Causes of Infertility

Infertility involves a disease or condition of the reproductive system which inhibits the couple's ability to conceive after a year of unprotected intercourse (six months for women over age 35), or to carry a pregnancy to term.

A number of factors may cause the condition, with over half of all couples having more than one cause. It is equally likely that it is a male cause as it is a female cause, approximately 35 percent each. It is due to a combined problem in 20 percent of infertility cases, and unexplained in 10 percent.

To obtain an accurate diagnosis of the cause of your infertility, your personal Conceptions Fertility Specialist will conduct an extensive evaluation of your past and present fertility status. Once your diagnosis has been established, you and your Fertility Specialist will then decide upon the course of treatment that's right for you.

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An increasing number of women are having their first child after the age of 35. Unfortunately, this biological timeframe corresponds directly to a decrease in fertility potential.

Every woman is born with a predetermined number of eggs, whose quantity and quality diminish over time. The healthiest eggs are produced during a woman's twenties and early thirties. By a woman's mid thirties, some of the remaining eggs may have been damaged, which can result in lower pregnancy rates, a higher occurrence of miscarriages and birth defects such as Down's syndrome.

Diagnostics will begin with a thorough medical history review and a pelvic exam. In addition, hormonal testing may be recommended to help reveal egg quality and the Clomiphene Citrate Challenge may be used to check ovarian function.

Healthy pregnancies may still be achieved later in life. However, if you are over the age of 40, we recommend consulting a fertility specialist as soon as possible. The sooner you begin your treatment, the more options you will have available to you.

Male Factor Infertility

Although infertility is still mistakenly thought of as only a woman's problem, it is in fact equally likely that the cause is due to a male factor fertility. Individually, each is the cause of infertility approximately 35 percent of the time. A combined problem exists in 20 percent of infertility cases, and in 10 percent of cases the cause is unexplained.

Male infertility problems often relate to sperm production, structural issues or immunological response. Disorders may be genetic or caused by exposure to radiation, medications, infection or trauma. Hormonal imbalance may also be a factor.

Diagnosis is typically based on the results of a semen analysis, which will be evaluated for sperm count, movement and shape. If one or more parameters are found to be abnormal, you and your Fertility Specialist will discuss your options for treatment. If the analysis is normal, additional testing for hormone imbalance and genetic defects may be recommended.

Recent technological breakthroughs have made great advances in the field of male infertility. Once limited to intrauterine insemination or in vitro fertilization with donor sperm, innovative new options now available at Conceptions Reproductive Associates of Colorado offer many males the opportunity to father their own children.

Unexplained Fertility

In approximately 10-15% of infertility cases, a diagnosis is not obtained. For all of the recent technological advances in infertility, some causes still remain outside the realm of our current understanding. For couples already dealing with the stresses of infertility, this conclusion can be extremely frustrating.

Should this situation occur, the first step would be to conduct a detailed review of the entire infertility evaluation. Sometimes, this can reveal an error made in either testing or interpretation, and can prompt further investigation into questionable fertility factors.

If a comprehensive review reveals no new information, additional patient testing may be recommended. In many cases, treatment options may be pursued based on all known parameters and the preferences of the couple.

Even without a conclusive diagnosis, assisted reproductive technologies can increase your chances for success by improving or bypassing a variety of potential fertility factors.

Recurrent Miscarriage

One out of five pregnancies ends in miscarriage. Although miscarriage is defined as the spontaneous loss of a pregnancy prior to the middle of the second trimester, most occur within the first 12 weeks. Recurrent miscarriage is a term typically applied after three successive miscarriages.

Causes are often unknown, but can include structural defects, genetic defects and medical conditions of the couple or chromosomal abnormalities of the embryo. Exposure to toxic substances such as drugs, cigarettes, alcohol and caffeine or environmental hazards such as radiation have also been known to play a role in miscarriage.

Diagnosis will begin with a medical history review and physical examination. Additional testing may include chromosome mapping for genetic defects, screening for diabetes, thyroid disease and auto immune disorders, hormone level testing, ovum tracking, endometrial biopsy, hysterosalpingogram (HSG), hysteroscopy, laparoscopy and ultrasound. Once a diagnosis has been determined, your physician may recommend treatment through surgery or medication.

As heartbreaking as recurrent miscarriage can be, the odds are eventually in your favor. In women who have previously had a successful pregnancy prior to recurrent miscarriage, 70% will have another successful pregnancy. In women who have had no previous success, 60% will eventually complete a successful pregnancy. Meanwhile, it can be beneficial to seek emotional care and resources through the support programs available at Conceptions.

Ovulatory Disorders

Ovulatory disorders are one of the most common causes of fertility, affecting up to 20% of women experiencing fertility problems. Symptoms of ovarian dysfunction include irregular, infrequent or no menstrual cycles.

Causes are often unknown, but may be attributed to hormonal imbalance, insulin or thyroid dysfunction, unusual weight gain or loss, intense physical training and extreme levels of stress. At Conceptions Reproductive Associates of Colorado, we're committed to identifying and treating not only the symptoms, but the underlying cause of the disorder whenever medically possible.

Diagnosis begins with a thorough evaluation of the patient's medical and menstrual history. A physical evaluation will also be conducted to assess thyroid and adrenal functions, blood pressure, nutritional status and more. To aid in diagnosis, you may need to use an ovulation predictor kit or ovulation calculator. In addition, testing for progesterone concentration, follicle stimulating hormone (FSH) and polycystic ovarian syndrome (PCOS) may be recommended.

Technological advances in reproductive endocrinology have made ovulation possible for over 90% of treated women and pregnancy possible for at least 75%.


Click on link for study results and information: Cutback Protocol for In-Vitro Fertilizationwith Polycystic Ovary Syndrome

In 2007 Conceptions Reproductive Associates of Colorado presented an abstract at the Annual American Society for Reproductive Medicine (ASRM) meeting; Selective Cut-Back Protocol for In-Vitro Fertilization (IVF) Ovarian Stimulation in Patients with Polycystic Ovary Syndrome (PCOS).

Polycystic ovarian syndrome (PCOS) affects 5-10% of reproductive-age women, making it the most common endocrine disorder among this group. In fact, almost half of all female-based infertility cases in some way stem from PCOS.

Indications of the disorder include the inability to ovulate, the presence of ovarian cysts and an elevated level of male hormones in the body. In addition to infertility, subsequent symptoms include heavy, irregular or no menstrual cycles, excess facial and body hair, acne, obesity and male pattern balding.

While the causes of PCOS are unknown, it appears that heredity and insulin metabolism are both important factors. Therefore, a complete medical history review and physical exam are critical to the diagnosis of PCOS. Additional testing may also be required, such as endometrial biopsy, hormone level assessment and ultrasound.

Although there is currently no cure available for PCOS, its symptoms may be managed to reduce or eliminate its effects on fertility and long-term health. Conceptions Reproductive Associates of Colorado offers access to numerous support programs, and periodically hosts informational seminars on the topic of PCOS. Please contact us to find out when the next seminar will be held.

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Endometriosis affects between 15-20% of all women, and 25-35% of women who experience infertility. It is defined as the occurrence of endometrial tissue - the tissue that lines the uterine cavity - outside of the uterus, many times on overlying pelvic organs. Although this disease is known to be associated with infertility, it is not yet known if it causes it.

Nearly two-thirds of all women who have endometriosis have a minimal to mild case of the disease. Pelvic pain can be a symptom of endometriosis, but the amount of discomfort experienced does not necessarily indicate the level of disease.

The cause of endometriosis is still unknown, but two possible theories currently exist. One proposes that it is a condition that occurs during fetal development. Another long-standing theory suggests that it results from menstrual flow reaching the pelvic cavity through the fallopian tubes.

A preliminary diagnosis may be made based on medical history and a pelvic exam, but laparoscopic surgery will be necessary to confirm any conclusions drawn. The results of this surgery will enable your physician to classify the level of endometriosis, and then discuss your options for treatment based upon your overall goals.

Tubal Factors

With their complex, fragile structure, it is not uncommon for fallopian tubes to develop disorders over time. Potential problems can include blockage or damage, such as corneal or proximal tubal occlusion, isthmic occlusion, hydrosalpinx and fimbrial phimosis, bipolar disease or tubal adhesions.

Causes of tubal factors can include surgery-related scar tissue, infections and tubal ligation. All can keep the sperm and egg from uniting, and a fertilized egg from reaching its uterine destination.

Diagnosis of tubal factors usually requires a thorough medical study, with your physician recommending the tests appropriate for your individual case. Possible tests include laparoscopic surgery, ultrasound and hysterosalpingogram (HSG), a dye study of the uterus.

Many successful treatment options exist - your Conceptions specialist will help you determine the one most effective for you.