• Endometriosis
• Getting Pregnant
• Infertility

Infertility Issues: Yours, Mine or Ours

Simply put, infertility is a problem of the reproductive system. While we often think of it as a woman’s problem, it can be caused by issues within the man’s body, the woman’s body, or both.

What Causes Infertility in Women?

To get pregnant, a woman needs functioning ovaries to produce eggs, fallopian tubes where the egg can get fertilized and move to the uterus, and a uterus where the embryo can develop. Conditions that affect any of these organs can also affect fertility:

• Ovulation problems: Sometimes a woman doesn’t make enough hormones to develop, mature and release a healthy egg.
• Anatomical problems: A problem with a woman’s anatomy can prevent the egg and sperm from ever meeting. The most common is a blockage in the fallopian tubes, often caused by scar tissue from past surgery or an infection.
• Endometriosis: Sometimes, the tissue lining the uterus grows outside the uterus, often on other reproductive organs. There, it can cause scar tissue to form and affect fertility. Dr. Heather Hilkowitz explains that many women with endometriosis can get pregnant.

Click play to watch the video or read video transcript.

Can I get pregnant if I have endometriosis?

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Women with endometriosis can get pregnant. Certainly may be a little more of a challenge in some patients depending on how severe the condition is. Some women conceive with ease and totally natural way and don't need any fertility assistance. But fortunately there are many different ways to help women get pregnant if they carry a diagnosis of infertility. Some of the reasons that someone with endometriosis might have a challenge getting pregnant may have to do with the inflammation that the endometriosis has caused inside the pelvis which could lead to scar tissue of the fallopian tubes or the ovaries or the uterus and to make it more challenging for that egg to get to where it needs to be to conceive. Other times their pelvis may look great and not have any problems with scar tissue yet there's still something biochemically about endometriosis that makes becoming pregnant a bit of a challenge. There are lots of different ways and medications and procedures that can be used for women who need them to achieve pregnancy in a minimally invasive way.
• Birth defects: Women whose mothers took DES (diethylstilbestrol) in the first half of their pregnancy can have a birth defect that affects fertility. The drug, used until 1971 to prevent miscarriages, can cause abnormal development of the baby’s uterus and cervix.
• Infection: Pelvic inflammatory disease (PID) can result from sexually transmitted infections like gonorrhea and chlamydia. PID may cause scar tissue to grow between reproductive organs, leading to chronic pelvic pain and a greater risk of ectopic pregnancy, where the fertilized egg implants outside the uterus.
• Immune system problems: Sometimes antibodies in a woman’s system fail to recognize a pregnancy and respond abnormally to the egg, damaging it. Women can also develop antibodies that attack and destroy sperm.

It can be caused by issues within the man’s body, the woman’s body, or both.

What About Infertility In men?

Several factors could cause a man to be infertile. Your doctor will analyze your partner’s semen and may recommend other tests to see if a problem exists:

• Low or no sperm production: A lack of healthy sperm means fewer chances of successful fertilization.
• Abnormal sperm production: Sperm must be healthy and able to swim and penetrate the egg.
• Varicoceles: These enlarged veins on a man’s testicles can affect sperm count and quality. The presence of varicoceles is a common cause of male infertility and is usually treatable by surgery.
• Hormone disorders: Abnormal male hormone or endocrine function can affect sperm production and fertility.
• Chromosome defects: Some chromosome defects are linked to male infertility.
• Birth defects: Abnormalities in a man’s reproductive system can develop before birth. One cause may be exposure to DES (diethylstilbestrol) taken by his mother during his early months in the womb.
• Immune system problems: A man can have anti-sperm antibodies that attack and destroy sperm.

Source: Premier Health; Centers for Disease Control and Prevention; Heather Hilkowitz, MD, Hilltop Obstetrics & Gynecology

Heather L. Hilkowitz, MD

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