What are the Main Causes of Infertility in Females and Males?

Infertility can be caused by a single issue or a culmination of a few problems. Finding the main causes of infertility in females and males is essential to help you to get the proper treatment. This can further help to ease your pregnancy journey.

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Knowing Why: Root causes of infertility

There are some main causes of infertility in females and males that most of my patients share. Most of the reasons are common, and only some are rare. These common conditions could affect your chances of conceiving. Hence, you will need treatments for it. Here are some common conditions, followed by suitable treatments for each situation.

1. Age

Female Age

Women are born with a lifetime supply of eggs. However, with age, they gradually decrease in both quality and quantity. The average number of eggs you have during the first menstrual cycle is around 300 000 to 400 000. As you grow old, the number of eggs starts to drop. By 30, the egg count stands between 39 000 to 52 000. By age 40, it reduces, even more, between 1 200 to 9 000. In determining fertility, a woman’s ovarian reserve must be of a level that facilitates pregnancy. If you plan to delay pregnancy, it is best to freeze your eggs. Start freezing at a younger age, so you have better chances of a successful pregnancy.

What tests are conducted?

To check the egg count, you may be suggested to take the Anti-Mullerian Hormone (AMH) Test. This test is usually conducted to assess a woman’s ovarian reserve or egg count. The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve. If your ovarian reserve is high, you have more chances of getting pregnant. If it is low, you may face problems conceiving. This also means that you may need to take treatments soon to get pregnant.

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Treatment options

You can get some treatments if the leading cause of infertility is age. For women around 35 to 45 years old, there are options like:

In vitro fertilisation (IVF) – Your egg is fertilised with a sperm in the laboratory. After fertilisation, the egg will be transferred to your womb so you can get pregnant.
Preimplantation Genetic Testing (PGT) – An additional test conducted during IVF. It helps to find any genetic defects in embryos before transferring them to the womb.
Endometrial Receptivity Assay (ERA / MIRA) – This procedure is conducted to check whether the endometrial cavity is ready for embryo implantation.

2. Fallopian Tube Obstruction

This is another leading cause of infertility in women. Your fallopian tubes may be blocked because of scar tissues, infections and pelvic adhesion. It means sperm cannot pass through to get to the egg. Moreover, fertilised eggs also may not pass through to the uterus. This main cause contributes to about 25 to 30 per cent of infertility cases. The condition includes cases of completely blocked fallopian tubes and cases where just one tube is blocked, or scarring narrows the tubes.

What tests are conducted?

Hysterosalpingogram (HSG) X-ray

This X-ray checks the fallopian tubes and uterus for any blockage. It usually takes a few minutes, and the patient can go home the same day.


It is a surgical procedure to check and if possible repair the fallopian tube. During this procedure, a thin tube with camera is inserted through a small incision in the patient’s belly button. It allows the doctor to inspect and find out the problems that causes the fallopian tube blockages.

Treatment Option

One of the common treatments suggested for this problem is IVF or the test tube baby. Since this procedure involves fertilisation in the lab, the sperm and egg are not required to travel through the fallopian tubes. The fertilized embryo will be implanted straight in the womb. This may increase chances of successful pregnancy.

3. Uterine Fibroids

It is a type of tissue growth in the uterus. It is a very common condition among women. Up to 40 per cent of women have at least one fibroid. They even tend to increase with age. They are not cancerous or otherwise harmful to health. However, they may make you feel uncomfortable.

Most fibroids do not affect fertility and do not need any treatment. The critical aspect affecting fertility is whether the fibroid is distorting the lining of the uterus or if it is located inside the uterus itself.

What tests are conducted?

If you feel uncomfortable around your abdomen, the doctor may do an ultrasound scan. It is used to confirm the presence of uterine fibroids. It uses sound waves to get a picture of the uterus to confirm the diagnosis. It is also used to map and measure fibroids.

Treatment Option

Laparoscopic Surgery – This type of surgery checks the abdominal and pelvic areas. During this surgery, a small cut is made to insert a narrow tube to remove the fibroid. It is usually recommended if you have smaller and few fibroids.

Myomectomy – A surgical procedure that removes fibroids while preserving the uterus. It is an option for you if you are considering getting pregnant in the future.

4. Polycystic Ovarian Syndrome (PCOS)

This is another common condition when the ovaries develop numerous small collections of fluid (follicles) and fail to release eggs regularly. This results in irregular menstrual cycles. 25 per cent of women of childbearing age have PCOS, but most do not even know that they have it until they begin trying to get pregnant.

What tests are conducted?

Ultrasound Scan – An ultrasound scan can indicate the presence of these follicles.
Blood Tests – Blood tests can measure your hormone level. You may have higher levels of testosterone. You might also have elevated Luteinising Hormone (LH). Blood tests may also indicate a change in blood glucose and insulin levels.
Pelvic Exam – A pelvic exam is also conducted to check reproductive organs for masses, growths or other changes.

How do we treat them?

Ovulation Induction – This treatment use medication to stimulate ovulation for women who do not have regular ovulation.
IVF – Fertilised embryos from the laboratory will be inserted into a woman’s womb. It is one of the common treatments for patients with PCOS and has a high success rate of around 70%.

5. Sperm Count

It is essential to understand the main causes of infertility in females and males. It is because infertility does not only affect women. In 40 per cent of couples with infertility, the male partner is either the sole cause or a contributing cause of infertility. This is most often due to problems with sperm production or sperm delivery.
A typical semen analysis result would show a sperm count of at least 15 million sperm per ml. Among the millions of sperms, at least half show forward progressive movement. If you have problems with sperm health, you may have infertility.

What tests are conducted?

If you are diagnosed with infertility, you may undergo Sperm Analysis Test. It is a laboratory test conducted to check sperm health. The analysis checks the quality of the sperms in three ways- the number of sperms, their motility (ability to move), and their morphology (size and shape). It also determines the volume and consistency of the ejaculated semen sample.

Treatment Option

The treatment for male infertility varies according to sperm health.
Normal – If your sperm health is normal, more focus would be given to your partner. She might undergo ovulation induction, a process to stimulate ovulation in women. They might have irregular or absent ovulation. The goal is to increase the chances of getting pregnant, which can happen through sexual intercourse. In addition, the timing of sexual intercourse may also affect the ability to get pregnant. Planning intercourse during ovulation can increase the chances of conceiving.

Average – If your sperm health is average, your doctor may suggest you to undergo Intrauterine Insemination (IUI). The doctor would insert sperm directly into the womb during this fertility treatment. The sperms are usually washed and concentrated. It makes the fertilisation process easier.

Poor – If you have poor sperm health, the doctor may suggest you to try Intracytoplasmic sperm injection (ICSI) to help increase the success rate of IVF.

6. Azoospermia

It is a condition where there is no sperm in ejaculation. It is a major cause of male infertility. This condition can be caused by blocked reproductive tracts, hormonal changes, ejaculation issues, or problems with structure or function of testicles.

There are two types:

Obstructive Azoospermia – It means you are producing sperm but there are blocks in the reproductive track. Hence, sperms are not able to pass through the tracks during ejaculation.
Nonobstructive Azoospermia – This means that there is problem with sperm production due to structure or functions of testicles or other causes.

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What tests are conducted?

The doctor will ask you to undergo semen analysis to check sperm count. If the semen sample does not contain any sperm, then you are diagnosed with Azoospermia.

How do we treat them?

Surgery – Doctors may suggest surgeries for Obstructive Azoospermia. It may help to remove the blocks so sperm can pass through
Intracytoplasmic sperm injection (ICSI) – The doctor may extract sperms from testicles. It will be washed and concentrated. Then, the doctor will inject one sperm directly to the egg to be fertilised.
Surgical sperm retrieval – This treatment is done to collect the sperm surgically.

These are the main causes of infertility in females and males. If you have any of these conditions, you are advised to consult your doctor and get suitable treatment. Getting proper treatment at the right time helps you to conceive and realize your parenthood dream.

Find out more about test for fertility assessments here: Fertility Assessment

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or +6-03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.