As a woman, your fertility and ability to have children is an important part of your health and future family planning. Unfortunately, infertility affects approximately 10% of women in the US, for reasons ranging from hormonal imbalances to damaged fallopian tubes. If you have been trying to conceive for over a year without success, it may be time to explore the potential causes of female infertility and your treatment options. This comprehensive guide provides an overview of infertility in women, from understanding your menstrual cycle to diagnosing conditions like endometriosis to exploring assisted reproductive technologies like IVF. You do not have to navigate infertility alone – there are many resources and support groups to help you in your journey to starting or expanding your family. While the path to overcoming infertility can be long, the reward of a child is worth the difficulties you may face along the way. Staying informed about your health and fertility options will empower you to make the best decisions for your situation. There is always hope, so read on to learn more about female infertility and how you can maximize your chances of success.
What Is Female Infertility?
Female infertility refers to the inability to become pregnant after having regular unprotected sex for at least 6-12 months. Infertility can be caused by problems with the reproductive organs, hormones, cells, or genetics. The most common causes of female infertility include:
- Ovulation disorders. Issues with ovulation, such as irregular or absent ovulation, account for about 25% of infertility cases. Polycystic ovary syndrome (PCOS) is a leading cause of ovulation problems.
- Tubal disease or blockage. Blocked or damaged fallopian tubes prevent sperm from reaching and fertilizing the egg. Pelvic inflammatory disease (PID) and endometriosis are common causes of tubal disease.
- Uterine or cervical abnormalities. Problems with the uterus or cervix can make it difficult for an egg to implant or for a pregnancy to progress. This includes uterine fibroids, polyps, or a misshapen uterus.
- Premature ovarian failure. Also known as early menopause, this condition refers to a loss of normal ovarian function before age 40. It affects about 1% of women and leads to irregular or absent ovulation.
- Unexplained infertility. For about 15-30% of infertile couples, the cause remains unknown after medical testing. This could be due to problems with egg or sperm quality, implantation, or other issues.
If you have been unable to conceive after trying for 6-12 months, consult your doctor right away for a fertility evaluation and diagnosis. From there, you can explore treatment options like medication, surgery, artificial insemination, or assisted reproductive technology procedures like IVF. With treatment, the odds of overcoming infertility and having a baby are good.
Types of Female Infertility: Unexplained, Structural, Hormonal, Etc.
There are several types of female infertility, each with its own causes and treatment options. As an overview:
- Unexplained infertility: No identifiable reason for inability to conceive after trying for 6-12 months. May be due to minor problems with ovulation or sperm interaction. Typically treated with fertility drugs and intrauterine insemination.
- Structural infertility: Physical problems with the reproductive organs like blocked fallopian tubes, uterine fibroids or endometriosis. Diagnosed through pelvic exam, ultrasound or laparoscopy. Treatment options include surgery to correct anatomical issues or in vitro fertilization (IVF) to bypass any blockages.
- Hormonal infertility: Issues with the hypothalamus, pituitary gland or ovaries that control the menstrual cycle and ovulation. Can often be treated with fertility drugs to stimulate ovulation. More severe cases may require IVF.
- Age-related infertility: As women age, especially after 35, the quantity and quality of eggs decrease, making conception more difficult. IVF using donor eggs from a younger woman is often the most effective treatment.
- Immunological infertility: Antibodies in a woman’s system can interfere with implantation or development of an embryo. Corticosteroids or IV immunoglobulin therapy may be options to suppress the immune system during IVF.
In summary, the causes of female infertility are complex but the good news is that for many women, effective treatments are available, from lifestyle changes and medication to advanced assisted reproductive technologies like IVF. The key is obtaining an accurate diagnosis through testing so you know all your options and the best path forward. With patience and perseverance, you can find the solution that helps make your dream of becoming a mother come true.
Causes of Female Infertility
Ovulation Disorders
One of the most common causes of female infertility is problems with ovulation, referred to as anovulation. Regular ovulation is essential for getting pregnant. There are several conditions that can interfere with or prevent ovulation:
- Polycystic ovary syndrome (PCOS): PCOS is a hormonal imbalance that inhibits the growth and release of eggs from the ovaries. It is a leading cause of infertility in women.
- Premature ovarian failure: Premature ovarian failure refers to the loss of normal ovarian function before age 40. It leads to irregular or missed periods and reduced fertility. In some cases, ovulation can still occasionally occur.
- Thyroid disease: An overactive or underactive thyroid gland can disrupt the menstrual cycle and ovulation. Getting thyroid levels balanced may help improve fertility.
- Excessive exercise: While regular exercise is important for good health, too much intense exercise can inhibit ovulation and decrease fertility. Reducing exercise levels may help regulate the menstrual cycle.
- Medications: Certain medications like chemotherapy drugs, antipsychotics, and corticosteroids can interfere with ovulation. Talk to your doctor about alternative medications or dosage adjustments that may have less impact on fertility.
Anatomical Problems
Structural problems with a woman’s reproductive organs can also contribute to infertility. Some examples include:
- Blocked fallopian tubes: Blocked or damaged fallopian tubes prevent sperm from reaching the egg and the egg from travelling to the uterus. Blockages are often caused by pelvic inflammatory disease, endometriosis, or scar tissue from a previous infection.
- Uterine fibroids: Fibroids are benign tumours in the uterus that can interfere with implantation and pregnancy. Large fibroids may need to be surgically removed to improve fertility.
- Endometriosis: Endometriosis occurs when uterine tissue grows outside the uterus. It can damage the fallopian tubes, ovaries, and other pelvic structures, leading to infertility. Treatment options include medication, hormone therapy, or laparoscopic surgery.
- Congenital abnormalities: Some women are born with abnormalities in their reproductive organs that make natural conception difficult. These include a septate uterus, double uterus, or problems with the development of the cervix, vagina, ovaries or fallopian tubes. Surgery may be able to correct certain congenital abnormalities.
Diagnosing Female Infertility: Tests and Procedures
When trying to determine the cause of infertility, your doctor will order several tests to evaluate different aspects of female reproductive health. These tests help identify any problems preventing pregnancy so appropriate treatment can be determined.
Hormone Testing
Blood tests are used to measure hormone levels, including follicle stimulating hormone (FSH) and estradiol (estrogen), at specific points in the menstrual cycle. Abnormal hormone levels can indicate issues like polycystic ovary syndrome or premature ovarian failure.
Ovulation Testing
These tests, like basal body temperature charts, ovulation predictor kits and blood tests, determine if and when ovulation is occurring. Irregular or lack of ovulation is a common cause of infertility.
Imaging Exams
Ultrasounds, sonohysterography, and hysterosalpingography are different imaging techniques used to examine the reproductive organs. Ultrasounds use sound waves to create images of the ovaries, uterus and fallopian tubes. Sonohysterography injects fluid into the uterus for better visualization. Hysterosalpingography uses dye and X-rays to check if the fallopian tubes are open. Blocked or damaged tubes prevent sperm from reaching and fertilizing an egg.
Laparoscopy
This minimally invasive surgical procedure examines the outside of the uterus, fallopian tubes and ovaries with a fiber-optic camera. It can detect endometriosis, adhesions, fibroids or other abnormalities. Surgery can sometimes be performed during the procedure to correct any issues found.
Endometrial Biopsy
A sample of the endometrium (uterine lining) is taken to determine if it’s suitable to support implantation and growth of an embryo. An abnormal endometrium can prevent implantation or increase miscarriage risk.
Going through the diagnostic process can be emotionally difficult. Talking to your doctor, a counselor, or an infertility support group can help provide education and coping strategies. Determining the underlying cause of infertility is the first step to developing an effective treatment plan and hopefully achieving pregnancy.
Treatment Options for Female Infertility
Medications
The first line of treatment for female infertility is typically medication to stimulate ovulation. The most common medications are clomiphene citrate or letrozole, which stimulate the ovaries to produce more eggs. Gonadotropins are injectable fertility drugs containing follicle-stimulating hormone (FSH) to stimulate the ovaries to produce eggs. These medications, often used together with intrauterine insemination (IUI), can increase your chances of pregnancy.
Surgery
If medications are not effective, surgery may be recommended to correct any anatomical problems. Surgeries for female infertility include:
- Laparoscopy: A minimally invasive surgery using small incisions to examine the fallopian tubes, ovaries and uterus for any abnormalities. It can also be used to remove endometriosis or scar tissue.
- Hysteroscopy: Examines the uterine cavity using a small camera. It is used to detect and correct uterine abnormalities like fibroids, polyps or a septum.
- Tubal surgery: Attempts to repair damaged fallopian tubes to restore fertility. The success rates vary depending on the level of tube damage.
- Ovarian drilling: Uses laparoscopy to puncture the ovaries with a laser, reducing hormone levels and promoting ovulation. It is mainly used for women with PCOS.
Assisted Reproductive Technology (ART)
If other treatments are not successful, ART procedures like in vitro fertilization (IVF) may be recommended. IVF involves retrieving eggs from the ovaries, fertilizing them in a lab, and transferring the resulting embryos into the uterus, increasing the chance of pregnancy. Intra-cytoplasmic sperm injection (ICSI) can be used with IVF for male factor infertility. Other options include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
The treatment path for female infertility depends on the underlying cause of infertility and how long you have been trying to conceive. Discussing with a reproductive endocrinologist can help determine the appropriate options based on your unique situation. With treatment, the chances of a successful pregnancy can be as high as 50-60% per treatment cycle.
Fertility Medications and Drugs for Female Infertility
Clomiphene Citrate (Clomid)
Clomid is an oral fertility medication used to stimulate ovulation in women who do not ovulate on their own. Clomid works by blocking estrogen receptors in the brain, which tricks the brain into thinking estrogen levels are low. In response, the brain stimulates the ovaries to produce more follicles and eggs, and ovulation. Clomid is often used as an initial treatment for infertility and polycystic ovary syndrome (PCOS).
Gonadotropins
Gonadotropins are injectable fertility drugs containing follicule stimulating hormone (FSH) and luteinizing hormone (LH) to directly stimulate the ovaries to produce multiple follicles and eggs. Brand names include Follistim, Gonal-F, Menopur, and Ovidrel. Gonadotropins are usually prescribed when Clomid alone does not result in ovulation or pregnancy. They do come with a higher risk of multiple births and ovarian hyperstimulation syndrome (OHSS) compared to Clomid.
### Human Chorionic Gonadotropin (hCG)
Once follicles have matured, hCG (brand name Ovidrel) is injected to trigger ovulation and release of the eggs. The timing of hCG injection is critical and based on monitoring via blood tests and pelvic ultrasounds. hCG must be administered just before ovulation would occur naturally. If given too early, the eggs may not be ready. If too late, ovulation may have already happened.
Other medications may be used in combination with the above or for specific conditions. Bromocriptine can be used for women with elevated prolactin levels. Cabergoline is another option for hyperprolactinemia and may have fewer side effects. Metformin is commonly prescribed for PCOS to help stimulate ovulation when combined with Clomid or gonadotropins. Estrogen and progesterone supplementation may also be needed in some treatment cycles.
In summary, female infertility medications work to stimulate development and ovulation of one or more eggs. They are most effective when properly monitored and timed based on a woman’s natural cycle. When combined with intrauterine insemination (IUI) or in vitro fertilization (IVF), these medications can be very useful for helping infertile women achieve pregnancy.
Surgery for Female Infertility: When It’s Needed and What’s Involved
Diagnostic Surgery
If other tests have not determined the cause of infertility, diagnostic surgery may be recommended. This involves a laparoscopy, in which a thin scope is inserted through a small incision in the abdomen to view the reproductive organs. This can detect endometriosis, fibroids, scarring, or other abnormalities. A hysteroscopy uses a similar scope to view the inside of the uterus. These minimally invasive surgeries are often done at the same time.
Corrective Surgery
If problems are found during diagnostic surgery, corrective procedures may be performed at the same time or scheduled for later. Options include:
- Removing endometrial implants or scar tissue. This can restore fertility if blockages or damage are minimal.
- Myomectomy: Removing uterine fibroids while preserving the uterus. Fibroids can interfere with implantation or cause miscarriage.
- Septum resection: Removing a uterine septum, a wall of tissue dividing the uterus. A septum can prevent pregnancy or cause miscarriage.
- Tubal surgery: Repairing or unblocking fallopian tubes to restore fertility. Only suitable if the tubes are minimally damaged. In severe cases, IVF may be a better option.
Hysterectomy
As a last resort, a hysterectomy (removing the uterus) may be recommended for some conditions causing uncontrollable pain or bleeding. A hysterectomy will end the possibility of pregnancy. Ovaries are usually left in place, so hormone levels are not affected. Alternative options should be tried before pursuing a hysterectomy for infertility.
In summary, surgery for female infertility is usually minimally invasive, with low risks when performed by an experienced surgeon. For some conditions, surgery can restore or significantly improve fertility. However, surgery may not be successful or additional treatments like IVF may still be needed. Discuss your options thoroughly with your doctor to determine if surgery is right for your situation.
Lifestyle Changes and Alternative Therapies for Female Infertility
Exercise Regularly
Exercising regularly can help increase fertility by keeping your body in shape and maintaining a healthy weight. Both overweight and underweight women have a higher risk of infertility. Aim for 30 to 60 minutes of moderate exercise most days of the week. Walking, jogging, yoga, and strength training are all excellent options. In addition to the physical benefits, exercise also relieves stress and releases feel-good hormones that can improve your chances of conception.
Reduce Stress
Chronic stress can negatively impact fertility by disrupting your menstrual cycle and hormone levels. Engage in relaxing activities like yoga, meditation, acupuncture, and massage therapy. Spending time with loved ones, limiting work hours when possible, and practicing self-care can help decrease feelings of stress and anxiety. Removing or reducing stressors in your environment may also be beneficial.
Limit Alcohol, Caffeine and Smoking
Minimize or eliminate unhealthy habits that can hamper fertility. Limiting alcohol, caffeine, and nicotine intake provides the optimum internal environment for conception and a healthy pregnancy. Alcohol, even in small amounts, can disrupt reproductive hormones and damage eggs. Caffeine also influences hormone levels and ovulation. Smoking reduces fertility and the chance of conception in addition to damaging DNA in eggs and sperm. Quitting smoking, in particular, can significantly improve fertility over time.
Supplements and Herbs
Some nutritional supplements and herbal remedies may aid fertility, though there is little evidence to support many claims. The most well-studied supplements for female fertility include folic acid, vitamin D, iron, omega-3 fatty acids, and coenzyme Q10. Herbs like red raspberry leaf, nettle leaf, and red clover are thought to support reproductive health, though talk to your doctor before using herbal medicines. Maca root, a traditional South American herb, may help balance estrogen levels and regulate ovulation, but more research is needed.
In summary, making positive lifestyle changes gives you the best chance of overcoming infertility due to non-medical issues. Focus on maintaining a healthy weight, reducing stress, exercising regularly, limiting unhealthy habits, and ensuring proper nutrition. When used under the guidance of your physician, supplements and herbal medicine may provide additional benefit, though natural therapies alone may not be enough to treat infertility caused by physical problems. Consult your doctor for an accurate diagnosis and to explore medical treatment options.
FAQs About Female Infertility: Your Most Common Questions Answered
Female infertility can be caused by a variety of medical issues, many of which are treatable. Understanding the potential causes and treatment options will help you navigate your fertility journey.
What Are the Common Causes of Female Infertility?
The most frequent causes of female infertility include:
- Ovulation disorders: Problems with the release of eggs from the ovaries, such as polycystic ovary syndrome (PCOS) or premature ovarian failure.
- Blocked fallopian tubes: Blockages or scarring of the fallopian tubes can prevent eggs from traveling to the uterus. This can often be caused by pelvic inflammatory disease.
- Endometriosis: A condition where tissue that normally lines the inside of the uterus grows on the outside of the uterus and other pelvic organs.
- Uterine conditions: Conditions like uterine fibroids, polyps, or a misshapen uterus can affect fertility.
- Age: Female fertility begins to decline more rapidly after age 35. While women can still get pregnant in their late 30s and early 40s, it may take longer.
- Unexplained infertility: In about 15% of cases, the cause of infertility cannot be determined. This is known as unexplained infertility.
What Tests Are Done to Diagnose Female Infertility?
Common tests for diagnosing female infertility include:
- Blood tests to check hormone levels, specifically follicle stimulating hormone (FSH) and estradiol. Irregular levels can indicate problems with ovulation or ovarian reserve.
- Pelvic exam to check the uterus and fallopian tubes for any abnormalities.
- Ovulation testing using ovulation predictor kits to determine if and when you ovulate.
- Hysterosalpingogram to check if the fallopian tubes are open and the uterus is normal in shape and size.
- Laparoscopy to examine the outside of the uterus, fallopian tubes, and ovaries for signs of endometriosis or other abnormalities.
- Ovarian reserve testing to determine the quantity and quality of eggs remaining in the ovaries. Low reserve can indicate diminished fertility.
- Genetic testing to check for any chromosome abnormalities that could affect fertility and pregnancy.
- Semen analysis to evaluate the male partner’s fertility which contributes to infertility in about 50% of cases.
What Are the Treatment Options for Female Infertility?
Treatment options depend on the underlying cause of infertility and may include:
- Fertility drugs or injections to stimulate ovulation.
- Surgery to repair reproductive organs or remove uterine fibroids/endometrial tissue.
- Intrauterine insemination (IUI) to place sperm directly into the uterus.
- In vitro fertilization (IVF) for more complex cases. IV
Conclusion
You now have a solid understanding of the complex topic of female infertility. Armed with this knowledge, you can have informed discussions with your doctor and partner to determine the best path forward based on your unique situation. While the road ahead may not always be easy, you can find comfort knowing you have a support system and resources to help guide you. By maintaining an open and honest dialog, staying positive, and exploring all options, there is hope. New treatments are emerging and success stories are happening every day. Although infertility can be an isolating struggle, you are not alone. With perseverance and the right team behind you, your dream of starting or expanding your family is still possible. Stay strong and keep the faith.
Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.
