What causes infertility in a couple? It is rarely one person's fault
Infertility is rarely one person's fault. Roughly a third of the time the cause lies with the woman, a third with the man, and the rest is a mix of both or unexplained, so both partners are tested from the start. Dr Mayur Pai explains the common causes, the simple tests, and the treatments available for most of them.
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Whose fault is it?
When a couple is not conceiving, the first question in their minds is usually a painful one: whose fault is it? Dr Mayur Pai answers it gently and honestly, because the truth takes a lot of pressure off both partners. Infertility is rarely one person's fault, and it is far more common, and more treatable, than most couples realise.
Picture a typical couple we meet: married a few years, trying for over a year, both healthy, and each quietly blaming themselves. What they need is not blame but answers. Here is what we actually look for.
What are the main groups of causes?
Roughly speaking, the causes fall into three broad groups, in almost equal measure. About a third of the time it is a female factor. About a third of the time it is a male factor. The rest is a mix of both, or unexplained.
That balance alone is why both partners must be checked from the start. Testing only the woman misses half the picture, and can mean months of treatment aimed at the wrong problem.
What causes infertility in women?
Ovulation problems. If you are not releasing an egg regularly, there is no egg for the sperm to meet in those months. The usual signal is very irregular periods. Conditions such as PCOS and thyroid imbalance sit here, and both are very treatable. Read more about PCOS and what the ultrasound shows.
Blocked or damaged fallopian tubes. The tubes are where the egg and sperm normally meet. A past infection, or earlier surgery, can leave them blocked or damaged, so the egg and sperm never get the chance to meet. This often causes no symptoms, which is why checking the tubes is part of the first evaluation.
Endometriosis. Here, tissue similar to the lining of the womb grows outside the womb, often around the ovaries and tubes. It can cause painful periods, but it can also quietly affect fertility with few symptoms at all.
Age. As the years pass, both the number and the quality of a woman's eggs decline. That is simply biology, not anyone's failing. Read the honest facts about fertility and age.
What causes infertility in men?
On the male side, it usually comes down to the sperm: how many there are, how well they move, and their shape. These can be affected by:
- infections,
- varicocele, which means enlarged, varicose veins in the scrotum,
- smoking and heavy alcohol,
- obesity,
- heat, and
- stress.
The encouraging part is that many of these can be improved. Sperm take about two to three months to form, so a change made today shows up on a later test. Read more about male infertility and the semen analysis.
What is unexplained infertility?
Sometimes all the standard tests come back normal and no single cause is found. This is called unexplained infertility. It sounds frustrating, and it is natural to feel that way. But it often carries a hopeful outlook, and there is still plenty we can do, including IUI and, where needed, IVF.
How is the cause found?
The evaluation is simpler than most people fear.
- For the woman: an ultrasound scan and a few blood tests to check ovulation and hormones, and a test to see whether the tubes are open.
- For the man: a semen analysis. If the result looks low, it is usually repeated after a short interval, because sperm counts naturally vary.
That is usually enough to point us in the right direction on the very first round. Coming together, as a couple, means both sets of results can be read side by side.
As a general guide, get checked together after about a year of trying, or after six months if the woman is over thirty-five. Come sooner if periods are very irregular, or if there is a known problem such as a past pelvic infection or earlier surgery.
Can infertility be treated?
Here is the honest, hopeful bottom line: most causes of infertility have a treatment. Depending on what the tests show, that can mean:
- simple tablets to help ovulation,
- surgery for tube problems or endometriosis,
- lifestyle changes, and treatment of any cause found in the man, or
- IUI or IVF, when needed.
Not every couple needs the most involved option. Knowing the cause is what lets us choose the simplest step that fits — see IUI vs IVF: which one do you need?
What helps couples most is simple: coming in together, coming early, and getting answers instead of blaming themselves in silence.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so the tests, any surgery and any fertility treatment happen in one place, under one team. Consultations are available across Goa, and a consultation looks at the whole picture, as a couple.
Getting started
For questions, send a short WhatsApp message to +91 95185 02773 with your situation and any reports either of you already has. Your first online consultation is free. To book a consultation, call our reception on +91 95459 20817; consultations are by appointment. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Is infertility usually the woman's problem?
No. Roughly a third of the time the cause lies with the woman, a third with the man, and the rest is a mix of both or unexplained. That is why both partners should be tested together from the start.
What are the common causes of infertility in women?
Ovulation problems such as PCOS or thyroid imbalance, blocked or damaged fallopian tubes, endometriosis, and age, as the number and quality of eggs decline over the years. A scan, a few blood tests and a check of the tubes usually show which of these applies.
What affects sperm count and quality?
Infections, varicocele (enlarged veins in the scrotum), smoking, heavy alcohol, obesity, heat and stress can all play a part. Many of these can be improved, and because sperm take about two to three months to form, the benefit shows on a later test.
What does unexplained infertility mean?
It means the standard tests for both partners come back normal and no single cause is found. It often carries a hopeful outlook, and there is still plenty that can be done, including IUI and, where needed, IVF.
Where can we be tested in Goa, and is travel help available?
Consultations are available across Goa, and tests and treatment take place at Pai Hospital in Goa, which has its own operating theatre and its own IVF laboratory. Free patient transport is available from across Goa and nearby areas.
Or call +91 95185 02773
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.