Leading causes of female infertility

Conceiving a baby is not as easy as it seems. Many women assume when the time is right for starting a family, conception will go smoothly with baby arriving within a few months. The reality is some women will have difficulties in making this dream come true.

Female infertility is considered a common issue in the United States as about 10 percent of women (6.1 million) between the ages of 15-44 have difficulty getting or staying pregnant according to the Centers for Disease Control and Prevention (CDC).  A woman is considered to be infertile if she has been unable to get pregnant after one year of trying (or six months if a woman is 35 or older). 

Infertility is not just a woman’s problem as both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems while another one-third is due to the man.  The other one-third is causes by a combination of both male and female problems or by unknown causes.

Causes of female infertility

In general, the primary causes of female infertility may happen for one or more of the following reasons:

·      Ovulation issues

·      The sperm is unable to reach the egg

·      Something prevents the embryo from developing

·      Something goes wrong with implantation of the embryo

In these situations, it can be very difficult to pinpoint the exact cause of why a woman may be unable to conceive.  But there are other conditions a woman may have that could be the explanation for her lack of fertility.  Here are some potential causes of female infertility that could be preventing a viable pregnancy:

·      Polycystic Ovarian Syndrome (PCOS)

PCOS is a common cause of female infertility and affects up to 8% of all women.  This condition leads to higher than normal levels of androgens or male hormones in a woman causing symptoms of acne, unwanted hair growth, irregular periods, and weight gain.  Because PCOS causes irregular ovulation or none at all, it can be a struggle for a woman with PCOS to become pregnant.  The hormonal imbalances also increase the risk for a miscarriage. 

Treatment for PCOS can include fertility drugs such as Clomid or Femera and if these don’t work, a woman may consider in vitro fertilization (IVF).

·      Endometriosis

Lining the uterus is a tissue called the endometrium.  Each month, the endometrium thickens and grows during a woman’s menstrual cycle preparing the uterus for implantation of an embryo.  When a woman does not become pregnant, the lining of the endometrium breaks down leaving the body during a woman’s monthly menstrual cycle.

Endometriosis is when the endometrium grows outside the uterus which should not happen.  This lining may form near the ovaries or fallopian tubes, around the urinary and the gastrointestinal tract.  This abnormal growth which occurs in about 1 in 10 women can cause pain along with infertility. 

The excess tissue from the endometrium can prevent an egg from getting into the fallopian tubes where it can be fertilized by sperm.  Endometriosis that forms on ovaries can cause problems with ovulation and the ability to get pregnant.

The treatment depends on the severity of endometriosis.  It could require surgical removal of endometrial deposits, fertility drugs or if the fallopian tubes are blocked, in-vitro fertilization may be required.

·      Age-related infertility

The ability to become pregnant can significantly decrease starting at age 35 and becomes even worse after the age of 40.  Even if a woman is still ovulating and having menstrual cycles, her egg quality is reduced as she ages.  This makes it more likely she is at a greater risk of having a miscarriage or a baby with a genetic disorder.

Treatment of this can vary greatly.  Clomid can be one source of help for some women while others will require stronger fertility drugs and possibly even IVF.

·      Thyroid dysfunction

The thyroid is a gland located at the front of the neck just above the collarbone.  It produces specific thyroid hormones that regulate energy and metabolism throughout the body.  It is not considered a part of the reproductive system but the hormones it makes can have an impact on fertility.

Hypothyroidism is when the thyroid gland doesn’t produce enough of these hormones while hyperthyroidism (Graves’ Disease) is when the gland produces too much thyroid hormones. 

The main issue with thyroid dysfunction is that it can lead to irregular ovulation or menstrual cycles which can make it difficult to get pregnant.  It can also increase the risk for miscarriages and birth defects. 

The treatment is to place a woman on medication to regulate her menstrual cycles improving her changes of conceiving.

·      Obesity

About 6% of women with primary infertility are due to obesity according to the American Society of Reproductive Medicine.  Obesity can be the result of a hormonal imbalance such as in the case of PCOS or hypothyroidism which both can lead to weight gain. 

Often obese women can have irregular cycles, unusually long periods along with heavy bleeding or they may have absent menstrual cycles.  Causing infertility in obese women are fat cells affecting hormonal regulation.  Too many fat cells make the body overproduce the hormone estrogen which sends a signal to the reproductive system to shut down, leading to ovulation issues.

The treatment is to have the woman lose weight through eating a healthy diet and increasing exercise.  Seventy percent of obese women who reach a healthier body weight will conceive on their own without fertility treatment. 

·      Premature or early menopause

When a woman goes through menopause before the age of 40, it is considered premature or early menopause.  Once this occurs, a woman will not ovulate or release an egg each month from her ovaries and will not be able to conceive on her own using her own eggs.  Early menopause tends to run in families but it can also occur after chemotherapy or the surgical removal of the ovaries. 

The treatment is to either use harvested egg(s) before a woman went into early menopause or to resort to IVF using donor egg(s).  Fertility drugs will not be helpful as they will not be able to stimulate the ovaries after menopause. 

In conclusion

Any woman who is experiencing difficulty in being able to conceive should consult first with her gynecologist.  They will often be able to tell if a woman is infertile based on abnormalities of a woman’s history, physical exam and through fertility tests.  A gynecologist will also be able to tell a woman if her infertility is treatable and what her chances of becoming pregnant are. 

If a gynecologist is unable to help a woman with infertility, they should refer her on to an infertility specialist who can do further testing to find a solution to the problem.