Infertility: Signs,
Causes &


Infertility is a common issue—one that can be a difficult journey to embark on if you and your partner aren’t sure where to start. Even though you may be facing challenges, such as low sperm count or are in need of medication to increase fertility, that doesn’t mean you’re alone in the process. Kofinas Fertility Group specializes in giving you the best opportunity at starting a family, and our expert team of top fertility specialists can answer all the questions you have to alleviate any concerns.


To give you a better idea of what kinds of issues you and your partner may be facing, we have constructed a guide that you can use to stay ahead of any unknown terrain. As you follow along, you’ll learn about:


» What Does Fertility or Infertility Really Mean
» Infertility in Women
» Infertility in Men
» Infertility Risk Factors and Prevention
» Financing Your Fertility & Insurance Opportunities


You’ll gain an understanding of what infertility is, what the causes are, how you can identify signs of infertility in your body, and when to seek treatment.


In addition, we will talk about therapy options that can help you through this difficult and emotional situation, what medical treatments you can seek, and what your insurance coverage and financing options are if treatment is necessary.

No matter what your experiences have been like so far, it’s important to remember that you are taking steps in the right direction. Starting a family is a wonderful process that takes time, so try your best to be patient with yourselves and don’t be afraid to seek assistance from the best. We’re here to help!



What Does Fertility & Infertility Really Mean

Understanding the differences between fertility and infertility can be a little confusing since the terms are regularly used to describe the same concept. However, each one represents a stage of diagnosing a problem and taking steps to solve it.

What is the definition of infertility?

Most experts define infertility as not being able to get pregnant after 1 year of trying — or not being able to get pregnant after 6 months of trying if you are 35 or older. Women who are able to get pregnant, but are unable to stay pregnant because of repeated miscarriages, may also be considered infertile. About 10 percent of women ages 14 to 44 in the United States have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control.


If either of these situations is the case, fertility interventions may be started depending on the subject’s age, physical condition, and medical, sexual, and reproductive history. Essentially, infertility means recognizing that there is a problem, whereas fertility means taking action to fix it.


Keep in mind, stating that someone is infertile represents a different meaning whether one is referring to a man or woman. In either case, it’s important to know what infertility means for each sex.

What causes infertility?

In about one-third of cases, infertility is due to the woman (female factors), and in another third infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.


Getting pregnant is a complicated process. To get pregnant,

a) A woman must release an egg from one of her ovaries (ovulation).
b) The egg must go through the fallopian tube toward the uterus (womb).
c) A man’s sperm must fertilize the egg along the way.
d) The fertilized egg must attach to the inside of the uterus (implantation).


Problems that interfere with any of these steps can result in infertility.


In women, problems with ovulation account for most cases of infertility. Other causes include blocked fallopian tubes, physical problems with the uterus and uterine fibroids.


In men, infertility is most often caused by problems with sperm count (producing too few sperm or none at all) or problems with the sperm’s ability to reach the egg and fertilize it.

How do you diagnose infertility?

One of our fertility specialists, also known as Reproductive Endocrinologists, will do an infertility workup, which includes a medical history review and physical examination. The doctor will then run blood tests to determine if you are ovulating with adequate progesterone stimulation of the uterine lining. As part of your blood work, we do hormone testing to check for endocrine problems. The fertility workup at the Kofinas Fertility Group typically includes an ultrasound procedure called a hysterosonogram, which allows our physicians to see inside the uterus in order to accurately diagnose for polyps, fibroids or adhesions. We may also conduct a hysterosalpingogram — an X-ray test that we use to look inside the uterus and fallopian tubes, as well as the surrounding area — to find problems such as blocked fallopian tubes or an abnormally shaped uterus. Your doctor may also perform an endometrial biopsy, which involves taking a small sample of the endometrium and checking it under a microscope for problems or hormone levels that are out of balance and can affect the endometrium.


To check for male fertility problems, the reproductive endocrinologist may do a semen analysis with a post-coital test, which checks a woman’s cervical mucus to see whether sperm are present and moving normally after intercourse.

How do you treat infertility?

There are many ways that we can treat infertility. Depending on your specific problem, we may treat you with medication, surgery, artificial insemination or assisted reproductive technology. Doctors recommend treatment based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and the woman
  • The overall health of the partners
  • Preference of both partners

Infertility in Women

Unfortunately, women bear the brunt of infertility issues when it comes to diagnosing reasons for unsuccessful pregnancies. In most cases, female infertility is caused by issues dealing with ovulation. It’s estimated that 25% of all infertility issues are caused by the women’s inability to ovulate on a regular schedule. This can be caused by a number of reasons, such as polycystic ovarian syndrome (PCOS), poor production of pituitary hormones, obesity, thyroid disease, or eating disorders.


Along with ovulation issues, another 25% of infertility cases deal with tubal or peritoneal factors. These can include damaged fallopian tubes or pelvic and abdominal linings, which cause faulty egg implantation within the uterus.


Roughly 10% of women in the U.S. experience infertility. The U.S. Department of Health and Human Services (HHS) gauges that 10 out of 100 women in the country, between the ages of 15-44, will have trouble becoming pregnant or staying pregnant. In the state of New York alone, over 4 million women are struggling with the same issues.


Recognizing the Signs of Infertility in Women

Now that you understand the basics of infertility, the next thing to be aware of are any warning signs that can help distinguish your odds of getting pregnant.


Before it’s too late, there are early indicators of infertility that you can take charge of to make a difference. In addition, there are also risk factors that you should work to prevent in order to increase your chances of reproducing. Sadly, there are plenty of individuals or couples that will show no infertility signs at all even though they will face the symptoms.


You should strive to cope with these signs with great care to avoid further complications as you begin your journey to a healthy pregnancy. As a reminder, couples who have been trying to achieve pregnancy over the course of 1 year with no results should consult with a doctor. If a woman is over the age of 35, she should seek assistance after a period of 6 months. Typically, issues with infertility tend to increase as a person gets older.


Irregular Menstrual Periods

Having a cycle that is inconsistent or unpredictable when compared to an average 28-day timeframe.


Painful or Heavy Menstruation

Periods that may be more painful than normal cramps, disrupting your daily life (potential sign of endometriosis).


Hormonal Changes

A change in sex drive, skin irritations, facial hair growth, damages hair follicles, or excessive weight gain.


Pain During Sexual Intercourse

This may be the result of hormonal fluctuations, endometriosis, or other issues that can increase odds of infertility.


Diagnosis of Specific Conditions

Having a previous diagnosis of PCOS, Endometriosis, Fibroids, and more can be a sign to look out for since we know certain conditions can contribute to or cause infertility.


Causes of Female Infertility

Along with common infertility signs, there are a number of contributing causes for each sex that you should understand in order to present the best odds of achieving pregnancy. We will also examine major risk factors that can increase infertility, giving you insight into what measures can be taken to lead a healthier lifestyle and maximize your efforts.


When reading through this section, be advised that some issues that cause infertility occur at birth for an individual. For others, infertility issues may develop over time. In either case, many issues can be solved with the right treatment, so any fears moving forward shouldn’t deter you from starting the family you’ve dreamed of.

Pre-existing Conditions


As mentioned before, PCOS causes severe hormonal changes, hyperprolactinemia (when too much prolactin is created, stimulating breast milk production), it can damage the ovulation process, and fluctuating levels of hyperthyroidism can stifle the menstrual cycle, leading to infertility.


This condition is an often painful condition where the protective lining inside the uterus (endometrium) grows outside of it and forms along other parts of the reproductive organs. Although it is outside of the uterus, it will still undergo the same reactions with each menstrual cycle, causing it to shed and bleed within the pelvic area. The severe pain results in a painful or heavy menstruation. Because of potential damage this can cause to your reproductive organs, endometriosis can also be a cause of infertility.

Uterine Fibroids

Uterine fibroids are typically benign, small tumors that grow inside the uterine wall (womb) and potentially cause disruption to pregnancies. Their presence can also cause hormonal changes within the reproductive system, which can also cause fertility issues.


In some cases, eating disorders, physical injuries, too much physical activity, and tumors have also been known to increase the odds of infertility.

Damaged Reproductive Organs

Damaged fallopian tubes, uterus, or cervix have the potential to cause infertility due to several abnormalities or infections. For example, salpingitis is a condition where the fallopian tubes become enflamed, resulting in damage or blockage to passageways. Often, pelvic inflammatory disease is to blame, stemming from an STD, endometriosis, or other membranous fibers.

When analyzing the uterus, harmful polyps can form that disrupt sperm penetration, as well as benign tumors (uterine fibroids) forming along the uterine wall and blocking the fallopian tubes in rare situations.

Primary Ovarian Insufficiency (Early Menopause)

Signs of early menopause (primary ovarian insufficiency) can occur in patients who are under the age of 40. In this circumstance, the ovaries stop functioning altogether, ending the menstrual cycle for unknown reasons. Possible reasons for early menopause have been linked to genetics (Turner syndrome, Fragile X syndrome) radiation therapy, chemotherapy, smoking cigarettes, and immune system diseases. However, most cases cannot be accurately diagnosed.

Surgery-related Issues

After pelvic surgeries or pelvic-related issues (infections, appendicitis), scar tissue can form and block transport of the egg. This is known as pelvic adhesions, which is often a result of endometriosis.

Cancer and Cancer Treatments

Medical Conditions

There are a number of other medical issues that contribute to infertility in women. These include celiac disease, diabetes, lupus, ovulation disorders, amenorrhea, and more.

Infertility in Men

The other 40% of sources of infertility among couples is largely due to a man’s inability to produce optimal levels of healthy semen. When analyzing the quality of semen and its potency, certain factors must be measured. For instance, healthy semen will be produced in a substantial volume with fluid motility and good sperm morphology. With this in mind, if any of these components become jeopardized, infertility can occur.


One of the most common reasons for male infertility is a condition known as varicocele, which causes veins within the testicles to swell and enlarge. The swelling creates heat that can damage both the quantity and quality of sperm. Aside from this condition, there are plenty of other factors that can contribute to male infertility, such as poor health habits, previous injuries, damage to reproductive organs, birth defects, or blocked passageways. Although it may be frustrating, roughly 10% of men throughout the U.S. experience issues with infertility, so finding a solution is certainly not something men have to do on their own.


Recognizing the Signs of Infertility in Men

Testicular Pain or Swelling:

Issues with testicular pain or swelling could be caused by a variety of reasons, but many of them can also cause infertility.


Loss of Sexual Desire:

A man’s sexual desire is often linked to his hormones, so any changes in their sex drive could indicate problems of infertility.

Difficulty Keeping Erections:

Issues maintaining an erection are also linked to insufficient hormone levels.


Ejaculatory Issues:

Having consistent dry spells or losing the ability to ejaculate can indicate a serious underlying issue that requires attention.


Poor Testicular Health:

Since the testicles are vital for sperm production, this condition can tell a lot about the reproductive health of an individual. If the testicles are small or firm, chances of infertility may be increased.


One of the benefits of recognizing male infertility includes warning signs that potential issues are on the outside of the body. If any of these instances occur, undergoing an exam and speaking with a medical professional can be a tremendous help. Also, if any pain or discomfort is felt within the testes, seek immediate medical attention.


Having problems on both sides is normal to encounter. It’s estimated that roughly 15% of all couples trying to conceive a child will face infertility issues, so if you and a loved one are experiencing any difficulties, trust that you can overcome them with the right plan. Being aware of what common signs to look out for can help keep you prepared, but more importantly, there are a number of contributing causes of infertility that you should also consider. Take our Fertility Quiz to figure out where your journey should begin!


Causes of Men Infertility

Along with common infertility signs, there are a number of contributing causes for each sex that you should understand in order to present the best odds of achieving pregnancy. We will also examine major risk factors that can increase infertility, giving you insight into what measures can be taken to lead a healthier lifestyle and maximize your efforts.


When reading through this section, be advised that some issues that cause infertility occur at birth for an individual. For others, infertility issues may develop over time. In either case, many issues can be solved with the right treatment, so any fears moving forward shouldn’t deter you from starting the family you’ve dreamed of.


Here are some other causes of male infertility to consider in addition to those listed in the previous section:

Everyone’s battle with infertility is different, and almost all of these conditions can be properly managed with professional help to ensure a healthy pregnancy.

On the other hand, you are in control of many fertility factors on your own! Being aware of the following issues is only half the battle; the other 50% relies on you making good decisions and eliminating any risk factors that can increase your odds of a healthy pregnancy whenever possible.


  • Impaired sperm production or functionality caused by various reasons, such as genetic defects, undescended testicles, sexually transmitted diseases (STD), diabetes, mumps, or HIV. Varicocele (see the Infertility 101 section) also has a strong effect on sperm quality and motility.
  • Sperm passageways that are disrupted or blocked as result of issues with reproductive organs, sexual performance (premature ejaculation, dry spells), or certain genetic diseases. Cases of cystic fibrosis have also been known to stifle sperm delivery, presenting structural issues causing blockages to form in the testicles or damage reproductive organs.
  • Constant exposure to environmental factors have been known to cause extensive damage to one’s reproductive health. Overexposure to harmful chemicals, radiation, and pesticides can affect sperm health and morphology. In addition, consuming drugs and alcohol or taking certain medications (steroids, certain antibiotics, and antihypertensives) can negatively affect fertility. Overheating the testes – spending long amounts of time in hot tubs or saunas, for example – can also affect sperm production.
  • Undergoing cancer treatments, such as radiation therapy or chemotherapy can severely impair sperm production.

Infertility Risk Factors & Prevention

There are no specific risk factors tailored for only men or only women. Instead, these are general things to avoid that can make a tremendous difference in your reproductive health and stability.


Don’t Start Trying Too Late:

Remember, after the age of 35, female infertility starts to plummet. Female eggs have the best shot of attaching during a woman’s early to late 20s. The same rules apply to men who are over the age of 40. Sperm quality and quantity tend to drop as you move away from younger years.


Quit Smoking:

Aside from it being terrible for your general health, it’s even worse on your chances of fertility. Smoking cigarettes leads to damaged fertility treatments, increased odds of miscarriages, erectile dysfunction, and a decreased sperm count.



Being overweight has a negative effect on your reproductive health due to constant inactivity, which can lead to infertility. For men, obesity has the potential to stunt sexual desire and lower sperm counts.


Eating Disorders:

Especially for women, making sure to eat enough calories and follow a balanced diet is crucial for a healthy pregnancy. Fertility issues can greatly increase from eating disorders, such as bulimia and anorexia.


Not Exercising:

If you don’t exercise regularly, your health will start to deteriorate, increasing your odds of infertility. Additionally, a lack of exercise can lead to obesity or weak physical stature. To counteract any negative effects, make sure to stay physically active with moderate exercise. Doing this will increase sperm production and can help lead to a healthy pregnancy.


Your ultimate goal is to maintain a healthy lifestyle so that your chances of achieving pregnancy are at an all-time high. Staying away from detrimental behavior will make a huge difference in your success, so make sure to take great care of yourself.


For couples looking to improve their odds of pregnancy a bit more, try your best to have consistent intercourse (several times) close to the ovulation period (a span of 5 days before and 1 day after). For women with 28-day menstrual cycles, ovulation periods can happen midway between menstruation. If challenges still persist after taking measures to have consistent sex and take control of your health, then knowing your options for treatment is the next best move.

Knowing Your Fertility Treatment Options

It can be intimidating to reach a point where you require fertility treatments to become pregnant, but Kofinas Fertility Group offers expert medical care and guidance to help you have the family you’ve always dreamed of.


Getting Started

To get started, a fertility specialist will give you a general assessment to have a complete understanding of your issues. Once the source of your infertility is discovered, a treatment plan will be designed for you that directly solves the problem and gives you the best possible chance for having a successful, complication-free pregnancy. During your assessment, you will undergo the following procedures:


Assessment Procedures

  • Ovulatory Function Evaluation - Analysis of your ovulatory cycle to develop a strong treatment plan.
  • Imaging - Ultrasound and X-ray imaging to examine the reproductive tract, discover any major issues, and develop targeted therapies.
  • Sample Testing - Gathering of reproductive samples to understand any issues or abnormalities that can prevent a healthy pregnancy.

Creating a Unique Treatment Plan

Once your case is fully examined, you and your fertility team will put your unique treatment into action. Your unique fertility therapies might include some of the following:


Each one has proven to be highly successful among former patients, and we at Kofinas Fertility Group are proud to be of service to so many wonderful families around the country.

Kofinas Fertility Group has a team of dedicated specialists and compassionate nurses who truly believe in the power of family. We make it our mission to help you achieve your fertility goals, while being strong advocates for your personal and long-term health. Potential patients can rest assured that all of your questions and needs will be taken care of with utmost patience and knowledge.


We have many amazing resources available to patients, such as family counseling, LGBTQ therapy, online resources and FAQs, and our online patient portal to easily connect with professionals and seek assistance. We also have several financial and insurance opportunities that can help manage the cost of expensive treatments.


Financing Your Fertility & Insurance Opportunities

Of course, deciding to start a family comes with its own obstacles, but dealing with infertility on either side can take a huge emotional and financial toll on you and your partner if you’re unprepared.


On average, fertility treatments can cost thousands of dollars, not to mention the emotional challenges of being told you’re infertile or realizing that a partner is infertile. Studies have shown that couples who are infertile are 3 times more likely to end their relationships than those who aren’t. On the other hand, there is substantial evidence that suggests overcoming infertility challenges can, in fact, strengthen a relationship!


It all depends on how you and your partner navigate the issue and create a plan to move forward. Successful pregnancies occur when both parties are committed to understanding the challenges and executing a plan for the future, so as long as you are both ready to take on whatever road lies ahead, there’s still so much to be hopeful for.


Offsetting the Cost of Fertility Treatment

People often assume infertility treatments come with outrageous price tags, but in fact, there are several ways to offset high prices and come up with a plan that is easy to manage financially. It’s important to remember that most patients will become pregnant using less expensive treatment options, such as intrauterine insemination (IUI) or by treating medical conditions (such as ovulatory disorders). Something like an in vitro fertilization (IVF), which can be pricey with initial costs and medications, will only be required for a small percentage of patients. Typically, any treatment options can be financed with third-party loan options from Prosper Healthcare Lending.



Take our Fertility Mandate Quiz to find out if you qualify for insurance coverage!



IVF Insurance Option - New York

In addition, Kofinas Fertility Group offers an Insured IVF Success program that will refund you completely if your IVF procedure isn’t successful.

This incredible program gives patients peace of mind when investing in their futures and the extra boost of financial relief can be a great way to keep your mind focused on what really matters: starting a family!

Essentially, couples who medically qualify for the program are offered up to three IVF or fresh donor egg cycles, along with as many frozen embryo transfer cycles until you have a viable 12-week pregnancy. We understand that most couples do not have insurance to cover the cost of an IVF, which is why we do our best to support couples in need and fully support your journey in any way possible.

After reading this guide, we hope you have a better understanding of what challenges lie ahead and how you can overcome them. Starting this new chapter in your life may be trickier than you once thought, but Kofinas Fertility Group is here to do whatever we can to help you reach your destination.

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