Medically ReviewedInfertility is a condition that affects the reproductive system and affects the body’s ability to conceive. It may result from issues within the man’s reproductive system, the woman’s, or a combination of both. Women who can conceive but are unable to maintain a pregnancy may also be considered infertile.
About 15 percent of U.S. couples are infertile. Between 10 percent and 13 percent of women in the United States of reproductive age experience challenges with either becoming pregnant or carrying a pregnancy to term. Some sources, including the Centers for Disease Control and Prevention, suggest even higher rates of 19 percent.
Approximately 12 percent of American men experience infertility. The rate of adverse reproductive changes in men, including declining sperm counts, lower testosterone levels, and rising rates of testicular cancer and erectile dysfunction, is increasing by about 1 percent per year, according to Shanna Swan, a world-renowned expert in reproductive epidemiology. Similarly, Swan states in her book “Count Down” that miscarriage rates among women have also climbed at the same annual rate.
Many factors may cause infertility. About one-third of the time, the problem originates in the female, another one-third of the time, it originates in the male, and the rest of the time, it's due to a combination of factors or its cause is unknown. Illustration by The Epoch Times, Shutterstock
What Are the Types of Infertility?
There are two types of infertility: primary and secondary.
Primary infertility describes couples who have been unable to achieve pregnancy after at least one year of regular, unprotected sex.
Secondary infertility applies to couples who have successfully conceived at least once but are now unable to become pregnant again.
What Are the Signs of Infertility?
A couple is considered infertile if pregnancy does not occur:
- After one year of unprotected sex.
- After six months, if the woman is over age 35.
What Causes Infertility?
For a pregnancy to occur, the following must take place:
- The man must produce healthy sperm, and the woman must produce healthy eggs.
- The fallopian tubes must be open for sperm to reach the egg.
- The sperm must fertilize the egg successfully to create a zygote (a fertilized egg).
- The zygote must implant in the uterus.
- The embryo must develop healthily.
Generally, infertility in both males and females is caused by the following:
- Hormone imbalances
- Structural problems with the reproductive organs or other parts of the body
- Medical conditions or diseases
- Genetic factors
- Environmental factors, such as toxins, diet, medication, and viruses
Female Infertility
Female infertility can take place when the ovaries have trouble producing healthy eggs; the eggs are unable to move from the ovaries to the uterus; a fertilized egg or embryo fails to survive after attaching to the uterine lining; or when the egg does not attach to the lining at all. Each of these factors can disrupt the process necessary for a successful pregnancy.1. Hormonal Factors
Irregular or absent periods suggest potential ovulation issues. Ovulation is triggered when the hypothalamus signals the pituitary gland to release hormones that stimulate the ovaries to mature eggs. Women are born with a finite egg supply, which declines in quality over time. By age 40, a woman’s chance of pregnancy per menstrual cycle drops to about 5 percent, largely due to the aging of her eggs.Disorders of the endocrine system involving the hypothalamus and pituitary glands can also lead to imbalances in reproductive hormones. Common conditions affecting this system include pituitary cancers and hypopituitarism.
2. Structural Problems, Genetics, and Medical Conditions
The following list of medical conditions, although not exhaustive, may lead to infertility:- Tubal disorders: Blocked fallopian tubes can prevent the meeting between egg and sperm.
- Ovarian cysts: An ovarian cyst is a sac filled with fluid that forms on an ovary. Hormonal conditions like polycystic ovary syndrome (PCOS) can lead to infertility.
- Cervical issues or growths: Around ovulation, cervical mucus usually becomes thin to aid sperm movement, but in some women, thick cervical mucus can obstruct sperm from progressing.
- Endometriosis: Endometriosis affects 10 to 15 percent of women of childbearing age. It occurs when tissue similar to the uterine lining grows outside the uterus, often in the pelvis. It can damage the fallopian tubes and ovaries, affecting egg and sperm movement. Even without damage to these organs, endometriosis can interfere with fertilization, embryo development, and implantation.
- Septate uterus: A septate uterus is a normally shaped uterus with a tissue wall dividing it into two cavities, which results from incomplete fusion during embryonic development. Women with this condition can lead a normal reproductive life, but it may increase pregnancy complications, including a higher risk of miscarriage, premature labor, and breech presentation (baby’s feet coming out first).
- Fibroids and polyps: Benign tumors within the uterus can prevent a fertilized egg from attaching to the womb or block a fallopian tube. Polyps, small growths that extend from the uterine lining, can also make a woman infertile.
- Blood clotting disorders: Blood clotting disorders such as antiphospholipid syndrome can increase the risk of blood clots during pregnancy, leading to complications such as miscarriage or preeclampsia.
- Metabolic issues: Fertility is reduced in women with Type 1 diabetes. Metabolic issues, such as thyroid disorders, can also disrupt a woman’s ovulation cycle.
- Hyperprolactinemia: Hyperprolactinemia (high levels of prolactin) can interfere with the brain’s signals to the ovaries, reducing the hormones needed for ovulation. This can lead to infrequent periods (oligomenorrhea) or no periods at all (amenorrhea).
- Immune system problems: Immune system issues can cause pregnancy loss by preventing the body from recognizing a pregnancy or by triggering an abnormal immune response. Women may also develop anti-sperm antibodies, which attack and destroy sperm.
- Genetic conditions: Several inherited conditions are linked to infertility, including Turner syndrome and fragile X syndrome.
3. Environmental Factors
Various environmental toxins can harm fertility, including:- Endocrine disrupting chemicals (EDCs): EDCs interfere with the body’s endocrine system. Exposure—particularly during critical developmental stages such as in utero or puberty—can contribute to infertility in both men and women. EDCs are associated with disorders in reproductive development, ovarian dysfunction, subfertility, and PCOS.
- Heavy metals: Examples include cadmium, mercury, and lead.
- Toxic chemicals and compounds: Examples include pesticides and per- and polyfluoroalkyl substances (PFAS), or “forever chemicals,” which can potentially reduce fertility in women by up to 40 percent.
- Infections: Pelvic infections can cause scarring or swelling of the fallopian tubes (hydrosalpinx) or pelvic inflammatory disease (PID), an infection of the upper female reproductive tract, including the uterus, fallopian tubes, and ovaries. Chlamydia trachomatis, the microorganism associated with the sexually transmitted infection (STI) chlamydia, is most strongly linked to an increased risk of infertility due to PID.
Male Infertility
Male fertility relies on the body’s ability to produce and deliver healthy sperm. Male infertility can result from a decreased sperm count, blockages that prevent sperm from being released, or defects in the sperm itself.1. Hormonal Factors
Problems with hormone levels (e.g., low testosterone) or the pituitary gland can affect fertility, as hormones regulate how the male reproductive system produces, stores, and transports sperm.The leading cause of male infertility is difficulty producing healthy sperm. Sperm may be underdeveloped, oddly shaped, unable to swim well, low in number (oligospermia), or sometimes not made at all (azoospermia). Sperm issues may arise from multiple factors. For instance, noncancerous pituitary tumors can lead to high prolactin levels, which can cause men to produce fewer sperm or no sperm at all. Hypogonadism, a condition characterized by abnormally low testosterone levels, can also affect sperm production. It may be caused by factors such as tumors, illegal drug use, or Klinefelter syndrome (a rare condition with an extra female chromosome).
Between 1973 and 2011, sperm concentration in men from Western countries declined by over 52 percent, and total sperm count dropped by more than 59 percent, according to a meta-analysis detailed in Swan’s book.
2. Structural Problems, Genetics, and Medical Conditions
Other genetic, structural, and medical conditions implicated in infertility include:- Cystic fibrosis: Cystic fibrosis is a genetic condition caused by a faulty protein that affects the body’s cells, tissues, and glands. Most men with cystic fibrosis are infertile but not sterile, as they still produce sperm. These men’s infertility is due to their lack of a sperm canal.
- Hemochromatosis: Hemochromatosis is a disorder where excess iron builds up in the body, potentially leading to poor sperm quality and testicular tissue damage.
- Chromosomal problems: Sperm carry half of the DNA needed to fertilize the egg. Changes in the number or structure of chromosomes, such as missing parts of the Y chromosome, can affect fertility.
- Immune system issues: Sometimes, the immune system mistakenly attacks a man’s own sperm, creating antibodies against them.
- Varicoceles: Varicoceles are found in approximately 40 percent of men with infertility issues. It is a condition where varicose veins form around the testes. These swollen scrotum veins can block proper blood drainage. They may cause blood to flow back into the scrotum from the belly, making the testicles too warm for sperm production, which can lead to low sperm count.
- Testicular torsion: Testicular torsion can cause a long-term decrease in sperm motility and a reduction in overall sperm count.
- Undescended testicles: Undescended testicles occur when one or both testes have not fully descended into the scrotum.
- Retrograde ejaculation: Retrograde ejaculation occurs when semen flows backward into the bladder instead of out of the penis. This happens when the nerves and muscles in the bladder don’t close properly during orgasm, although the semen may still contain normal sperm. This condition can result from surgery, medications, or nervous system health issues.
- Erectile dysfunction: This was formerly termed impotence.
3. Environmental Factors
These factors include:- Toxins: These include insecticides, fungicides, pesticides, and microplastics. The rise in plastic production and, thus, microplastics, has coincided with a “population-wide decline in human sperm production, which appears to be accelerating since 2000,” according to a 2024 research article in Frontiers in Endocrinology.
- Electromagnetic fields (EMFs): The electric and magnetic forces in EMFs, found at various frequencies, are generated by electromagnetic radiation. As technology advances, exposure to EMF continues to increase across all populations, raising concerns about potential health risks. Exposure to radiofrequency electromagnetic fields may cause oxidative stress by increasing reactive oxygen species, which can adversely affect sperm quality and potentially lead to infertility.
- Infections: For example, mumps can affect sperm production.
- Medications: Drugs that can harm male fertility are those commonly prescribed to treat arthritis, depression, digestive issues, anxiety, infections, high blood pressure, and cancer. Examples include sulfasalazine and anabolic steroids. Root extracts of the Chinese herb Tripterygium wilfordii can also affect sperm production or shrink the size of the testicles.
- Vasectomy or failed vasectomy reversal: A vasectomy involves cutting and sealing the vas deferens (tubes that carry sperm out of the testicles) to prevent semen from containing sperm. While a vasectomy can be reversed, the success of the reversal is generally low.
Who Is More Likely to Be Infertile?
The following factors heighten one’s infertility risk:
- Age: Healthy couples under 30 who have regular sex have a 20 percent chance of getting pregnant each month. Women are most fertile in their early 20s, with fertility beginning to decline around age 35, with a more significant decrease after 40. As for men, there is growing evidence that men over 45 are less fertile than younger men, though men may also begin to become less fertile in their 30s.
- Smoking: Smoking reduces fertility by decreasing both egg quantity and quality and is linked to a 30 percent higher risk of early menopause in women who have ever smoked. Smoking tobacco can also lower semen quality, affecting the amount of semen, sperm count, and movement, health, and shape of the sperm. The harmful effects of smoking typically disappear within a year after quitting.
- Excessive alcohol consumption: Alcohol use is linked to changes in estrogen and progesterone levels, as well as irregularities in menstrual cycles and ovulation. It has also been linked to testicular atrophy, decreased testosterone, and lowered sperm production.
- Many sexual partners: Women with multiple sexual partners have a 5.3 times higher risk of infertility and are eight times more likely to report an STI compared to those with only one partner.
- Obesity: Extra weight can lead to metabolic issues, such as PCOS, that affect fertility. Plus, for every additional 20 pounds of excess weight, a man’s likelihood of experiencing infertility rises by approximately 10 percent.
- Stress: Severe physical or emotional stress can lead to amenorrhea in women.
- Marijuana: While more research is needed, marijuana use does appear to have adverse effects on male fertility. Current and past marijuana users have more damaged sperm, lower sperm counts, and reduced semen volume than nonusers.
- Cocaine: Cocaine use can change sperm motility and may also affect female fertility.
- Prolonged exposure to high heat: High temperatures can harm sperm quality by reducing semen volume, sperm count, concentration, ability to move, and proper shape.
How Is Infertility Diagnosed?
A health care provider will inquire about any past pregnancies and children, how long the couple has been trying to conceive, frequency of intercourse and any difficulties, former contraception, and relevant medical history and lifestyle factors.
If a female patient is being evaluated, the provider may check her body mass index (BMI) and examine the pelvic area for signs of infection, lumps, or tenderness. This exam can help detect conditions such as fibroids, ovarian tumors, endometriosis, or PID.
For a male patient, the doctor may examine the testicles for lumps or deformities and assess the penis for any structural abnormalities.
Fertility Tests
For women, these include:- Blood tests: Blood tests can measure several hormone levels, check for chlamydia antibodies, and test thyroid function.
- Home ovulation kits: These kits detect ovulation through urine testing.
- Basal body temperature (BBT) monitoring: This tracks daily temperature to confirm ovulation. Many wearable biometrics devices can track BBT.
- Anti-mullerian hormone (AMH) test: AMH testing assesses a woman’s ovarian reserve, which refers to her ability to produce eggs that can potentially be fertilized for pregnancy.
- Hysterosalpingography (HSG): A hysterosalpingogram uses a special dye and X-ray to examine the womb and fallopian tubes to help identify blockages or other abnormalities.
- Pelvic ultrasound: This examines the uterus, eggs, and follicles.
- Laparoscopy: This test involves making a small incision in the lower abdomen. A thin tube with a camera (laparoscope) is inserted to examine the womb, fallopian tubes, and ovaries.
- Hysteroscopy: Hysteroscopy is considered the gold standard for evaluating the uterine cavity. It allows doctors to visualize any abnormalities or pathology within the uterus directly and offers the ability to perform immediate surgical corrections if needed.
- Saline infusion sonogram (SIS): A SIS is less invasive than hysteroscopy and may be used as a screening tool in diagnosing infertility.
- Semen analysis: Sperm count is evaluated through semen analysis, which typically involves collecting at least two semen samples on separate days. This routine lab test measures the number of sperm produced and assesses sperm quality, including motility (movement), to determine how effectively the sperm can swim.
- Blood tests: Blood tests can check hormone levels and rule out other underlying issues that could affect fertility.
- Imaging tests: Imaging tests (usually ultrasound) can examine the testicles, blood vessels, and internal structures within the scrotum.
- Testicular biopsy: A testicular biopsy may be performed if semen analysis reveals few or no sperm. The doctor removes a small tissue sample from each testicle for examination. In addition to identifying the cause of infertility, this procedure can also collect sperm for use in assisted reproductive techniques.
- DNA integrity test: A DNA integrity test evaluates sperm DNA fragmentation and is recommended for men whose partners have experienced recurrent miscarriages.
What Are the Possible Complications of Infertility?
Complications of infertility and its treatments are:
- Childlessness.
- Emotional stress: The frustration, sadness, and anxiety associated with infertility can lead to depression and feelings of inadequacy.
- Relationship strain: Infertile couples may experience tension, miscommunication, or conflict.
- Financial issues: Fertility treatments can be expensive and may not be covered by insurance in the United States, leading to financial burdens.
- Health risks: Some fertility treatments carry risks, such as ovarian hyperstimulation syndrome, multiple pregnancies, and ectopic pregnancies (when a fertilized egg implants outside the uterus) in women, as well as surgical complications and medication side effects in men.
What Are the Treatments for Infertility?
Infertility can resolve on its own or with treatment. Up to 20 percent of couples diagnosed with infertility may conceive naturally without treatment, while most achieve pregnancy after receiving treatment.
Learning about choosing the right timing for intercourse can help couples improve their chances of pregnancy. Having sex at least two days before ovulation and during ovulation is ideal. Ovulation typically takes place around two weeks before a woman’s next period. For a 28-day cycle, intercourse between the 10th and 18th days after menstruation starts is best. Since sperm may be able to survive for at least two days inside the female body, having intercourse before ovulation maximizes the likelihood of fertilization, as an egg can only be fertilized within 12 to 24 hours after its release.
If timing and persistence do not yield results, many other options exist. Fertility treatments for both men and women include the following.
Medications
The doctor can prescribe various medications to help a woman with infertility regulate her ovulation. However, these medications can also stimulate the release of multiple eggs, thus increasing the likelihood of twin or multiple births.Some medications used to treat infertility include:
- Clomiphene citrate: This is often used by women with PCOS.
- Human menopausal gonadotropin (hMG): This injectable medication directly stimulates the ovaries to promote ovulation.
- Follicle-stimulating hormone (FSH): FSH works similarly to hMG.
- Gonadotropin-releasing hormone (GnRH) analog: This type of medication is used in women with irregular ovulation or who ovulate too early.
- Metformin: Metformin is used for women with insulin resistance or PCOS to lower high male hormone levels, which helps support ovulation.
- Bromocriptine: Bromocriptine is used to treat ovulation problems in women with high prolactin levels, the hormone responsible for milk production.
- Hormonal therapy: In some cases, low levels of gonadotropins can be the cause of infertility in men. Taking these hormones as medication may help increase sperm production.
Treatments
A type of artificial insemination, intrauterine insemination (IUI) is an infertility treatment where specially prepared sperm is injected into the female’s uterus. It’s often combined with ovulation-stimulating medications and is used to treat mild male infertility, cervical mucus issues, or unexplained infertility in couples.If a man cannot ejaculate on his own, rectal probe electroejaculation may be performed under anesthesia, except in men with spinal cord damage. While it collects a large number of sperm, the sperm’s movement and shape may still affect fertility.
Assisted reproductive technologies (ART) are procedures that involve retrieving eggs from the ovaries and manipulating eggs and sperm in a lab setting. The different types of ART are:
- In vitro fertilization (IVF): IVF is the most effective form of ART. The process begins with administering medication to stimulate the woman’s ovaries to produce multiple mature eggs. Once collected, these eggs are fertilized in a laboratory dish with the sperm. After three to five days of development, viable embryos are selected and implanted into the woman’s uterus to initiate pregnancy.
- Zygote intrafallopian transfer (ZIFT): Also called tubal embryo transfer, ZIFT is similar to IVF; however, after fertilization in the lab, the early embryo is placed in the fallopian tube rather than the uterus.
- Intracytoplasmic sperm injection (ICSI): ICSI is similar to IVF, but it involves injecting a single sperm directly into a mature egg, after which the resulting embryo is transferred to the uterus or fallopian tube.
- Gamete intrafallopian transfer (GIFT): GIFT involves transferring both the egg and sperm into the woman’s fallopian tube so fertilization occurs in the woman’s body.
Surgery
Surgery may be performed to remove scar tissues or treat certain conditions (e.g., fibroids) that cause infertility. Today, most reproductive surgeries are performed using minimally invasive techniques, such as laparoscopic surgery (through the abdomen) or hysteroscopic surgery (through the cervix and into the uterus).In men, surgery may include vasectomy reversal or percutaneous epididymal sperm aspiration (PESA). Under local anesthesia, a thin needle is inserted into the testicle to retrieve sperm, which are then used immediately for ART or frozen for future use.
How Does Mindset Affect Infertility?
While it cannot directly influence fertility, mindset plays a crucial role in influencing both emotional and physical health. A positive outlook can reduce stress, improve coping abilities, and promote healthier lifestyle choices, which may enhance fertility. Mental well-being also affects relationships and the ability to manage fertility treatments, with a hopeful attitude potentially improving outcomes.
What Are the Natural Approaches to Infertility?
Various natural methods may help treat infertility, but further research is needed to confirm their effectiveness and safety. Consulting a health care provider before trying them is advised.
1. Herbal Medicinals
As per a 2021 review, some medicinal herbs are rich in polyphenolic compounds such as isoflavones and flavonoids, which support women’s reproductive health. These compounds help regulate endocrine pathways and treat reproductive disorders, including PCOS, premature ovarian failure, endometriosis, and hyperprolactinemia. Some of the medicinal herbs used in traditional medicine include the following:- Wuzi Yanzong pills: A 2020 meta-analysis found that Wuzi Yanzong pills, which use tu si zi as a main ingredient, along with four other traditional Chinese medicine (TCM) ingredients, could “remarkably enhance male semen parameters” and may help treat male infertility.
- Goji berry (Fructus lycii): Goji berry is the fruit of the Lycium barbarum plant. A 2024 study found that a goji berry extract boosted female fertility by lowering age-related oxidative stress in the ovaries and significantly increased pregnancy and live birth rates in naturally aged mice. Goji berries are also a main ingredient of Wuzi Yanzong pills, as the combination of tu si zi and goji berries is the primary herb pair in many TCM male infertility treatments.
- Middle Eastern herbal remedies: According to a 2019 study, in the West Bank area, Ceratonia siliqua pollen grains, Anastatica hierochuntica fruits, and Parietaria judaica leaves are the most popular herbal remedies for female infertility. Ferula hermonis roots, Phlomis brachyodon leaves, and Phoenix dactylifera pollen grains are the most commonly used for male infertility. However, more research is needed on their effectiveness and safety.
2. Supplements
Supplements that may improve egg and sperm quality include:- Coenzyme Q10 (CoQ10)
- Folic acid
- L-carnitine
- Lycopene
- N-acetyl cysteine (NAC)
- Selenium
- Vitamin C (ascorbic acid)
- Vitamin D
- Omega-3 fatty acids
- Folate
- Melatonin
3. Acupuncture
As per a 2020 meta-analysis of 24 studies on the effectiveness of different methods involving acupuncture in treating female infertility, warm acupuncture showed the highest likelihood of increasing pregnancy rates, while acupuncture alone most positively affected ovulation rates. A combination of acupuncture and moxibustion led to significant improvements in miscarriage rates among Chinese women.4. Apitherapy
Apitherapy is treatment using bee products such as pollen, royal jelly, bee venom, and propolis. A 2023 review indicated that bee products could help with infertility related to PCOS. A 2021 review suggested that bee products may offer benefits for infertile males, as well. As per a small 2003 randomized controlled trial, bee propolis was found to potentially be an effective treatment option for infertility linked to mild or minimal endometriosis.5. Massage
A 2015 study found massage therapy enhanced IVF outcomes in patients undergoing blastocyst (early embryonic cell structure) transfer during a frozen embryo cycle. This was likely due to reduced stress, decreased uterine contractions, and improved blood flow in the abdominal area. In a 2008 study, 28 infertile women with complete fallopian tube blockages received 20 hours of manual physical therapy to their abdominal area. One month later, 61 percent of the patients showed the blockages had been cleared, and nine of those 17 women became pregnant.How Can I Prevent Infertility?
It’s not always possible to prevent infertility, as sometimes it is due to genetic or structural issues. However, barring those factors, the following strategies may help prevent infertility in other cases:
- Limit the number of sex partners and use condoms to reduce STI risk, as untreated STIs may cause infertility.
- Maintain a healthy diet, weight, and lifestyle.
- Avoid lubricants during sexual intercourse to improve sperm function.
- Avoid smoking or marijuana.
- Avoid exposure to harmful chemicals and environmental toxins.
- Limit alcohol consumption.
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