Causes of Infertility
Key Points
- Infertility is multifactorial and may involve AFAB factors, AMAB factors, both partners, or unexplained causes.
- Primary infertility occurs when pregnancy has never occurred; secondary infertility occurs after a prior achieved pregnancy.
- Common AFAB contributors include ovulatory dysfunction, endometriosis, tubal disease, uterine abnormalities, and endocrine disorders.
- Common AMAB contributors include impaired sperm production/transport, hormonal disorders, varicocele, and sexual-function disorders.
Pathophysiology
Infertility reflects disruption of one or more required steps in conception: gamete production, transport, fertilization, and implantation. The source notes two categories: primary infertility (never pregnant) and secondary infertility (prior pregnancy but inability to conceive again). Lifestyle and environmental factors, including toxins, nutrition, and substance use, can impair egg or sperm quality and reduce fecundity.
AFAB infertility frequently involves hormonal-ovulatory disorders (oligoovulation or anovulation), endometriosis, pelvic adhesions, tubal occlusion, uterine/tubal structural abnormalities, and hyperprolactinemia. Hydrosalpinx and other tubal lesions can impair gamete movement and increase ectopic-pregnancy risk. Uterine abnormalities may reduce sperm passage or implantation success.
AMAB infertility can present as azoospermia (no sperm) or oligospermia (low count) and may result from transport obstruction, endocrine dysfunction, altered spermatogenesis, varicocele, sperm antibodies, or ejaculatory/erectile disorders. Gonadotoxins, heat exposure, chronic illness, medication effects, and substance use can worsen sperm quality, motility, and production.
Classification
- Infertility type: Primary infertility and secondary infertility.
- AFAB factors: Ovulatory, tubal, uterine, endometriosis/adhesive, and endocrine causes.
- AMAB factors: Sperm-count/quality disorders, transport obstruction, hormonal causes, and sexual-function causes.
- Cross-cutting factors: Medication, toxins, infection, chronic disease, lifestyle, and psychosocial stress.
Nursing Assessment
NCLEX Focus
Prioritize identifying whether infertility cues point to ovulation, tubal/uterine structure, sperm production/transport, endocrine dysfunction, or modifiable lifestyle factors.
- Determine infertility type and timeline, including prior pregnancies and duration of conception attempts.
- Obtain focused menstrual/ovulatory, sexual, and reproductive history from both partners.
- Assess medication and substance exposure risks (including high-risk drugs and recreational substances).
- Screen for STI/PID history, prior pelvic/abdominal surgery, endocrine disorders, and chronic illness.
- Evaluate psychosocial burden, stress response, and coping resources during evaluation or treatment.
Nursing Interventions
- Provide targeted education on modifiable fertility factors: weight optimization, smoking/substance cessation, and toxin avoidance.
- Teach ovulation-tracking strategies and timing principles for intercourse during the fertile window.
- Reinforce STI prevention and early treatment to reduce tubal scarring risk.
- Support stress-reduction and mind-body coping resources during prolonged infertility workups.
- Coordinate timely referral for specialist testing when severe male-factor, ovulatory, or structural causes are suspected.
Single-Cause Bias
Assuming infertility is caused by only one partner can delay complete evaluation and prolong time to effective treatment.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| ovulation-induction-agents | Clomiphene and gonadotropin treatment contexts | Used for selected ovulatory dysfunction patterns with cycle-based monitoring. |
| dopamine-agonists | Hyperprolactinemia treatment contexts | Prolactin control may restore ovulatory function in endocrine-related infertility. |
Clinical Judgment Application
Clinical Scenario
A couple reports 14 months of infertility. The AFAB partner has irregular cycles and prior PID history; the AMAB partner uses anabolic steroids and reports reduced libido.
Recognize Cues: Dual-partner risk factors suggest possible ovulatory, tubal, and male endocrine/sperm issues. Analyze Cues: Infertility is likely multifactorial rather than attributable to one isolated cause. Prioritize Hypotheses: Priority is comprehensive bilateral workup and urgent mitigation of modifiable factors. Generate Solutions: Initiate education, risk-reduction counseling, and coordinated reproductive-endocrinology referral. Take Action: Document timeline/risk profile and support follow-through for staged diagnostics. Evaluate Outcomes: Patients understand contributors, begin risk modification, and engage in complete evaluation.
Related Concepts
- fertility-and-conception - Infertility develops when one or more conception steps fail.
- genetics-in-reproductive-care - Genetic and chromosomal abnormalities are part of infertility assessment.
- treating-infertility - Cause-directed therapy depends on accurate etiologic classification.
- preconceptual-care - Early risk optimization can prevent some infertility contributors.
- family-health-and-cultural-factors - Family and social context can shape stress and treatment participation.
Self-Check
- Which historical cues most strongly suggest tubal-factor infertility?
- How do AMAB endocrine disorders alter sperm production and fertility potential?
- Why is bilateral partner evaluation essential in infertility care planning?