According to global health estimates, female infertility is a serious health concern impacting almost 1 in 6 individuals worldwide during their reproductive years. Infertility can be attributed to male, female, or both; however, female infertility represents a considerable number of cases.
Modern fertility medicine has advanced to the point of developing numerous diagnostic tools and treatment options. With the assistance of these tools, more women are achieving healthy pregnancies.
It is important to know the causes of female infertility, recognize the symptoms, and seek medical assistance as early as possible. In doing so, the likelihood of treatment success is increased.
What is Female Infertility?
Female infertility is defined as the inability to achieve pregnancy after:
- 12 months of regular, unprotected intercourse for women aged 35 and younger.
- 6 months of regular, unprotected intercourse for women aged 35 and over.
Female infertility may be attributed to a variety of causes including anovulation, disorders of the reproductive system, hormonal imbalances, and other medical underlying conditions. Female infertility may be classified as primary (the individual has never become pregnant) or secondary (the individual has previously been pregnant and is now experiencing difficulty achieving subsequent pregnancies).
The likelihood of treatment success is greater when a woman seeks medical assistance sooner rather than later.
How Pregnancy Happens
There are a number of processes that must happen to ensure that pregnancy occurs successfully, such as:
- A mature egg is released from a healthy ovary.
- The egg is transported by the fallopian tubes.
- A healthy sperm fertilizes the egg.
- The fertilized embryo makes its way to the uterus.
- The embryo successfully implants itself in a healthy uterine lining.
- Issues at any of the above stages can result in female infertility.
Causes of Female Infertility
There are many causes of female infertility; however, the most prevalent causes concern the following:
1. Ovulation Disorders
Because infertility is commonly caused by problems with ovulation, this brings about the following conditions, such as:
- Polycystic Ovary Syndrome (PCOS)
- Premature ovarian insufficiency
- Hormonal disorders
- Thyroid disorders
- Increased prolactin
- Irregular or completely absent ovulation lowers the chance of conception.
2. Blocked Fallopian Tubes
Fallopian Tubes are where the egg and sperm meet.
Blockages can result from many causes, such as:
- Pelvic Inflammatory Disease (PID)
- Past pelvic surgeries
- Tubal infections
- Endometriosis
- Sexually Transmitted Infections (STIs)
Completely blocked fallopian tubes prevent fertilization.
3. Endometriosis
Endometriosis occurs when tissue that is similar to the uterine lining is found outside the uterus. This can cause
- Pelvic pain
- Scar tissue
- Blocked fallopian tubes
- Decrease in egg quality
- Increased difficulty implanting embryos
Endometriosis is a major contributing factor to infertility.
4. Uterine Conditions
When there are a number of structural issues with the Uterus, this can negatively affect implantation. Some common examples of this can include:
- Uterine Fibroids
- Endometrial Polyps
- Uterine Congenital Deformities
- Intrauterine Adhesions (Asherman’s Syndrome)
- The following factors may diminish the likelihood of a successful pregnancy.
5. Age-Related Fertility Decline
A woman’s fertility begins to decline with age. For women over 35:
- The quantity of eggs decreases.
- The quality of eggs decreases.
- The likelihood of a miscarriage increases.
- The likelihood for chromosomal disorders increases.
Women over 40 often have lower rates of natural conception.
6. Hormonal Disorders
Ovulation and menstrual cycles are regulated by hormones.
The following can affect fertility:
- Thyroid disorders
- Adrenal disorders
- Pituitary disorders
- Diabetes
- Insulin resistance
Treatment of the imbalanced hormone will most likely improve fertility.
7. Lifestyle Factors
Some lifestyle factors that can negatively affect fertility include:
- Smoking
- Excess alcohol consumption
- Both being overweight and underweight
- Poor diet
- Stress
- Sedentary lifestyle
- Substance use
Eating a healthy diet, maintaining a healthy weight, and eliminating substance use can restore fertility
8. Unexplained Infertility
Some women have difficulty conceiving while all standard fertility evaluations are normal. This is unexplained infertility, which accounts for 10-20% of infertility.
Symptoms of Female Infertility
The main symptom of female infertility is the inability to get pregnant.
Common additional symptoms include:
- Irregular monthly cycles
- Missed monthly cycles
- Painful monthly cycles
- Heavy monthly cycle bleeding
- Light monthly cycle bleeding
- Pelvic/cramping pain
- Pain during sex
- Hormonal symptoms (acne/excess facial hair)
- Multiple miscarriages
Infertility may be indicated if there is a combination of these symptoms. The affected woman should see a gynaecologist/fertility specialist for further evaluation.
Risk Factors
Infertility is more likely based on combination of these factors:
- Age 35 or older
- Polycystic Ovarian Syndrome
- Endometriosis
- Obesity
- Underweight
- Cigarettes/other drugs
- Sexually Transmitted Disease
- Pelvic surgeries (especially laparoscopies)
- Infertility (family history)
- Cancer (especially with radiation/chemotherapy)
There are more specific evaluations for this age group when considering infertility.
How Female Infertility is Diagnosed
Several evaluations are done by a fertility specialist.
Medical History
The specialist will perform a thorough evaluation of:
- Menstrual cycles
- Pregnancies (history)
- Surgeries (history)
- Lifestyle (habits)
- Sex (history)
- Family history (medical)
- Physical Examination
A pelvic exam may reveal fertility abnormalities.
Blood Tests
An evaluation of hormone levels may include:
- FSH
- LH
- AMH
- Estradiol
- Thyroid hormones
- Prolactin
Ovulation Testing
There are several regularity tests for ovulation, including:
- progesterone blood test
- Ovulation test kits
- Ultrasound (with monitoring)
Ultrasound
Pelvic ultrasounds may evaluate:
- Ovaries
- Uterus
- Ovarian cysts
- Uterine fibroids
- Endometrial thickness
- Hysterosalpingography (HSG)
This is a special X-ray that determines if the fallopian tubes are open and assesses the shape of the uterus.
Hysteroscopy
This procedure uses a small camera to evaluate the uterus for any fertility related abnormalities.
Laparoscopy
When less invasive surgery is appropriate, it may be used to diagnose the following:
- Endometriosis
- Pelvic adhesions
- Tubal disease
Female infertility treatment options
The cause of infertility, the age of the woman and her desired reproductive goals will determine treatment options.
1. Lifestyle changes
This may include:
- A healthy weight
- Good nutrition
- Exercise
- No smoking
- Limits on alcohol
- Stress management
- Adequate sleep
Some of these changes may lead to improved fertility.
2. Ovulation Induction
Ovulation can be chemically induced with:
- Clomiphene citrate
- Letrozole
- Gonadotropin injections
These medications are ideal for women with infertility due to an ovulation problem.
3. Hormonal Therapy
Hormone balance can be achieved with:
- Thyroid medications
- Prolactin lowering medications
- Insulin sensitising medications
- Progesterone
Restoration of the hormonal disorder will lead to the return of ovulation.
4. Surgery
Surgery may correct the infertility caused by the structural abnormalities.
This may include any of the following:
- Removal of fibroids
- Surgery for endometriosis
- Removal of uterine polyps
- Opening of the blocked fallopian tubes
- Removal of pelvic adhesions
5. Intrauterine Insemination (IUI)
IUI is the process of placing prepared sperm directly in the uterus during the time of ovulation.
This procedure may be done for:
- Mild infertility
- Cervical factor infertility
- Unexplained infertility
- Mild male factor infertility
6. In Vitro Fertilization (IVF)
IVF is one of the most successful assisted reproductive technologies. The IVF process is:
- Ovarian stimulation
- Retrieval of oocytes
- Fertilization and embryology
- Transfer of embryos to the uterus
- IVF is appropriate in cases of:
- Obstructed tubes
- Severe endometriosis
- Advanced maternal age
- Unsuccessful IUI
- Unexplained infertility
7. Donor Eggs
Improved success of pregnancy may be achieved using donor eggs in women with early ovarian insufficiency and a diminished ovarian reserve.
8. Fertility Preservation
Women may choose to freeze their eggs to preserve their fertility after undergoing cancer treatment or after elective surgery to delay pregnancy.
Can Female Infertility Be Prevented?
Most female infertility is not entirely preventable, but maintaining a healthy lifestyle can influence and reduce certain risk factors associated with infertility. These can include:
- – Regular healthy weight
- Not smoking
- Drinking alcohol in moderation
- Safe sexual practices
- Proper management of chronic health conditions
- Regular exercise
- Timely treatment of pelvic infections
- Less postponement of childbearing
Long preventive healthcare can help to maintain reproductive health.
When Should You See a Fertility Specialist?
You should seek a fertility specialist if:
- You are under 35 and have not conceived after 1 year
- You are over 35 and have not conceived after 6 months
- Your periods are irregular
- You have PCOS or endometriosis
- You have had more than 1 miscarriage
- You have had pelvic infections or surgeries
- Your partner has a known fertility issue
The sooner you are able to seek a specialist Dr Anushka Madan, the better your treatment outcome will be.
Final Thoughts
The causes of female infertility which can vary from age and structural issues, to ovulation and hormonal problems are complex. Although, the desire to have children can be emotionally exhausting, the reproductive sciences are at the forefront of medicine for greater treatment options and more precise diagnoses.
Early intervention and evaluation with a tailored specific plan can all greatly improve fertility. The treatment options can range from a healthy lifestyle to medications and reproductive technologies. Many women are able to have successful pregnancies with healthy children after IVF at vrinda fertility . If there are any issues with conception, the best option is to see a fertility doctor who will be able to address your individual concerns and offer customized solutions.