A grounded overview of the most common factors behind difficulty conceiving.
✍️ By Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG — Reproductive Medicine Specialist · Updated August 2026
PCOS, hypothalamic suppression, thyroid disorders, hyperprolactinemia, and premature ovarian insufficiency.
Prior pelvic infection, endometriosis, adhesions from prior surgery, and hydrosalpinx.
Fibroids, polyps, adhesions, adenomyosis, and dysmorphic uterus — many require 3D imaging to diagnose accurately.
Abnormal sperm count, motility, morphology, or DNA fragmentation; varicocele; obstructions; and hormonal issues.
Egg quantity and quality decline with age — the largest single fertility variable for women.
Weight, sleep, alcohol, smoking, chronic stress, and environmental exposures can all matter.
About 15–30% of couples have no clear cause on standard testing. Advanced workup including 3D ultrasound often uncovers contributing factors.
Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.
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