Female Infertility

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This is an article from our “Doctor’s Corner” series, brought to you by Samitivej Hospital. Make sure to read the entire series!

Infertility Background

After perhaps spending years taking the needed steps to prevent pregnancy, couples who are ready to begin a family can find it extremely upsetting when pregnancy doesn’t seem to want to happen. Infertility is diagnosed in couples who have been having regular unprotected sex for one year or more without becoming pregnant. And about 15 percent of couples in the United States and Europe find themselves in this situation every year.


Depending on the age of the couple and their health history, a physician may wish to look into and/or treat a couple’s inability to conceive before the one year mark. I think it’s a good idea for couples who are considering pregnancy to visit their doctor and talk about their wishes to conceive, their health history, and perhaps complete a physical exam and/or some diagnostic tests. Kind of like a fertility “warm up” before the big game!

Infertility can be due to many things. Thirty-eight percent of the time the cause is found in the female partner, 27 percent of the time it’s found in the female and male partner, 20 percent of the time in the male partner, and 15 percent of the time it simply can’t be found.

Underlying Causes of Female Infertility

  • In 33 percent of cases the cause is found in the fallopian tubes or pelvic cavity. The fallopian tubes are the pathway between the ovary and the uterus. It is along this pathway where fertilization occurs (egg and sperm meet) and the created embryo (the ball of cells that are created and grow in number) travels towards the uterus where it will develop into a baby. The fallopian tubes share their space with the uterus and ovaries in the pelvis. Any problems in the pelvic area that have been there from birth, came about after an infection, came about after a surgical procedure(s), and/or masses that for some reason developed in the area, can all make it harder for the egg and sperm to meet or travel in the fallopian tube and/or implant in the uterus.
  • In 25 percent of cases the cause is found to be due to poor quality or a deficient number of eggs released from the ovaries. Problems that are known to decrease the ovaries ability to release good eggs at regular times includes genetic disorders, being older than the mid-thirty’s, and any health condition that effects how hormones regulate the ovulation cycle.
  • In 19 percent of cases the cause for infertility is not found, which must be extremely frustrating.
  • In 15 percent of cases the cause is endometriosis. Endometrial tissue should only be found in the uterus. It’s this tissue that women shed during their period every month. When an individual has endometrial tissue outside of the uterus, it responds like the tissue in the uterus causing damage to the pelvic area and normally pain than normal during a women’s period.
  • In 5 to10 percent of cases the cause is found in the cervix and/or the mucus that is produced there. Abnormalities in the cervix may be present from birth or may be due to poor estrogen, the result of infection, a surgical procedure, or radiation therapy.

Underlying Causes of Male Infertility

  • In 40 to 50 percent of cases no cause is found.
  • In 30 to 40 percent of cases the cause is found in the testes.
  • In 10 to 20 percent of cases the cause is found to occur in the sperms pathway from testes to the exit.
  • In one to 2 percent of cases the cause is found in the part of the brain that regulates hormone production (the pituitary and hypothalamus).

Let’s face it women and men – have very complicated “plumbing” for lack of a better word. Lots can go wrong. At Samitivej there are doctors who specialize in female and male plumbing.

Going Forward

Being diagnosed with infertility can cause feelings of anger, anxiety, shame, guilt, and depression. It seems that everywhere you look there is another happy looking pregnant mom rubbing her belly! It’s not surprising that having these feelings leads to even lower rates of fertility. I have had many patients tell me that having sex now feels like “work”, that the romance is gone, there is just too much pressure. What I tell my patients is that seeking medical help is not enough. Try to keep flirting with each other, try to make sure sex stays fun and spontaneous (even when it’s planned). Remember what was like when you first met, what attracted you to your partner then, and focus on that. Some people find relaxation and stress management techniques helpful; others find support from couples who are also having trouble. One fiction book I loved was called Inconceivable by Ben Elton (entertaining and at times close to home). Find out what makes this challenging time better for you and do that.

Healthy lifestyle behaviors such as attaining and maintaining a healthy weight, participating in a regular exercise program, minimal to no consumption of alcohol and caffeine, and smoking cessation are all great ways to stay healthy and are believed to enhance fertility.

The good news is that tests and treatments are available to couples with infertility. Moreover, assisted reproductive techniques can and have helped many couples conceive.

Samitivej Women's Health CenterThis article courtesy of our Medical Publishing Partner Samitivej Women’s Health Center.


American Academy of Family Physicians. (2011). Things to Think About Before You’re Pregnant. Retrieved from http://familydoctor.org/online/famdocen/home/women/pregnancy/basics/076.html

Horstein, M. D. & Gibbons, W. E. (2010). Optimizing Natural Fertility in Couples Planning Pregnancy. Retrieved from http://www.uptodate.com/contents/optimizing-natural-fertility-in-couples-planning-pregnancy?source=see_link

Kuohung, W. & Hornstein, M. D. (2010). Patient Information: Evaluation of the Infertile Couple. Retrieved from http://www.uptodate.com/contents/patient-information-evaluation-of-the-infertile-couple?source=search_result&selectedTitle=2%7E150

Kuohung, W. & Hornstein, M. D. (2010). Causes of Female Infertility. Retrieved from http://www.uptodate.com/contents/causes-of-female-infertility?source=search_result&selectedTitle=1%7E95

Puscheck, E. (2010). Infertility. Retrieved from http://emedicine.medscape.com/article/274143-overview

Kuohung, W. & Hornstein, M. D. (2010). Patient Information: Evaluation of the Infertile Couple. Retrieved from http://www.uptodate.com/contents/patient-information-evaluation-of-the-infertile-couple?source=search_result&selectedTitle=2%7E150

Swerdloff, R. S. & Wang, C. (2011). Causes of Male Infertility. Retrieved from http://www.uptodate.com/contents/causes-of-male-infertility?source=search_result&selectedTitle=1%7E75

Wang, C. & Swerdloff, R. S. (2010). Patient information: Treatment of Male Infertility. Retrieved from http://www.uptodate.com/contents/patient-information-treatment-of-male-infertility?source=related_link

Wang, C. & Swerdloff, R. S. (2010). Treatment of Male Infertility. Retrieved from http://www.uptodate.com/contents/treatment-of-male-infertility?view=print

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Fully equipped with the state-of-the-art technologies, our innovative Women's Health Center at Samitivej Sukhumvit Hospital provides comprehensive gynecological and obstetrical service for women of all ages.

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