Female Infertility: Causes and Treatment

What is Female Infertility

Infertility is characterised by the inability to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. This can be the result of female infertility, male infertility, or a combination of both. Almost one-third of infertility cases are due to female infertility causes. The good news is that almost all cases of female infertility are responsive to fertility treatments.

Causes of Female Infertility

Ovulation, normal healthy sperm, healthy fallopian tubes, and a healthy uterus is a must for pregnancy to occur. Female infertility can result from age, physical problems, hormone issues, lifestyle, and certain medical treatments. Some common factors that can impact female fertility are listed below.

Age

Ageing is the most common explanation for female infertility. As the age of a woman increases, the quality and quantity of eggs decline. Ovarian reserve is an important indicator of female fertility that reflects the number of viable eggs present in the woman. Ovarian reserve is measured using a transvaginal ultrasound and a blood test. Advanced maternal age also increases the risk of miscarriage and chromosomal abnormalities in the embryo.

Ovulation Disorders

Irregular or no periods often indicate problems in ovulation. To become pregnant normal ovulation is a must wherein the ovaries produce and release an egg in every menstrual cycle. Hormonal imbalances and problems in the ovaries can result in ovulation disorders like:

Polycystic Ovary Syndrome (PCOS)

PCOS is a common cause of female infertility. It is a hormonal disorder characterised by infrequent, prolonged periods or high levels of male hormone (androgen) in the body. In this condition, the ovaries may develop tiny fluid filled sacs or follicles that prevent the egg from being released. PCOS is also associated with insulin resistance, obesity, abnormal facial or body hair as well as acne.

Hypothalamic Dysfunction

Ovulation is controlled by two hormones: Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). These hormones are produced by the pituitary gland. Any disruption in normal production of these hormones can negatively impact ovulation and make conception tougher.

Premature Ovarian Failure

Premature ovarian failure is a condition in which the ovaries stop functioning normally before the age of 40 years. This condition is also called primary ovarian insufficiency and results in abnormal production of oestrogen in the body and/or irregular ovulation.

Excess Production of Prolactin

Prolactin is a hormone produced in the pituitary gland. Excess prolactin can reduce oestrogen production and cause infertility. This imbalance can be the result of problems in the pituitary gland or side-effects of certain medications.

Problems with the Fallopian Tubes (Tubal Infertility)

Problems in the fallopian tubes can prevent pregnancy by either stopping sperm from reaching the egg or by blocking the passage of the fertilised egg into the uterus. Fallopian tubes can be damaged or blocked due to several reasons including:

Infections

Like Pelvic inflammatory disease or PID (an infection of the uterus and fallopian tubes) can damage the fallopian tubes. It is most caused by sexually transmitted infections like chlamydia and gonorrhoea.

History of Surgery in the Abdomen or Pelvis

Like surgery for ectopic pregnancy can damage or block one or both fallopian tubes.

Endometriosis

Endometriosis is a progressive disorder characterised by abnormal growth of the tissue that forms the lining of the uterus (endometrium) outside the uterus. This excess tissue growth as well as surgical treatment of endometriosis can result in scarring and obstructions in the fallopian tubes. Endometriosis can also affect fertility in less direct ways by negatively impacting the lining inside the uterus and disrupting implantation of the embryo.

Uterine or Cervical Problems

Problems in the uterus or cervix can interfere with implantation and increase the likelihood of miscarriage. These issues can arise from benign polyps or tumours in the uterus, endometriosis scarring or inflammation within the uterus and congenital abnormalities like T-shaped uterus.

Lifestyle

Unhealthy habits like consumption of alcohol, tobacco, and illicit drugs as well as unsafe sexual intercourse can harm fertility. Being overweight or obese can also affect normal ovulation.

Diagnosing Female Infertility

Female fertility is assessed with a combination of a pelvic ultrasound scan, blood test and analysis of medical history. The ultrasound scan is used to check for any issues like polyps and fibroids that are likely to impact fertility. Hormone levels that indicate ovarian reserve are studied from the blood test. Further tests such as hysteroscopy may be recommended to explain any anomalies detected in the preliminary investigations.

Treatments for Female Infertility

Treatment for female infertility depends on several factors including cause of infertility, age of the patient, and personal preferences. In some cases, combination of several treatments may be required. Some treatment options are:

Ovarian Stimulation

Fertility drugs or hormone therapy can be used to stimulate ovulation. This treatment is often used in ART procedures like IVF and IUI and is a preferred treatment for women with infertility due to ovulation disorders.

Surgical Intervention

Certain surgical procedures are used to detect and treat issues in the reproductive system. These include laparoscopic or hysteroscopic surgeries used to correct problems like polyps and abnormal uterine shape as well as tubal surgeries used to treat issues like blockages in the fallopian tubes.

Assisted Reproductive Technology

ART procedures are significantly effective in treating a wide range of fertility problems, including tubal infertility. IVF and IUI are the most used methods of reproductive assistance.

Frequently Asked Questions

How long should couples try to get pregnant before seeing a doctor?

Medical experts recommend trying to conceive for atleast one year before a fertility consultation for women younger than 35 years of age. For women over the age of 35 years, fertility consultation is recommended if pregnancy does not occur after 6 months of trying. In case of any health problems that indicate infertility like irregular periods or endometriosis, it is advisable to seek help before trying to become pregnant.

What is IUI?

IUI or intrauterine insemination is an ART procedure that involves placing specially prepared sperm directly into the uterus during ovulation. In some cases, hormone therapy is used to complement IUI treatment.

How can you prevent infertility?

While some causes of infertility cannot be prevented (like congenital abnormalities), certain steps can help optimize fertility. These include maintaining healthy body weight, not smoking, or drinking alcohol, reducing stress and limiting caffeine intake.

Female infertility

What is Female Infertility

Causes of Female Infertility