What Causes Female Infertility And How Can It Be Treated?

New life begins when a sperm fertilizes an egg. Ovulation occurs when the ovary releases an egg, usually about 14 days before the start of the menstrual cycle. The egg then travels into the fallopian tube toward the uterus. If fertilized, the egg implants in the lining of the uterus, marking the start of pregnancy.

For a healthy, young couple, the chance of conceiving each month is about 25%. However, if there is no pregnancy after a year of trying (or after six months for women over 35), infertility may be a concern.

Infertility Challenges

About one in six couples face fertility issues. In many cases, assisted reproductive technologies (ART) can help. Infertility may arise from either the woman, the man, or both. Around one in 10 couples have “unexplained infertility,” where no cause is identified.

Age-related infertility is becoming more common as people have children later in life. Women’s fertility naturally declines with age, and this can lead to difficulties in conceiving. Lifestyle factors, such as weight, caffeine, alcohol, and smoking, also play a role in fertility.

Causes of Female Infertility

Female infertility can stem from various issues, including:

Ovulation problems
Polycystic ovary syndrome (PCOS)
Fallopian tube blockages or damage
Uterine problems
Endometriosis

Ovulation Problems

For ovulation to happen, the brain’s hypothalamus triggers hormone release from the pituitary gland, which stimulates the ovaries to release an egg. If periods are irregular or absent, ovulation may be irregular too. Women over 40 face a much lower chance of pregnancy due to the aging of eggs, which also increases the risk of miscarriage and genetic abnormalities.

Polycystic Ovary Syndrome (PCOS)

PCOS is a common hormonal condition affecting one in seven women. It can cause irregular periods and make it harder to conceive. PCOS is usually caused by hormonal imbalances, not ovarian disease.

Fallopian Tube Issues

Blocked or damaged fallopian tubes can prevent an egg from meeting sperm, making fertilization difficult.

Uterine Problems

Some conditions in the uterus, such as fibroids (non-cancerous growths) or polyps (small growths), can interfere with the implantation of a fertilized egg.

Cervical Problems

The cervix allows sperm to enter the uterus. In some women, thick cervical mucus can block sperm from passing through.

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, causing damage to the ovaries and fallopian tubes, and affecting fertilization.

Diagnosing Female Infertility

Infertility tests for both partners are necessary. For women, common tests include:

A physical exam and medical history review
Blood tests to check ovulation hormones
Laparoscopy (a minimally invasive surgery to examine the reproductive organs)
Ultrasound scans to check for fibroids and other conditions.

The male partner will have a semen analysis to check for fertility issues.

Treating Female Infertility

Treatment depends on the cause of infertility and may include:

Surgery
Ovulation induction (hormonal treatments)
Assisted reproductive technologies (ART) like in-vitro fertilization (IVF).

Surgery for Female Infertility

Surgery can help with issues like fibroids, polyps, endometriosis, and ovarian cysts. Most reproductive surgeries are done through minimally invasive methods like laparoscopy or hysteroscopy. In some cases, open surgery may be necessary.

Ovulation Induction

If ovulation is irregular or absent, medications can help. Oral medications like clomiphene citrate (Clomid) stimulate the release of hormones that trigger ovulation. Injectable hormones can also help mature eggs, and treatment is monitored through blood tests and ultrasounds.

Assisted Reproductive Technologies (ART)

ART involves egg retrieval and fertilization in a lab. In IVF, eggs are mixed with sperm, and the fertilized embryo is transferred to the uterus. In ICSI, a single sperm is injected into an egg. Multiple embryos may be frozen for future use.

Risks of ART

ART carries some health risks, including:

Ovarian hyperstimulation syndrome (OHSS)
Multiple pregnancies
Premature birth and low birth weight
A higher likelihood of needing a cesarean delivery.

When ART Doesn’t Guarantee Pregnancy

Although ART has advanced, it doesn’t guarantee pregnancy. Success depends on factors such as the woman’s age, the cause of infertility, and the type of treatment used.