Female infertility

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 16, 2016
StartDiseasesFemale infertility

Infertility can be one of the most devastating diagnoses that a woman can face. Female infertility is defined by the inability to get pregnant after at least one year of active trying through unprotected sex. Approximately 6% of women are infertile in the United States.

Contents

Definition & Facts

A variety of health conditions can obstruct the processes of conception and pregnancy and thus cause female infertility. They can include hormonal disorders and structural abnormalities of the uterus, cervix, or ovaries.

In order for conception to occur, the woman must ovulate. During this process, the ovaries release an egg into the uterus where it will remain until it is fertilized by the male's sperm through sexual intercourse. Conception also relies upon the fallopian tubes being unobstructed and the uterus healthy. In order for the egg to move into the uterus for fertilization, the fallopian tubes must be open and functioning normally. They must have the ability to release the egg. In addition, the uterus must have the capacity to nourish the growing embryo. 

In many cases, the inability to get pregnant is caused by both male and female factors equally or simply by male infertility. Insufficient sperm production can cause infertility and can be caused by a number of factors including surgery and certain health conditions. A fertility specialist can perform tests to indicate if this is the case. 

Failing to conceive can simply be a matter of not timing intercourse in such a way that pregnancy is possible. If the couple is not having sex during the woman's fertile time, failing to conceive is a natural outcome. It can be difficult to diagnose the underlying issues that cause infertility, which can hamper efforts to treat infertility and enable conception.

Symptoms & Complaints

The main symptom of female infertility is that the female is not getting pregnant despite trying. Symptoms that women with infertility experience due to underlying disorders that cause female infertility include irregular menstruation, pelvic pain, and in the case of polycystic ovary syndrome (PCOS), weight gain and hirsutism.

Causes

In some cases, the cause of infertility is simply age. A woman is born with all of the eggs that she will have available for reproduction, and those eggs dwindle every year. A third of women over the age of 35 trying to conceive experience fertility problems.

While there are often multiple factors in place that cause infertility in women, there are some clear cut reasons that a woman may experience this condition. They include ovulatory disorders such as polycystic ovary syndrome, or PCOS. This is a hormonal disorder that may cause infertility.

Hypothalamic dysfunction can contribute to female infertility, creating deficiencies in FSH (follicle-stimulating hormone) and LH (luteinizing hormone) both of which play crucial roles in ovulation. This dysfunction is often accompanied by symptoms such as abnormal periods which are longer or shorter than normal. 

Premature ovarian insufficiency is a condition in which the ovaries cease to function before the age of 40. This condition is often caused by treatments such as radiation or chemotherapy or it may be idiopathic.

Another source of infertility is when the fallopian tubes become damaged or blocked, making pregnancy impossible. This can be due to conditions like pelvic inflammatory disease (PID) or due to certain sexually transmitted diseases like chlamydia or gonorrheaSurgery to the pelvis or surgery to the abdomen can cause scar tissue to form which can block the fallopian tubes and make getting pregnant difficult. 

In addition to causes of female infertility, there are a number of risk factors that may increase the likelihood that a female becomes infertile. They include:

  • Age. A woman's fertility starts declining naturally in her late 20s, and by her mid-30s, she has fewer viable eggs remaining. This can make getting pregnant or carrying a pregnancy to term difficult. 
  • Smoking. Smoking causes damage to both the fallopian tubes and the cervix. Smoking can also age eggs prematurely, leading to the inability to get pregnant. 
  • Weight. Being abnormally overweight or underweight can hinder ovulation and make getting pregnant difficult. Doctors suggest working towards a normal BMI (body mass index) before seeking fertility treatment
  • Sexual history. Having unprotected sex with multiple partners can increase the risk of contracting several sexually transmitted diseases that can damage the cervix, uterus and fallopian tubes.

Diagnosis & Tests

There are several fertility tests that the fertility specialist will conduct to diagnose the problem and create a course of treatment. These tests include:

  • Ovulation tests. These tests will measure whether the woman is releasing an egg each month. In many cases, this is the beginning and end of the problem. The doctor can simply inject the woman with hormones that encourage ovulation. 
  • Ovarian reserve tests. This test will determine how many viable eggs are available to achieve pregnancy. If the test determines that there are not enough eggs available, the doctor will suggest the use of donor eggs in order to achieve pregnancy. 
  • Imaging tests. Imaging tests will allow the doctor to see if there are any structural issues that are preventing pregnancy.

Treatment & Therapy

Treatment for infertility depends largely on the cause of the condition. If the infertility is caused by blocked fallopian tubes, for example, specialists can remove the blockage in order to assist in reproduction. 

If the problem is with the fertilization process, assisted reproductive technologies (ART) can provide in vitro fertilization which allows the specialist to extract eggs from the ovaries, fertilize them outside of the body with the male's sperm and re-insert the fertilized eggs into the uterus. There are a number of such treatments available to help people achieve pregnancy successfully.

Prevention & Prophylaxis

The best way to prevent female infertility is to keep the female reproductive system healthy. Avoiding activities that can damage the organs by quitting smoking and abstaining from drug use may help prevent infertility. Women older than 35 may wish to consult a reproductive specialist if they are planning to get pregnant.