Conditions That Affect Fertility and When IVF May be Needed

Infertility is a multifaceted challenge, and it can arise from conditions in women, men, or both partners. Understanding the underlying causes can clarify when in vitro fertilization (IVF) may be the most effective option. Below, we explain key conditions, how they interfere with fertility, and when IVF often becomes part of the solution.

Source: UnityPoint Health

Female Conditions That Can Affect Fertility

Endometriosis

With endometriosis, uterine-like tissue grows outside the uterus, causing inflammation, adhesions, and scarring. This can distort pelvic anatomy, damage fallopian tubes, reduce egg quality, and create a less receptive environment for embryo implantation.

In IVF cycles, women with endometriosis often require higher medication doses, yield fewer eggs, and may face higher cancellation rates. Some studies show that advanced endometriosis (stage III/IV) is linked with lower clinical pregnancy rates in IVF.

Ovulation Disorders

Problems with regular ovulation (e.g., polycystic ovary syndrome, hypothalamic/pituitary dysfunction) mean eggs may not be released predictably. IVF helps by controlling ovulation and retrieving eggs directly rather than waiting for natural cycles.

Tubal-Factor/Blocked or Damaged Fallopian Tubes

If fallopian tubes are blocked, damaged, or scarred (from infections, surgeries, or conditions like hydrosalpinx), sperm and egg can’t meet in the body. Tubal infertility accounts for approximately 30% of female infertility cases. In such cases, IVF bypasses the tubes entirely by retrieving eggs and placing embryos directly in the uterus.

Low Ovarian Reserve/Poor Egg Quality

As women age or due to genetic, medical, or environmental factors, the number and quality of eggs decline. This can lead to fewer eggs available for fertilization and lower chances of successful pregnancy.

While IVF can still help, outcomes depend heavily on egg quality, which is harder to optimize. In some cases, donor eggs may be considered.

Male Factors That Can Contribute to Infertility

Low Sperm Count, Poor Motility, Abnormal Morphology

These are classic “male factor” infertility issues. Even if many sperm are produced, if too few move well (motility) or have healthy shape (morphology), fertilization may fail. IVF with intracytoplasmic sperm injection (ICSI) can address many of these challenges by injecting a single sperm into the egg.

Hormonal Imbalances

Low testosterone, elevated prolactin, thyroid dysfunction, or other endocrine disorders can impair sperm production or function. Correcting hormonal issues can sometimes restore fertility; if not, IVF may be necessary.

Varicocele (Enlarged Testicular Veins)

Varicocele is common and associated with impaired sperm parameters and reduced live birth rates in IVF. 

A varicocele is an enlargement of the veins within the scrotum when blood pools in the veins rather than circulating efficiently out of the scrotum.

Some studies show that men with varicocele have slightly lower live birth rates compared to men without. Repairing varicocele may improve sperm function and support better IVF outcomes, though evidence is mixed.

Shared or Combined Factors (Both Partners) Age

Female fertility declines with age especially after the mid-30s due to diminished egg reserve and quality. IVF success rates drop accordingly.

Male fertility also declines with age: in men over 50 or 60, sperm quality (motility, DNA integrity) can suffer, which may reduce pregnancy rates and increase miscarriage risk.

Recurrent Pregnancy Loss / Miscarriages

When couples experience repeated pregnancy loss, it may reflect genetic, immunological, or sperm-related issues. Research suggests male factor infertility might contribute to recurrent miscarriages.

IVF (with genetic testing) is often used in these scenarios to select healthier embryos and reduce the recurrence risk.

When IVF Becomes the Preferred Option

When one or more of the above conditions are present, fertility specialists often consider IVF for these reasons:

• It bypasses anatomical barriers (e.g. blocked tubes, tubal disease).

• It gives control over timing, egg retrieval, and embryo selection (helpful in low reserve or poor egg quality).

• It helps overcome male factor infertility when sperm count, motility, or morphology are insufficient.

• It allows for Preimplantation Genetic Testing (PGT), which may reduce miscarriage risk in couples with prior losses.

• It’s often more effective than less invasive treatments (clomid, IUI) in many of these diagnoses, particularly in older patients or complex cases.

  
  

However, IVF is not a guaranteed solution. Success depends on multiple factors including age, ovarian reserve, sperm health, embryo quality, and overall health.

Tips for Navigating Fertility Challenges

• Get a comprehensive evaluation for both partners early, instead of only focusing on one side.

• Ask about egg reserve tests (AMH, FSH) and semen analysis to identify potential issues.

• Discuss with your fertility team how IVF protocols may need to be adjusted (e.g. higher stimulation for endometriosis, ICSI for male factor).

• Consider genetic counseling if recurrent miscarriages occur.

• Maintain health factors: avoid smoking, optimize weight, reduce stress, and support reproductive health.

  
  

Important Note:

This article is for informational purposes only and does not replace professional medical, legal, or psychological advice. Always consult qualified professionals for guidance specific to your situation.