What Could be Causing My Infertility?


If you’ve been trying and can’t get pregnant, you’re probably asking yourself: why? Wanting to know what’s causing your infertility is natural, and, while there are some cases of unexplained infertility, there is usually a reason for the inability to conceive on your own.

In those cases, seeing a San Francisco fertility doctor, or reproductive endocrinologist, to help identify the cause – and develop a treatment plan to get past it – is a good idea.

Reproductive Medicine Associates of Northern California (RMANorCal) Drs. Scott Morin and Jonathan Kort, who practice out of the clinic’s San Francisco and Palo Alto offices, see many different causes of infertility every day. Here’s what they examine to determine the cause:


Properly functioning ovaries are extremely important to your fertility. Each month, the brain sends your ovaries a signal, known as Follicle Stimulating Hormone (FSH), to tell them to grow follicles that will mature and release one egg. While those follicles are growing, they release another hormone, Anti-Mullerian Hormone (AMH).

During your first few fertility work-up appointments, your doctor will draw your blood to check the level of these two hormones, which gives a good picture of your fertility. If your FSH level is high, for example, it could mean your brain is working too hard to tell your ovaries to grow more follicles because your egg supply is low, known as Diminished Ovarian Reserve (DOR). If your AMH level is too high, it could mean your ovaries are growing a lot of follicles but none of them ever grow into a mature egg that is released, which is a common symptom of a condition known as Polycystic Ovary Syndrome (PCOS).

Both DOR and PCOS are common causes of infertility, and both can be treated with either medication, Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).

Fallopian Tubes

The fallopian tubes are another vital aspect of your fertility – this is where the egg and sperm meet and fertilize before the resulting embryo travels to the uterus for implantation. If there is a blockage in either of your tubes, the egg and sperm will not be able to meet, resulting in infertility. To check whether your tubes are open, your doctor will perform a procedure called a hysterosalpingogram (HSG), which requires injecting dye into your uterus and fallopian tubes. If the dye fills your uterus and fallopian tubes and spills out of each tube, your tubes are open. If there is a blockage in your tubes, you can sometimes have the blockage removed through surgery, or you can undergo IVF to bypass the tubes entirely.


As the ‘home’ of the developing embryo, the uterus plays a big role in fertility. The health of the uterus may be evaluated with an HSG, a saline sonogram, or a transvaginal ultrasound. All three can show doctors if there are any growths – like a fibroid or polyp – that could prevent an embryo’s implantation in the uterus.


It’s a little known fact that sperm issues account for about half of all infertility cases. Getting your partner checked out during your visit to an infertility doctor is important. When a man has a semen analysis done, doctors will check for three things: sperm count, sperm shape and the number of swimming sperm, or the Total Motile Sperm Count (TMSC). This is the most important indicator of a man’s fertility. If this number is low, IVF with Intracytoplasmic Sperm Injection (ICSI) is available as a form of treatment.

There are other causes of infertility as well, including endometriosis, autoimmune diseases and thyroid issues. But the good news is that treatment has advanced so much in the last decade that regardless of the cause, the chances of success are good for those who seek treatment.

If you or your partner are struggling with infertility, book a consultation to meet with Dr. Kort or Dr. Morin.