Diagnosing Infertility

You've seen a fertility specialist. You've been poked and prodded and had just about every conceivable fluid tested. Now your doctor finally has some answers, but what do those answers mean? Here's a look at some of the common diagnoses made by infertility specialists. As you'll see, many conditions leave ample room for hope. With proper treatment, parenthood may just be within reach.



Female infertility

In the old days, women almost always took the blame when a couple struggled to conceive. Today, we know that in couples having trouble conceiving, male infertility contributes to the problem close to 15 percent of the time; in another 30 percent of couples, it is the sole cause. But the focus on women has produced one benefit: Doctors understand the female reproductive system in great detail. In many cases, the cause of female infertility can be quickly diagnosed and treated. Common causes of infertility in women include the following:



•Endometriosis. This condition occurs when the tissue that normally lines the inside of the uterus grows on the outside, or even on other organs in the abdomen. Some women experience excruciating pain with endometriosis, while others don't feel anything unusual. According to Resolve, a national infertility association, about 40 percent of women with endometriosis will have fertility problems. Surgery to remove the abnormal tissue can relieve symptoms and improve the chances for conception. In more severe cases, in vitro fertilization (IVF) bypasses the inflamed area and offers a high probability of conceiving.
•Ovulation problems. Many women fail to produce a mature egg every month. Ovulation disorders can stem from a number of causes, including an underactive or overactive thyroid gland, hormonal irregularities, polycystic ovarian syndrome (see below) or irregular periods due to extreme weight loss or too much exercise. Stress can play a role as well. In many cases, fertility drugs can stimulate ovulation and make pregnancy possible.
•Polycystic ovary syndrome. This hormonal disorder is one of the most common causes of infertility in women -- and one of the most underdiagnosed. Possible symptoms include significant weight gain, acne, excessive facial hair, and irregular periods. Your doctor can confirm the diagnosis by measuring hormone levels in your blood. While it isn't curable, the condition can often be controlled through diet, exercise, or medication. Treatment options include medications that affect the body's sensitivity to produce insulin, hormones that stimulate ovulation, in vitro fertilization, and -- rarely -- surgery to remove ovarian cysts.
•Premature ovarian failure. Roughly 1-4 percent of women stop menstruating before the age of 40, a condition known as premature ovarian failure or early menopause. Menstrual periods may stop suddenly or taper off over several years. Possible causes of premature ovarian failure include cancer or radiation treatments, uncommonly severe pelvic inflammatory disease, and autoimmune diseases such as lupus or Type 1 diabetes. Some cases seem to happen for no reason. Unfortunately, the only available treatment option is egg donation.
•Uterine abnormalities. Fibroids, benign growths inside the uterus, are a common cause of infertility. Scar tissue resulting from an infection can also block conception. The good news is that surgery can often remove these obstacles. Some women are born with malformed uteruses that make it difficult, if not impossible, for them to conceive, even with treatment. Other abnormalities, such as walls that form in the uterine lining, can keep a fertilized embryo from implanting. Fortunately, this can be easily corrected with surgery.

Male infertility

A typical man can produce hundreds of millions of healthy sperm cells every day. Unfortunately, the organs that produce the sperm and the passages that carry them are vulnerable to a wide range of problems. Here are some examples of the conditions that can cause male infertility:



•Varicoceles. Some experts believe that varicose veins or "varicoceles" in the testicles are a common cause of male infertility, but others feel the evidence is inconclusive. These veins can cause a rise in temperature in the testes, which hampers the production of mature sperm. Surgery to correct this can boost a man's sperm count and improve his chances for fatherhood.
•Blockages. Varicoceles aren't the only possible explanation for a low sperm count. Some men have blockages along their genital tracts that keep sperm from reaching the semen. The blockages are often caused by sexually transmitted diseases, other infections, or genetic diseases such as cystic fibrosis. They can often be surgically repaired.
•Structural problems. Some men are born with abnormalities that make it impossible to father a child without medical help. In rare cases, a man may be born without the vas deferens, the tubes that carry sperm from the testicle. This is most commonly seen in men with cystic fibrosis. Some men are born with an undescended testicle, a condition that usually corrects itself early on, or is corrected surgically when the child is about a year old. Other congenital problems may include a malformed urethral opening, which can often be surgically repaired, and hormonal imbalances, which can sometimes be reversed with hormone treatments.
•Sexual and ejaculatory problems. Some men produce plenty of healthy sperm but have trouble making the all-important delivery. If a man suffers from erectile dysfunction, a doctor can recommend one of many effective treatments, from vacuum devices to sildenafil (Viagra). Less commonly, a man may have trouble fathering a child because much of his semen spills into the bladder during orgasm, a condition called retrograde ejaculation. Surgery can often reroute the semen to the intended destination.
•Immune system and hormonal disorders. According to Resolve, about 5 to 10 percent of all men have a hormonal disturbance that can interfere with fertility. Kallmann's syndrome is a condition in which the man doesn't produce the hormones necessary for making testosterone and sperm. An overactive thyroid gland or pituitary tumor can affect the number and quality of sperm a man produces. Or a man may simply have low levels of certain hormones critical to the production of sperm. Hormone treatments are often a quick and effective solution to such problems.

Some men and women go through all the tests and physical exams only to find no identifiable cause of their infertility; others seem to have only the subfertility common to couples or women in their late 30s and early 40s. This can be extremely disheartening, but it doesn't have to be the end of the road. According to the Mayo Clinic, the pregnancy rate for couples with unexplained infertility is among the highest. But since there are no guarantees, couples may want to discuss assisted reproductive technology options with their doctor.



Whatever your diagnosis, it's only the beginning. Overcoming infertility can be a long and difficult journey, and only you and your partner know if you're ready for the challenge.