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Causes

By Mayo Clinic staff

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Illustration of egg being fertilized Fertilization

To become pregnant, the complex processes of ovulation and fertilization need to work just right. For some couples attempting pregnancy, something goes wrong along the way, resulting in infertility.

The cause or causes of infertility can involve one or both partners. In general:

  • In about one-third of cases, infertility is due to a cause involving only the male partner.
  • In another one-third of cases, infertility is due to causes involving both the male and female.
  • In the remaining one-third of cases, infertility is due to a cause involving only the female.

Causes of male infertility
A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. The most common causes of male infertility include:

  • Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects or repeated infections.
  • Problems with the delivery of sperm due to sexual problems, such as premature ejaculation or painful intercourse (dyspareunia); health issues, such as retrograde ejaculation; certain genetic diseases, such as cystic fibrosis; or structural problems, such as blockage of the part of the testicle that contains sperm (epididymis).
  • General health and lifestyle issues, such as poor nutrition, obesity, or use of alcohol, tobacco and drugs.
  • Overexposure to certain environmental factors, such as pesticides and other chemicals. In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
  • Damage related to cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility. Removal of one or both testicles due to cancer also may affect male fertility.
  • Age. Men older than age 40 may be less fertile than younger men.

Causes of female infertility
The most common causes of female infertility include:

  • Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis). Chlamydia, a sexually transmitted infection, is the most frequent cause.
  • Endometriosis, which occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the sperm, egg and ovaries, uterus, and fallopian tubes.
  • Ovulation disorders, which can prevent the ovaries from releasing eggs (anovulation). Underlying causes may include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.
  • Elevated prolactin (hyperprolactinemia), the hormone that stimulates breast milk production. High levels in women who aren't pregnant or nursing may affect ovulation.
  • Polycystic ovary syndrome (PCOS), a condition in which your body produces too much of the hormone androgen causing ovulation problems. PCOS is also associated with insulin resistance and obesity.
  • Early menopause, which is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.
  • Uterine fibroids, which are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.
  • Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.

Other causes in women

  • Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped.
  • Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility.
  • Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman's ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women.
  • Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, kidney disease and diabetes, can affect a woman's fertility.
Risk factors Symptoms
References
  1. Infertility. U.S. Department of Health and Human Services. http://www.womenshealth.gov/faq/infertility.cfm. Accessed May 16, 2011.
  2. Kuohung W, et al. Overview of infertility. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  3. Infertility. The Merck Manuals: Home Edition for Patients and Caregivers. http://www.merckmanuals.com/home/sec22/ch254/ch254a.html. Accessed May 16, 2011.
  4. Swerdloff RS, et al. Causes of male infertility. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  5. Kuohung W, et al. Causes of female infertility. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  6. Lobo RA. Infertility: Etiology, diagnostic evaluation, management, prognosis. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed May 13, 2011.
  7. Kuohung W, et al. Overview of treatment of female infertility. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  8. Evans MI, et al. Screening and testing in multiples. Clinics in Laboratory Medicine. 2010;30:643.
  9. Pauli SA, et al. Current status of the approach to assisted reproduction. Pediatric Clinics of North America. 2009;56:467.
  10. Zoorob RJ, et al. Women's health: Selected topics. Primary Care: Clinics in Office Practice. 2010;37:367.
  11. Peck JD, et al. A review of the epidemiologic evidence concerning the reproductive health effects of caffeine consumption: A 2000-2009 update. Food and Chemical Toxicology. 2010;48:2549.
  12. Boivin J, et al. Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. British Medical Journal. 2011;342d:223.
  13. Uterine fibroids: Frequently asked questions. U.S. Department of Health and Human Services. http://www.womenshealth.gov/FAQ/uterine-fibroids.cfm. Accessed May 16, 2011.
  14. Hornstein MD, et al. Optimizing natural fertility in couples planning pregnancy. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  15. Fauser BC. Overview of ovulation induction. http://www.uptodate.com/home/index.html. Accessed May 16, 2011.
  16. Wilkins KM, et al. Depressive symptoms related to infertility and infertility treatments. Psychiatric Clinics of North America. 2010:33;309.
  17. Coddington CC (expert opinion). Mayo Clinic, Rochester, Minn. June 3, 2011.
DS00310 Sept. 9, 2011

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