What Causes Female Infertility and How Do We Treat It?
Infertility is the inability to conceive or carry a child to term despite a year of unprotected sex. Up to 11% of women have problems with infertility. While not uncommon, this can be incredibly frustrating if you are attempting to start a family and actively trying to have a baby.
To help with your family planning journey, this article will first provide thorough detail on the factors that can lead to infertility. Next, it will discuss options for diagnosis. Finally, it will cover the various treatment options specific to each cause of infertility.
Armed with this knowledge and guidance from your physician, you can determine the most suitable treatment plan for you. This will help you make informed decisions regarding your ongoing care.
What Causes Female Infertility?
The ability of women to conceive relies on several factors. Firstly, an egg must exit the ovary, travel through the fallopian tube, and be fertilized by sperm before leaving the uterus. Additionally, a hospitable environment within the uterus is necessary for the successful implantation and growth of the fertilized egg. Lastly, adequate uterine lining is essential in supporting fertilization and growth of the embryo. The timing of egg release and uterine lining buildup and breakdown are all part of your menstrual cycle. Your menstrual cycle is tightly regulated by hormones.
Infertility may result from various issues at any stage in your cycle. It could arise due to problems with egg release, blockages in the fallopian tubes, or an inhospitable environment in your uterus. Additionally, hormonal imbalances can contribute to infertility. These can disrupt the coordinated release and buildup of the uterine lining.
Infertility can result from various overlapping factors. In this article, we will discuss the primary causes of infertility for better understanding and clarity.
Problems with Ovulation
Ovulation is a term that describes the process through which an egg is released from an ovary. Disruptions in this process are common causes of fertility problems. The most common issues with ovulation are:
- When the ovaries stop releasing eggs
- Infrequent egg release
- Insufficient pool of eggs to release
Ovaries may stop releasing eggs due to various factors. These include significant weight loss, high stress levels, and other health problems. This can also result in irregular menstrual cycles or even a complete absence of periods.
A regular menstrual cycle typically ranges between 28 to 33 days. If your cycle is significantly longer than this, it is considered irregular and may make it difficult to predict the best time to try to conceive.
As women age, the number of available eggs decreases over time, which causes ovulation issues.
Structural Problems in the Uterus or Fallopian Tubes
Problems within the organs of the female reproductive system can result in infertility issues. These structures include the ovaries, fallopian tubes, and uterus. Cysts, polyps, and fibroids are growths of different sizes that may develop in these structures. These growths can cause blockages or an unfavorable environment for implantation.
Scarring may also occur, either due to these abnormal growths or from past surgeries or procedures. Additionally, a condition called endometriosis can lead to further blockages or scarring. Endometriosis is characterized by excessive uterine lining growing outside of the uterus. All of these problems can make it hard for the fertilized egg to implant into the uterine wall and develop effectively.
Age-Related Decline in Fertility
As a woman ages, her fertility naturally decreases due to a combination of factors related to reproductive biology. One significant factor is the gradual decline in the number and quality of viable eggs in her ovaries. At birth, a female is born with a finite number of eggs, and as she ages, these eggs diminish in quantity. This process is known as ovarian reserve decline.
Women’s hormones start to change in levels as she ages, making the process of releasing an egg each month challenging. Most women stop ovulating between the ages of 45 and 55, a process known as menopause.
A cyst is a particular type of growth that is filled with fluid. Polycystic ovary syndrome (PCOS) is a condition that occurs when there is too much of a particular hormone released. This results in subsequent cysts within the female reproductive system. The cysts often scar upon healing. This can cause blockages in the fallopian tubes and create challenges for embryo implantation.
Another hormonal issue that can lead to infertility is called Primary Ovary Insufficiency (POI). POI is characterized by a lack of hormone and egg release from the ovaries and irregular menstrual cycles. Unlike menopause, this condition affects younger women. While ultimately caused by a hormonal issue, POI effectively leads to a problem with ovulation. When ovulation does not occur, there is no egg to be fertilized. This results in the inability to conceive.
An autoimmune disorder is a type of condition where the body makes a protein called an antibody that ends up attacking itself. The body usually makes antibodies to fight off foreign invaders like viruses and bacteria. However, in the case of autoimmune disorders, these antibodies are misdirected.
Certain thyroid autoimmune disorders — such as Hashimoto’s disease and thyroiditis — can disrupt fertility. It is not fully known how these disorders disrupt fertility. One possibility is that these antibodies start attacking reproductive tissue. This would create inflammation and make embryo implantation challenging.
How Is Female Infertility Diagnosed?
If you're struggling to conceive, your doctor will first review your medical history. They will likely also conduct a physical examination to check for any of the conditions reviewed above. In your medical exam, you can expect your doctor to ask you about:
- Your menstrual cycle
- Whether you have any pelvic pain
- If you have any bleeding off cycle
- Whether you are lactating
- If you have ever been pregnant or had a miscarriage
In a physical exam, you may also receive a Pap smear and pelvic exam to check for any visible signs of physical problems. They may also perform blood work to ensure your hormone levels are appropriate. Specific hormone imbalances could indicate the presence of conditions like PCOS or POI. Certain hormone tests can also reveal whether your ovaries are still releasing eggs.
Your physician might ask you to start tracking your menstrual cycle if you aren’t already. This is to help determine how often you ovulate and if timed attempts at conception could improve your success rate.
There are also advanced diagnostic procedures to help you and your team figure out what is going on. These include:
- Transvaginal ultrasounds
- Saline sonohysterogram
- X-ray hysterosalpingogram
A transvaginal ultrasound is a procedure that allows your doctor to see the size and structure of your reproductive organs. This can be useful for detecting any abnormal masses, unusual uterine lining, and health of ovaries. A transvaginal ultrasound can be used in combination with a saline sonohysterogram. This involves a saline injection into the cervix and helps with imaging contrast in the ultrasound.
Hysteroscopy is a procedure where a small camera is inserted through the cervix to detect any structural problems in the uterus.
A laparoscopy is a minimally invasive surgery through the stomach. It uses a small camera to detect blockages in the fallopian tubes and endometriosis. This procedure is also used for egg -retrieval during treatment of infertility.
X-ray hysterosalpingogram is a procedure where radioactive dye is injected into your cervix, and X-ray images are taken. This is to see if there are any blockages in the fallopian tubes.
Treatment Options for Female Infertility
Depending on the cause of your infertility, a number of treatment options may be available to you. These include hormonal treatments, surgical procedures, and assisted reproductive technologies (ART). These solutions aim to address various fertility issues in a targeted manner.
Hormonal medications for infertility come as oral pills and injectable medication. The purpose of these medications is generally to stimulate and regulate ovulation in a timed way.
The most commonly prescribed oral medication is Clomiphene. This is a medication that helps eggs mature and be released from the ovaries. It is most effective for women who have stopped releasing eggs or have irregular release. It is taken at the beginning of the menstrual cycle for 5 days for up to 6 cycles.
Letrozole and anastrozole are also oral medications. They stimulate the release of eggs from the ovaries by blocking a hormone called estrogen. These have been found to be more effective for individuals struggling with PCOS. These are also taken toward the beginning of the cycle for 5 days.
Injectable gonadotropins are often used if Clomiphene is not effective. They are also used if you are undergoing assisted reproductive technologies (discussed below). Gonadotropins are hormones that directly stimulate the maturity and release of eggs from the ovaries.
There are also certain medications for other conditions that cause high amounts of a hormone called prolactin, which can decrease fertility. Bromocriptine and cabergoline are oral medications that can be used to lower the amount of prolactin in your body.
While not always successful, there are some surgical procedures offered for treating infertility. They can help remove blockages in the fallopian tubes or misplaced uterine lining caused by endometriosis.
Laparoscopy may also be used in other family planning methods to retrieve eggs.
Assisted Reproductive Technologies (ART)
Assisted reproductive technologies (ART) put science and our understanding of fertilization and the growth of a fertilized egg into motion. ART is an umbrella term that can include any of the following technologies:
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
- ART with donor eggs or embryos
IUI, or intrauterine insemination, is a procedure in which sperm is directly injected into the uterus. Primarily used to address sperm-related issues, it can also be employed for female infertility when scarring or damage to reproductive organs is present.
IVF is a process in which eggs are collected from the ovaries using laparoscopy and combined with sperm in a Petri dish. This allows fertilization to occur outside the uterus. Once the egg transforms into an embryo, it is implanted back into the uterus.
If eggs are unable to be retrieved, it is possible to receive donor eggs or embryos and have them implanted into your uterus.
Lastly, if you are able to have your eggs retrieved but embryo implantation is not successful, you may consider using a surrogate. A surrogate or gestational carrier can carry an embryo that was fertilized in a dish. Unsuccessful implantation may occur because of endometriosis, scarring, or growths in the uterus.
Lifestyle Changes for Fertility
It is essential to maintain a healthy lifestyle in your infertility journey and to improve overall fertility. While it is still important to consult your doctor, it may feel empowering to have some control over various factors in your health.
Maintaining an optimal weight, neither overweight nor underweight, can increase your chances of conceiving. Additionally, reducing stress plays a significant role in successful conception.
Dietary choices also impact fertility; nutritional deficiencies like low iron or folate levels can reduce the likelihood of getting pregnant. Consuming foods rich in iron, folate, selenium, iodine, non-refined sugars, vegan protein, and fiber can help with ovulation disorders while promoting a healthier lifestyle.
The fertility diet and Mediterranean diet have evidence to support them in improving ovulation-related fertility disorders.
Female infertility can be challenging to cope with, especially when trying to start or expand your family. Understanding the causes is crucial for coming up with an appropriate treatment plan. Common reasons for infertility include ovulation problems, hormonal imbalances, autoimmune disorders, and structural issues in the uterus, fallopian tubes, or ovaries. Age-related fertility decline also plays a role.
Various diagnostic procedures can help pinpoint the cause of infertility. Once identified, you and your physician can decide on suitable treatments. These may include hormonal therapies or assisted reproductive technologies. Additionally, making lifestyle changes may help improve your fertility.
If you're struggling to conceive, consult with your physician. Being informed about potential causes within your body will help you create the best treatment plan.