Many have a friend or family member who has struggled to conceive or stay pregnant. Often, she will have irregular cycles or is unsure if she is ovulating. She and her partner have likely tried to get pregnant for many months, maybe years. Approximately 10%–15% of the population has issues with infertility. 

Evaluating infertility is unique because it involves a couple rather than an individual. It is defined as the inability for a couple to conceive after 12 months of regular intercourse without the use of contraception. If the woman is 35 years or older, then infertility is defined at six months.

How does pregnancy occur?

In the monthly menstrual cycle, ovulation occurs 14 days prior to the next cycle. For example, if your cycle length is 28 days, then you will ovulate on day 14. If your cycle length is 35 days, then you will ovulate on day 21.  This releases an egg that moves into the fallopian tubes. If a woman has intercourse around ovulation, then the egg and sperm meet in the fallopian tube where fertilization occurs. The fertilized egg moves through the tube into the uterus where it attaches and grows. Infertility results if there is a problem with any of these steps.

What causes infertility?

Many factors may cause infertility. It is estimated that female factors are the cause one-third of the time and male factors about one-third of the time. A combination of factors in both partners is responsible for remaining couples. Many times, no cause is identified, resulting in unexplained infertility. Below are the common reasons for infertility.

  • Lack of or irregular ovulation is very common, especially with polycystic ovary syndrome, a condition that causes increased androgen levels and multiple cysts on the ovaries. Women may notice abnormal menstruation or male pattern hair growth.
  • Problems with the male testes that affect sperm development and function. A semen analysis can help identify these issues.
  • Advancing age is a major factor that causes egg quantity and quality to decline. Healthy couples in their 20s or early 30s have a 25%–30% chance of becoming pregnant in any single menstrual cycle. This percentage declines beyond a women’s early 30s and more rapidly in the late 30s. The chance of a woman getting pregnant falls to around 10% per menstrual cycle by age 40.
  • Permanent scarring of the fallopian tubes from prior surgery, sexually transmitted diseases, and endometriosis can prevent the sperm and egg from joining.
  • Lifestyle factors causing women to be underweight or overweight can affect ovulation and make it difficult to conceive.
  • Smoking, heavy drinking, marijuana use, and exposure to other toxins can decrease sperm count and movement.
  • Chronic diseases such as lupus, diabetes, and thyroid disorders.
  • Exposure to chemotherapy can affect the quantity and quality of eggs and sperm.
  • Uterine abnormalities such as a septum, fibroids, or a polyp can make it difficult for an embryo to implant and grow. This increases the risk of miscarriage and can be causes for recurrent miscarriages.

Be aware that despite the stresses and hardships of infertility, most couples can be treated. It may require lifestyle changes, medication, surgery, or assisted reproductive technologies. If you have not been able to get pregnant after trying for a year or have any questions on preparing for pregnancy, see your doctor for an evaluation and to discuss potential treatments.

Dr. Gregory Burana is an OB/GYN with Adams Patterson. His special interests include high-risk obstetrics, basic infertility, menopause, and minimally invasive surgery including robotic-assisted surgery, laparoscopy, and hysteroscopy. For more information, visit or call 901.767.3810.