Dr. Springer Discusses Causes For Infertility
The first step toward successful treatment of your infertility is to determine it's cause-or causes. This is not always easy and sometimes, after weeks of testing, doubt may still remain as to the precise reason for your failure to conceive. Nevertheless, I am usually able to place the cause into one or more of five broad categories. I would like to spend a little time discussing each of these.

Tubal Factor
Tubal factor infertility implies that your fallopian tubes have been damaged to the point where they are no longer capable of allowing sperm, eggs or a fertilized egg to pass unhindered through the entire length. Tubal factor may be associated with a complete obstruction of your tube. Tubal factor also may exist when the tubes are still open-but not functioning normally. This latter condition may be associated with endometriosis or mild cases of inflammatory disease.

Male Factor
This condition may exist when there is a decrease in any of the following:

• Sperm concentration-that is, sperm count per ml. of semen



• Forward sperm motility



• Normal shape of the sperm

Male factor may be difficult to diagnose in borderline conditions and may sometimes require a second analysis. At the other extreme-azospermia-the complete absence of sperm-is the most severe form of male factor.

Ovarian, or Egg Factor
Egg factor may present as a cause of infertility in one of three ways:

• Eggs are present in the ovary, usually of good quality, but are not being released -ovulated-on a regular basis. I see this most often in polycystic ovarian disease- a very common condition in infertility patients.



• Eggs are being released regularly-but they may be of poor quality. This may occur in a variety of conditions, including polycystic ovaries. It may also be seen in early stages of decreasing ovarian reserve.



• Only the poorest quality eggs remain. This condition, severely decreased ovarian reserve, is usually not compatible with pregnancy unless donor eggs are used.

Miscellaneous Factors
This category includes such things as poor cervical mucus, luteal phase defect and unidentified infections. In my experience, these factors rarely are sole contributors to infertility. A great deal has been written about the role of poor cervical mucus as a cause of infertility. To date, there seems to be no convincing data to support a relationship. We do not routinely test for this condition.

Unexplained Infertility
I am amazed that some 25% of my patients, following extensive infertility testing, still have no identifiable cause for their failure to conceive. This large group reflects, more than anything our still imprecise knowledge of the process of conception.

I suspect several possibilities: Subtle abnormalities in the sperm, undiagnosed decrease in egg quality-often related to decreasing ovarian-or poor fertilization. I have used the phrase "decreased ovarian reserve" several times in this section. It is such an important factor in infertility that I would like to discuss it further.

Decreased Ovarian Reserve
Soon after the onset of puberty, a woman has somewhere in the range of 400,000 eggs in both ovaries. She will never produce any additional eggs. As a matter of fact, the remaining eggs are already disappearing at an alarming rate.

The rate at which these eggs are lost is genetically predetermined. Because the best eggs go first, there will come a time in every woman's life-long before menopause-when her remaining eggs are of such poor quality that they are no longer capable of developing into an embryo.

The age at which this happens varies tremendously from one woman to the next. And it is a gradual process-it does not happen overnight.

Loss of ovarian reserve may start at any age-but it is very rare in women in their 20's. It becomes a frequent problem as women enter their mid 30's, but I remain suspicious of decreasing ovarian reserve in a woman of any age with more than a few years of unexplained infertility.

Conclusion
Clearly, we do not know all there is about the causes of infertility. Sometimes our testing leads us to obvious conclusions...other times, we are perplexed. Often, there are multiple factors involved. I hope the information in this section is helpful and will open up further areas when we are together. If you should have any further questions or wish to set up a consultation visit, please call our friendly staff during office hours.