Problems Conceiving

Getting pregnant may seem simple, but the act of conceiving a child can often be very difficult. It involves many bodily functions and systems being in good condition in both the male and the female, all of which must happen in the right sequence and at the right time.

Consider that the average woman of reproductive age only has a 20 percent chance of getting pregnant in any month of trying. And if conditions are hampering male and/or female reproductive systems, the chances are much worse. Infertility – defined as not conceiving after 12 months of having sex on a regular basis with no contraception – affects as many as 1 in 8 couples.

Causes of infertility can range from not timing intercourse properly to being overweight to structural problems with the reproductive organs. Reproductive Science Center of New Jersey’s goal is to find out what factors are causing infertility in a woman or couple and develop a personalized treatment plan to help them achieve pregnancy.

The primary causes of failure to achieve pregnancy fall into three categories: medical issues, lifestyle factors and genetics. Patients can address some of these lifestyle issues and our reproductive endocrinologists can address most medical conditions. Genetic issues have no direct solution as far as correcting the genetic problem, but that doesn’t mean we can’t work around them.

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In this section

Lifestyle issues affecting conception

Lifestyle issues that impede fertility are factors that one can often change by choices and behaviors. As such, we encourage people having troubling getting pregnant to try these changes first, if they are applicable. Most of the lifestyle issues can affect both men and women.

Weight. This is one of the primary lifestyle issues that can cause infertility in both men and women. Women who are obese or overweight may experience problems with ovulation, which reduces the effectiveness of in vitro fertilization (IFV). In men, obesity can harm sperm production.

While consistent exercise is important to a healthy weight, women who are trying to get pregnant should avoid excessively strenuous workouts.

Diet. Without proper nutrients, a woman’s body doesn’t perform tasks efficiently, including reproduction. In particular, women should limit caffeine intake. Poor nutrition can also limit sperm production in men.

STDs. Sexually transmitted diseases (STDs) can cause infertility in women, and some STDs can block delivery of sperm in men. Safe sex with a limited number of partners is the best way to prevent infection.

Stress. This can disrupt hormone activity in women that regulates ovulation and can cause similar hormonal issues in men that inhibits healthy sperm.

Alcohol. Men should limit consumption, and women trying to get pregnant should avoid drinking altogether.

Illicit drug use. This can cause varied reproductive related problems in both sexes.

Exposure to toxins. Whether through work, outdoor activities or unhealthy indoor environments, chemicals, pesticides and other toxins can alter the hormonal balance in men and women, affecting fertility.

Temperature. Men should avoid things that raise the temperature of their scrotum, such as a laptop computer placed there.

Age. While not an adjustable factor, age is also a major influence in infertility, affecting females more dramatically than males. Men generally experience infertility issues later in life due to injury or illness.

Medical conditions that cause problems conceiving

Males and females have different medical issues and conditions, some present at birth, that can cause trouble getting pregnant. One medical condition may also lead to another illness or disorder that inhibits infertility.

Male medical issues

• Sperm problems are the primary medical cause of male infertility
• Infections, tumors, medications, surgeries
• Hormonal problems
• Erectile dysfunction and ejaculation issues
• Structural problems, including undescended testicles and varicocele

Female medical issues

• Ovulation disorders are the most common medical cause of infertility in women
• Structural defects
  • Fallopian tube issues (hydrosalpinx)
  • Uterine fibroids
  • Ovarian cysts
  • Anatomical uterine abnormalities
• Diseases and conditions that can result in some of the causes above
  • Endometriosis
  • Polycystic ovary syndrome
  • Factors that make a woman prone to miscarriage

Genetic issues affecting conception

Genetic problems generally relate to chromosomal abnormalities and single gene issues. These often cause embryo implantation failure and pregnancy loss, as well as possibly resulting in birth defects when a child is born with a chromosomal or single gene defect.

Chromosomal disorders can relate to one or more of an embryo’s chromosome pairs containing either one too many or one too few chromosomes. When the chromosome is not paired correctly, it is called aneuploidy. A chromosome may also have an abnormal structure. Both kinds of chromosome problems can be present in the female egg and/or the male sperm.

Single gene defects result from the embryo inheriting a genetic flaw from one or both parents. The gene could be one that results in cystic fibrosis or muscular dystrophy in birth. These single-gene defects can also cause embryo implantation failure or pregnancy loss.

Genetic issues often can be identified through preimplantation genetic screening, two types of embryo evaluation during IVF that can identify either form of genetic issues.

Unexplained infertility

Unexplained infertility is the diagnosis that fertility specialists give an individual or couple when fertility tests can not confirm a definitive cause for infertility. Unexplained infertility does not mean that there is not a cause for infertility; it simply means that the tests and examinations are not able to detect the reason an individual or couple is struggling to conceive.

Unexplained infertility is the diagnosis in about 10-15% of infertility cases.

When is unexplained infertility the diagnosis?

Individuals and couples will receive an unexplained infertility diagnosis when the following conditions exist.

• The woman is ovulating regularly and has an appropriate ovarian reserve (antral follicle count).
• The female or female partner has at least one open fallopian tube (evaluated using a hysterosalpingogram).
• The male or male partner’s semen analysis is normal (including sperm count, shape and movement).
• Exams of the individual or of both partners did not result in the diagnosis of conditions or structural abnormalities that can cause infertility, such as uterine fibroids in women or varicoceles in men.

Unexplained infertility treatment

The inability to pin down a diagnosis with current fertility testing technology does not mean that a couple cannot get pregnant. In some cases, simple lifestyle changes or weight loss can improve the chances of pregnancy.

Fertility treatments such as fertility medications combined with IUI (intrauterine insemination) or in vitro fertilization (IVF) can dramatically improve the chances of pregnancy for those struggling with unexplained infertility.