Getting pregnant and carrying a pregnancy to term can actually be a difficult and complicated process for some. There are many factors that contribute to fertility and that can prevent a successful pregnancy. If you are struggling with this, here is a list of some symptoms and causes of infertility that may help you to navigate any issues you are experiencing. Our list includes some of the common causes and isn’t designed to be all-inclusive. You should talk with her health care provider about possible treatments if you are having difficulty getting pregnant or carrying a pregnancy.

Symptoms and causes of infertility in women

Not getting pregnant

A primary sign of infertility is not getting pregnant after trying for a certain length of time. For women under 35, fertility problems may exist if she has not become pregnant after 1 year of trying. For a woman over the age of 35, the time frame is generally set by doctors as 6 months before you should speak to a professional.

Pain during sex

Pain during sex or dyspareunia, can be a symptom of an underlying health problem that may influence a woman’s fertility. Examples of such health issues include infections, endometriosis, and fibroids.

Obesity

Obesity can negatively affect reproductive health. Women with obesity have a lower probability of conceiving and are at a higher risk for issues during pregnancy than those without weight issues.

Heaviness and colour of menstrual cycle

Your period can provide key signals about your fertile health. Heavy, painful periods may indicate an underlying condition affecting fertility such as endometriosis. If menstrual blood is regularly paler than usual (rather than bright red), this may be a cause for concern. Also passing very dark, old blood at the beginning of a period can also be a sign of endometriosis.

Irregular menstrual cycles

The length of a menstrual cycle varies between individuals and over time. Having an irregular cycle, including missing periods, can contribute to infertility, as it means a woman may not be regularly ovulating. Irregular ovulation can be due to many issues, including polycystic ovary syndrome (PCOS), obesity, being underweight, and thyroid issues.

Hormonal Problems 

Hormonal problems can cause anovulation and other fertility problems. Signs of hormonal changes can be nonspecific, and a person may not notice them or know the underlying cause. Fluctuations /imbalances in hormone levels can cause: unexplained weight gain, acne, facial hair in females, among other symptoms.

Polycystic Ovary Syndrome (PCOS)

PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.

Malfunction of the hypothalamus

The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. If the hypothalamus fails to trigger and control this process, immature eggs will result and this will affect ovulation.  

Malfunction of the pituitary gland

The pituitary gland’s responsibility lies in producing and secreting FSH and LH. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced. 

Primary Ovary Insufficiency (POI)

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40. This can lead to premature menopause

Endometriosis

Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus, the endometrium, grows outside the uterus. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. Symptoms of endometriosis include: chronic pelvic pain (not only during menstruation), back pain, fatigue, nausea, irregular periods and spotting, bowel problems or pain with bowel movements.

 Implantation failure

The causes of implantation failure are diverse and due to different factors. Implantation failure refers to the failure of a fertilised egg to implant in the uterine wall to begin pregnancy. While the specific cause of implantation failure are often unknown, possibilities include: Genetic defects in the embryo, thin endometrium, endometriosis, progesterone resistance.

Autoimmune Disorders

The links between autoimmune diseases and infertility are complex and vary. When the immune system is functioning normally, it can recognize a pregnancy as a desirable condition within the body. For women with autoimmune diseases however, the immune system fails to recognize the embryo and attacks the embryo itself. This can cause recurrent miscarriages. Each autoimmune condition is different but conditions such as Lupus, Hashimoto's and other types of thyroiditis, or rheumatoid arthritis, may affect fertility.

Polyps and fibroid

Polyps and fibroids can interfere with getting pregnant. Uterine polyps ocur when too many cells grow in the endometrium, the lining of the uterus. Fibroids grow in the wall of the uterus. Other abnormalities of the uterus can also interfere with fertility.

Fallopian Tubes problems

These structures carry eggs from your ovaries, which produce eggs, to the uterus, where the baby develops. They can get damaged when scars form after pelvic infections, endometriosis, and pelvic surgery. That can prevent sperm from reaching an egg in the tube.

Cervical Issues

Some women may have a condition that prevents sperm from passing through the cervical canal.

Infections

Caused by both bacteria and viruses and usually transmitted sexually, some infections commonly cause inflammation resulting in scarring and damage.  One example is Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube. Chlamydia and gonorrhea if not treated may cause pelvic inflammatory disease (PID) and infertility.

Some signs of infertility in men

• Hormonal imbalances - a variety of hormonal imbalances can affect a man’s fertility.
• Testosterone is a key hormone for male fertility, so problems with the testes that produce this hormone may lead to infertility.
• Poor quality semen – abnormal sperm production or function
• Problems with delivery of sperm e.g. erectile dysfunction, problems with ejaculation.
• Obesity - Obesity can increase the risk for other conditions that may impact a man’s fertility such as sperm quality and sexual dysfunction.
• Overexposure to certain environmental factor, or damage related to cancer can also affect male fertility.

Getting help for infertility

There are 3 main types of fertility treatment: medicines, surgical procedures, assisted fertility procedures.

Medicines

Some common fertility medicines include:

• Clomifene – encourages the monthly release of an egg (ovulation) in women who do not ovulate regularly or cannot ovulate at all
• Metformin – is particularly beneficial for women who have polycystic ovary syndrome (PCOS) and lowers insulin and blood sugar levels, and can also stimulate ovulation.
• Gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men

Surgical procedures

There are several types of surgical procedures that may be used to investigate fertility problems and help with fertility.

• Fallopian tube surgery : If fallopian tubes have become blocked or scarred, surgery can be used to break up the scar tissue making it easier for eggs to pass through them.
• Endometriosis, fibroids and PCOS : Laparoscopic surgery is often used to treat endometriosis by destroying or removing fluid-filled sacs called cysts. It may also be used to remove fibroids. For polycystic ovary syndrome (PCOS), a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation medicine has not worked.This involves using either heat or a laser to destroy part of the ovary.
• Epididymis blockage and surgery to retrieve sperm: The epididymis is a coil-like structure in the testicles that helps store and transport sperm. This can become blocked preventing sperm. Surgery can be used to correct the blockage.
• In case of an obstruction that prevents the release of sperm, or the absence of the tube that drains the sperm from the testicle, surgical extraction of sperm may be an option.

Assisted conception

• Intrauterine insemination (IUI): Intrauterine insemination (IUI), also known as artificial insemination, involves inserting sperm into the womb via a thin plastic tube passed through the cervix.
• In vitro fertilisation (IVF): In vitro fertilisation (IVF), is when an egg is fertilised outside the body. Fertility medicine is taken to encourage the ovaries to produce more eggs than usual.Eggs are removed from the ovaries and fertilised with sperm in a laboratory. A fertilised egg (embryo) is then returned to the womb to grow and develop.
• Egg and sperm donation: If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually done using IVF.

If you have been struggling to get pregnant, and/or if you or your partner suspect you may be dealing with one of the conditions mentioned in this article, you may want to discuss matters with your health practitioner.