Infertility, Explained

May 11, 2022


Alto Pharmacy

About 9% of men and 11% of women in the U.S. have faced fertility issues. These challenges may feel overwhelming, but there are a variety of treatment options for both male and female infertility to support your family building journey.

Here’s an overview of the causes and symptoms of male and female infertility and common fertility treatments.

Common causes of infertility

Infertility, defined as the inability to get pregnant after twelve months or more of unprotected sex, is a health condition that affects both men and women. Approximately one-third of infertility cases stem from a female reproductive factor, one-third stem from a male reproductive factor, and one-third stem from a combination of both or unknown causes.

These are some common causes of female infertility.

Problems with ovulation

The majority of female infertility cases are caused by problems with ovulation, the release of a mature egg from the ovaries. There are several causes of ovulation disorders, including the following.

  • Polycystic ovary syndrome (PCOS), a condition characterized by a hormone imbalance that impacts ovulation. It is the leading cause of female infertility.

  • Hyperthyroidism and hypothyroidism

  • Excessive exercise, eating disorders, or stress, each of which can result in hormonal imbalances

  • Primary ovarian insufficiency, sometimes referred to as premature ovarian failure

Damaged or blocked fallopian tubes

Fallopian tube damage or blockage can prevent sperm from reaching an egg, or fertilized eggs from attaching to the uterus. Common causes of fallopian tube damage or blockage include pelvic inflammatory disease — an infection of the uterus and fallopian tubes from chlamydia, gonorrhea, or other sexually transmitted infections — or a prior surgery in the abdomen or pelvis, including surgery for ectopic pregnancy.

Uterine or cervical causes

Uterine or cervical issues such as the following can disrupt the implantation of an egg into the uterus or increase a woman’s risk for miscarriage.

  • Benign polyps or fibroids may block fallopian tubes or interfere with the implantation of an embryo. However, many women with these growths are able to conceive.

  • Structural issues with the uterus that are present at birth

  • Cervical stenosis, a narrowing of the cervix


Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. The abnormal tissue growth — as well as surgical procedures to remove it — can block the fallopian tubes, preventing the fertilization of an egg. In some cases, endometriosis may interfere with implantation of the fertilized egg, or embryo.

Male infertility is most often an issue of sperm production — including the quantity and quality of sperm produced — or of sperm mobility, which affects the sperm’s ability to find and fertilize an egg. A blockage in the testicle or damage to the reproductive organs can also contribute to male infertility.

Age is a factor in both male and female fertility issues. The quality and quantity of a woman’s eggs begin to decline as she enters her mid-thirties, and age factors into the success rates of in vitro fertilization (IVF).

Symptoms of infertility

Many individuals and couples first learn of a fertility issue after trying to conceive without success, and the primary symptom of infertility is the inability to get pregnant. There aren’t always noticeable symptoms, but the following may indicate an underlying fertility problem.

  • A menstrual cycle that’s irregular, absent, longer than 35 days, or less than 21 days

  • Unusually light or heavy bleeding during menstrual cycles

  • Pelvic pain

  • Erectile dysfunction or low sex drive in men

The timeline for seeking fertility treatment depends on your age. If you are under the age of 35, most health experts suggest consulting a reproductive specialist after a year of trying to conceive. If you are between 35 and 40, you may want to pursue testing or treatment after six months of trying to become pregnant. And if you are over 40, you may want to pursue testing or treatment before you start trying to conceive.

Diagnosing infertility in men and women

An evaluation for fertility issues and potential treatment begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

  • An hysterosalpingogram (HSG), an x-ray taken to examine issues within the uterus and fallopian tubes

  • Blood tests to measure hormone levels related to fertility and reproduction

  • Ovarian reserve testing, which evaluates the number of viable eggs in your ovarian reserve. These are typically used for women over 35 or those at risk of a low egg count for other reasons.

A semen test is used to diagnose most cases of male infertility. This identifies how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail. In some cases, additional blood tests and/or genital ultrasounds may be used to rule out other health conditions.

Treatment for infertility

Fertility problems do not mean that you won’t be able to have children biologically. There are many treatment options that can help increase your chances of conception. The most effective course of treatment depends on the underlying cause of your or your partner’s fertility issues. These are among the most common fertility treatments.

  • Forms of assisted reproductive technology (ART) including in vitro fertilization (IVF), a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. In addition to treating female infertility, IVF can also be used when male infertility is a factor.

  • Intrauterine insemination (IUI), a type of artificial insemination in which sperm that have been washed and concentrated are placed directly into a woman’s uterus during ovulation.

  • Injectable fertility medications including gonadotropins and oral fertility medications such as Clomid® and Femara® can treat fertility-related hormonal imbalances.

Your doctor may also recommend lifestyle changes or treating a related health condition.

A fertility pharmacy partner you can rely on

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

Reach out any time via phone at 1-800-874-5881, or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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