregular or absent.

Depending on the cause, medication may help stimulate ovulation or address an underlying hormonal problem.

These medicines should be used under medical supervision because the appropriate drug, dose, and monitoring depend on the individual situation.

Surgery

Surgery may sometimes be recommended to treat certain causes of infertility.

For example, treatment may be considered for:

• Certain fibroids
• Endometriosis
• Blocked fallopian tubes in selected cases
• Some structural abnormalities
• Varicocele in selected men

Whether surgery is appropriate depends on the individual diagnosis.

Intrauterine Insemination (IUI)

IUI, or intrauterine insemination, is a fertility treatment in which prepared sperm is placed directly into the uterus around the time of ovulation.

IUI may be considered in selected situations, including some cases of unexplained infertility, ovulation problems, or certain male fertility problems.

In Vitro Fertilization (IVF)

IVF, or in vitro fertilization, is a more advanced fertility treatment.

During IVF, eggs are collected from the ovaries and fertilized with sperm in a laboratory. An embryo can then be transferred into the uterus.

IVF may be recommended for several reasons, including certain tubal problems, some forms of male infertility, reduced ovarian reserve, endometriosis, or when other fertility treatments have not been successful.

Your fertility specialist can explain whether IVF is appropriate for you.

Can Infertility Be Prevented?

Not all causes of infertility can be prevented. However, some habits may help protect reproductive health.

You can support your fertility by:

• Avoiding smoking and tobacco
• Maintaining a healthy weight
• Limiting excessive alcohol consumption
• Managing chronic medical conditions
• Practicing safer sex to reduce the risk of sexually transmitted infections
• Seeking medical attention for menstrual or reproductive problems
• Discussing fertility preservation when appropriate

It is also important to understand that female fertility naturally declines with age, particularly as the number and quality of eggs decrease.

Does Infertility Mean You Cannot Have a Baby?

No.

A diagnosis of infertility does not automatically mean that you cannot have a baby.

The chances of pregnancy depend on many factors, including the woman's age, the cause of infertility, ovarian reserve, sperm health, the condition of the reproductive organs, and whether fertility treatment is needed.

Some couples conceive naturally after evaluation or lifestyle changes. Others may benefit from medication, IUI, IVF, surgery, or other fertility treatments.

The most important step is to identify the possible cause and understand your available options.

Frequently Asked Questions About Infertility

How long should you try before seeing a doctor for infertility?

If you are under 35, you should generally consider an evaluation after 12 months of regular, unprotected sex without pregnancy. If you are 35 or older, consider seeking help after about 6 months. Earlier evaluation may be appropriate when there are known fertility concerns.

Can infertility affect both men and women?

Yes. Infertility can be caused by female factors, male factors, a combination of both, or an unexplained cause. This is why both partners may need evaluation.

What is the first test for male infertility?

A semen analysis is commonly one of the first tests used to evaluate male fertility. It provides information about sperm count, movement, and morphology.

What are the most common causes of female infertility?

Common causes include ovulation problems, PCOS, endometriosis, blocked fallopian tubes, age-related fertility decline, reduced ovarian reserve, and certain uterine or hormonal problems.

Can infertility be treated?

Yes. Depending on the cause, treatment may include lifestyle changes, medicines, surgery, IUI, IVF, or other assisted reproductive techniques.

When should I see a fertility specialist?

Consider seeing a fertility specialist if you have been trying to conceive without success for the recommended period, are older than 35, have irregular periods, have a known reproductive condition, or have other reasons to be concerned about fertility.

Takeaway

Infertility can be stressful, but you do not have to go through the process alone. Infertility can affect both women and men, and many causes can be identified and treated.

If you have been trying to conceive without success, don't feel that you have to keep waiting and worrying. A fertility evaluation can help determine whether there is an underlying problem and what treatment options may be appropriate.

The earlier you understand what may be affecting your fertility, the sooner you can make informed decisions about your reproductive health.