You’ve been trying to conceive for almost a year now with no luck. To find out why, you’ve had fertility tests done and are just waiting to get the results back. But what will you find out? There are many possible diagnoses you could receive after going for fertility tests. Here is an overview of some of the possible explanations and just what they mean.
This is when lining from your uterus is found outside of your uterus. Endometriosis mainly affects women in their 30s to 40s and about 40% of women with endometriosis will have some problems conceiving. The main cause of infertility from endometriosis seems to be scarring and adhesions that result in a blockage. This prevents the egg from being fertilized or the fertilized egg from traveling properly along the fallopian tubes. This can result in an ectopic pregnancy (this is when the fertilized egg implants itself somewhere other than in the uterine lining). However, there are some other theories as to how infertility is caused by endometriosis.
Endometriosis can be treated with surgery. If you experience pain while having sex, have very painful menstrual cramps, and/or experience heavy bleeding during your period or unusual spotting, you may have endometriosis. However, about 30% of women with endometriosis will never show any symptoms except for fertility problems.
Polycystic Ovarian Syndrome (PCOS)
The bad news about PCOS is that it is one of the main causes of infertility among women yet is severely under diagnosed (less than 25% of women who suffer from the syndrome have actually been diagnosed). One of the main reasons that it is not diagnosed is because symptoms of the syndrome generally do not appear to have any connection with each other. Usually it’s not until a woman has troubles getting pregnant and she gets professional help that she learns she has PCOS. Some symptoms of PCOS include weight gain, acne, irregular or absent periods, infertility, and failure to ovulate. PCOS can be diagnosed through a series of blood tests. It can easily be managed through the use of hormones that will trigger ovulation and will also help you get pregnant.
About 40% of female fertility problems are caused by ovulation problems such as irregular periods or failing to ovulate at all. These disorders can be caused by a variety of things such as excessive weight loss, stress, thyroid problems or hormone imbalances. The way the disorder is treated depends on the cause.
Premature Ovarian Failure (POF)
This can be a very upsetting diagnosis as it means that you are no longer menstruating even though you are under the age of 40. Causes of POF can range from defects from before birth (like a chromosomal abnormality that results in defective ovaries) to your ovaries becoming resistant to your body’s natural hormones when you are in your 20s and 30s. Pelvic surgery, chemotherapy, and radiation have also been known to result in POF. In very few cases, POF is present in a woman’s family history. You can also experience intermittent ovarian failure. Women who are affected by this will go for months with no period and then suddenly begin to menstruate again for a short time. As well, her hormone levels may appear normal while she is menstruating. If she were to seek treatment during this time, it would appear as though everything were fine with her ovaries, thereby making it difficult to diagnose her with intermittent ovarian failure. Treatment of POF can be difficult. You may try hormone pills in order to promote ovulation but this is often not successful. Another option is IVF with a donor egg that is fertilized by your partner’s sperm.
This category encompasses problem you may have with your uterus. If you have gone for fertility testing, you will probably receive a specific diagnosis as to just what the problem is. Some possible factors that can affect your uterine and your ability to conceive include uterine fibroids, uterine didelphys (this when you a born with a uterus that is made up of two parts with a wall dividing them), a complete lack of a uterus, scar tissue in the uterus or exposure to DES in the womb (DES was a drug given to pregnant women up until the late 1960s. Children born to women who took this drug often had defects, one of which is an irregularly shaped uterus). Depending on just what the problem is, different treatments may be recommended.
Suffering from a miscarriage is always difficult, but suffering from one when you have been trying for months to get pregnant can be truly upsetting. While the main cause of miscarriage is genetic defects with the fetus, miscarriage can also be caused by problems with the uterus or cervix, unusual hormone levels, or infections or toxins in your environment. If you have been trying to conceive and have suffered two miscarriages or more, book yourself an appointment with your health care provider or geneticist. The miscarriages could be your first hint of fertility problems that need to be investigated.
Luteal Phase Defect (LPD)
This can be caused by two things both involving your body’s progesterone development. The first cause of LPD is attributed to your ovaries not secreting enough progesterone. The second reason could be that your endometrium is not responding to the progesterone stimulation. Either way, the end result is that the endometrium is not properly prepared for pregnancy, thereby causing either fertility problems or an early miscarriage. If you have been found to have LPD, you will most likely receive some form of stimulants or hormones, which will help in developing the endometrium.
It is estimated that 40% of infertility problems are due to problems with the man. Although this may take some pressure off of you, remember that, for many men, being told that they have fertility problems can cause a great deal of anxiety and upset about their abilities as a man. While you may be unable to conceive because of your partner, keep in mind that this is an issue you both must deal with, not just him. So, what are some of the reasons that cause men to be infertile? Well, they may have a blockage somewhere along their reproductive tract that prevents sperm from making its way to you. Your partner could also have fertility problems producing sperm or ejaculating or it may be that there is some disorder (like a low sperm count) that is preventing the sperm from reaching its destined target. Depending on what the exact problem is, your health care provider may suggest surgery or hormones to improve your chances of becoming pregnant.
This may be one of the most aggravating things to hear if you are having troubles conceiving. Yes, even after going through all sorts of tests to figure out what is wrong, one in five couples will be told that their infertility is unexplainable. This doesn’t mean that there isn’t a reason for your fertility problems. Rather, the tests available today are not able to identify just what the problem is. But what does this mean for you? That’s hard to say. You can explore the different fertility treatment options or just keep trying and hope for the best. If your fertility problems can’t be identified, talk with your health care provider as well as you partner as to what the best course of action may be for you.
Women who have been going through fertility treatments that involve medication to stimulate ovulation and have had no luck may fall into this category. If you find yourself in this situation, then it indicates that you require a higher dosage of stimulation medication yet you may still have a negative outcome. If you have been considering IVF, try having an ovarian reserve test done beforehand. Women who do not respond well to fertility drugs are often not very successful at conceiving through IVF. Having an ovarian reserve test performed may help you save time, money and stress by letting you know if you are a suitable candidate for IVF. If you are a suitable candidate, then you and your health care provider may want to try different kinds of stimulant medications to see which one you respond best to. If you are a ‘poor responder,’ then make sure you are receiving treatment from a facility that has experience with other women who have been diagnosed as poor responders. This will help ensure that you get the best care designed just for you.
You and your partner have already had a child or two and now you are trying again but with no luck. But you’re not infertile - you’ve already had children! Infertility can strike at any point in your life. Just because you have had a child with no problems does not guarantee that all future children will be conceived with ease. If you are experiencing fertility problems after already having at least one child, then you are considered to be experiencing secondary infertility. This is actually more common than primary infertility (fertility problems experienced by those people who have never had a child), yet is often ignored or not recognized as a problem. While fertility problems can cause stress in a relationship, secondary infertility can really take its toll on a couple. It is important to keep communication open between you and your partner so that you both know what each other wants, hopes for and is willing to do (or not do) to become parents again.
While it may be hard to deal with the issue of infertility, facing it head on is the first step in achieving your dream of having a child. There are many treatments and medications available today that can help you out that may not be as expensive as you thought. Be sure to read up on all the possibilities so that you and your partner can decide what is best for both of you.
Revision date: June 11, 2011
Last revised: by Sebastian Scheller, MD, ScD