Causes of Infertility

Infertility can be due to reproductive health problems in the male (1/3 of cases) or female (1/3 of cases), a combination of both, or other unexplained factors (the latter 2 making up the final 1/3 of cases). If you're having trouble getting pregnant, it's important to talk with your doctor about potential causes and possible treatment options.

Common causes of female infertility

In about 1/3 of cases, female reproductive health issues are the cause of infertility. Some common causes of female infertility include:

  • Endometriosis

    A condition in which cells from the lining of the uterus attach and grow in other areas of the body. This tissue growth can lead to blockage in the reproductive organs, which can interfere with or prevent pregnancy. Signs can include painful and/or abnormal periods and abdominal cramping, although some women experience no symptoms.

  • Polycystic ovary syndrome, or PCOS

    A condition in which the body's sex hormones are not balanced. Signs of PCOS may include absent or irregular periods, acne, and changes in body and facial hair. With PCOS, normal ovulation is disrupted when eggs in the follicles do not mature and release, instead forming small cysts in the ovaries.

  • Primary ovarian insufficiency, or POI

    A loss of normal ovarian function (decreased estrogen, irregular egg production) prior to age 40. Signs of POI such as irregular periods, hot flashes, and difficulty concentrating are similar to those seen with menopause.

  • Fallopian tube damage or blockage

    Internal blockage or inflammation of the fallopian tube, most often caused by pelvic inflammatory disease (PID).

  • Uterine fibroids

    Noncancerous tissue growths in the uterus that can interfere with attachment of a fertilized egg to the uterus (implantation) or interfere with the sperm's ability to travel to the fallopian tubes. Signs include heavy and/or longer-lasting periods, pelvic pain, painful intercourse, and frequent urination, although some women have no symptoms.

  • Pelvic adhesions

    Bands of scar tissue that can bind the abdominal organs, usually after surgery or pelvic infection, and may cause long-term pelvic pain.

  • Elevated prolactin, or hyperprolactinemia

    High levels of prolactin (the hormone that causes breast milk production) in women who aren't pregnant or lactating can cause impaired ovulation.

  • Reproductive tract abnormalities

    Reproductive tract abnormalities occur when the reproductive system does not form as it should. Common forms include müllerian agenesis (the uterus and fallopian tubes do not form) and müllerian duct fusion disorders (the müllerian ducts do not come together correctly). Fusion disorders include didelphic uterus (a complete duplication of the uterus, cervix, and sometimes the vagina), bicornuate uterus (two uteri share a single cervix and vagina), septate uterus (a fibrous band of tissue divides the uterus), and arcuate uterus (a dent on the top of the uterus).

Common causes of male infertility

Male infertility is responsible for about 1/3 of infertility cases. Common causes may include:

  • Low sperm count

    Defined as fewer than 20 million sperm per milliliter of semen, low sperm count means reduced odds that one will fertilize an egg.

  • Abnormal sperm movement or shape

    Atypical sperm shape or damaged sperm motility (movement) can affect the sperm's ability to travel to and/or penetrate the egg.

 

These causes can be the result of certain medical conditions, including:

  • Varicocele

    A swelling of the testicular veins that can lead to improper cooling of the testicles and decreased sperm count and function.

  • Infection

    Certain types of infection can interfere with sperm production or create scarring that blocks sperm passage.

  • Retrograde ejaculation

    When semen enters the bladder instead of emerging through the penis.

  • Hormone imbalance

    Disorders of the male sex hormones, including low levels of testosterone.

If you or your partner are experiencing any signs or symptoms of the above conditions, it's important to talk with your doctor right away.

Health and lifestyle factors

Besides certain medical conditions, many other health issues can affect male and female fertility, including:

  • Age
  • Smoking
  • Alcohol consumption
  • Stress
  • Being overweight or underweight
  • Certain medications

BRAVELLE® (urofollitropin for injection, purified)

BRAVELLE® (urofollitropin for injection, purified) is a prescription medicine that contains hormones. BRAVELLE contains follicle stimulating hormone which stimulates healthy ovaries to make eggs. BRAVELLE is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use BRAVELLE if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

BRAVELLE may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. BRAVELLE can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. BRAVELLE may cause you to be pregnant with twins or more than two babies at the same time.

The most common side effects with BRAVELLE are stomach cramps and headache.

Please see full Prescribing Information for BRAVELLE.

MENOPUR® (menotropins for injection, USP)

MENOPUR® (menotropins for injection, USP) is a prescription medicine that contains hormones. MENOPUR contains the hormones follicle stimulating hormone and luteinizing hormone. These hormones stimulate healthy ovaries to make eggs. MENOPUR is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use MENOPUR if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

MENOPUR may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. MENOPUR can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. MENOPUR may cause you to be pregnant with twins or more than two babies at the same time.

The most common side effects with MENOPUR are headache, stomach pain, and upset stomach. Sometimes there is an injection-site reaction that can cause bruising, pain, or redness.

Please see full Prescribing Information for MENOPUR.

ENDOMETRIN® (progesterone)

ENDOMETRIN® (progesterone) is a vaginal insert that contains the hormone progesterone, one of the hormones essential for helping you to become and to stay pregnant. ENDOMETRIN is for women who need extra progesterone while undergoing treatment in an Assisted Reproductive Technology (ART) program.

Important Safety Information

Do not use ENDOMETRIN if you:

  • Are allergic to anything in ENDOMETRIN
  • Have unusual vaginal bleeding that has not been evaluated by a doctor
  • Currently have or have had liver problems
  • Have or have had blood clots in the legs, lung, eyes, or elsewhere in your body

Progesterone can increase your chance of getting blood clots. Blood clots can be serious and lead to death. Serious blood clots include those in the legs, lungs, eyes, heart, and brain.

Call your doctor and get medical help right away if you have: persistent lower leg pain, sudden shortness of breath, coughing up blood, sudden blindness (partial or complete), severe chest pain, sudden severe headache, vomiting, dizziness, or fainting, weakness in an arm or leg, or trouble speaking, yellowing of the skin and/or white of the eyes indicating possible liver problems.

Common side effects seen with ART and ENDOMETRIN included pelvic pain after surgery, abdominal pain, nausea, and swollen ovaries (ovarian hyperstimulation syndrome).

Please see full Prescribing Information for ENDOMETRIN.

REPRONEX® (menotropins for injection, USP)

REPRONEX® (menotropins for injection, USP) is a prescription medicine that contains purified hormones. REPRONEX contains the hormones follicle stimulating hormone and luteinizing hormone. These hormones stimulate healthy ovaries to make eggs. REPRONEX is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use REPRONEX if you: have ovaries that are not able to make eggs even with the use of hormones, are pregnant or think you may be pregnant, have problems with your thyroid gland or adrenal gland that are not controlled by taking medicine, have cancer in your female organs (ovaries, breasts, uterus), have a tumor of your pituitary gland or any other tumor in your brain, or have heavy or irregular vaginal bleeding and the cause is not known.

REPRONEX may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. REPRONEX can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. REPRONEX may cause you to be pregnant with twins, or more than two babies at the same time.

The most common side effects with REPRONEX are headache, stomach pain, and upset stomach. Sometimes there is an injection-site reaction that can cause bruising, pain, or redness.

Please see full Prescribing Information for REPRONEX.

NOVAREL® (chorionic gonadotropin for injection, USP)

NOVAREL® (chorionic gonadotropin for injection, USP) is a prescription medicine that contains a hormone to help stimulate healthy ovaries to make eggs. NOVAREL is used for women who need medical help to get pregnant. Your doctor may prescribe more than one medicine as part of a pregnancy plan.

Important Safety Information

Do not use NOVAREL if you have begun puberty at an unusually early age, have prostate cancer, or have had a prior allergic reaction to this hormone. This hormone may cause harm to an unborn baby when given to a pregnant woman.

NOVAREL may cause serious side effects. It sometimes stimulates the ovaries too much. This is called ovarian hyperstimulation syndrome (OHSS) and can be a serious medical problem. OHSS may cause pelvic pain or breathing problems, or it may make you urinate less. In rare cases, patients with this problem have had serious lung problems. NOVAREL can also cause blood clots and strokes. Call your doctor or get medical help right away if you have: severe pelvic pain, nausea, vomiting, diarrhea, sudden weight gain, trouble breathing, or decreased or no urination. NOVAREL may cause you to be pregnant with twins or more than two babies at the same time.

Other side effects of NOVAREL include headache, irritability, restlessness, depression, fatigue, swelling, and pain at the site of injection.

Anaphylaxis has been reported with urinary-derived hCG products.

Please see full Prescribing Information for NOVAREL.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.