Infertility is defined as the inability to achieve pregnancy after 12 months or more of regular unprotected intercourse. It affects approximately 10-15% of couples globally. Female infertility specifically refers to infertility caused by problems in the female reproductive system that prevent conception or early pregnancy loss.

Understanding the causes and treatments for female infertility is important for several reasons. First, it enables women experiencing fertility issues to identify potential causes they can address. Second, it equips them to have informed discussions with their doctor about diagnostic testing and possible treatments. Finally, learning about causes reduces stigma or misconceptions about infertility being a woman’s fault. Ultimately, education empowers women to take charge of their reproductive health.

This guide will provide an overview of the most common causes of female infertility as well as details on diagnosis, tests, and both medical and surgical treatment options available. The goal is to help women experiencing fertility challenges understand possible reasons, evaluate their options, and work with their doctor to develop an optimal treatment plan. With the right information and support, many causes of infertility can be resolved, cleared, or managed effectively.

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Common Causes of Female Infertility

Infertility is defined as the inability to conceive after one year of unprotected intercourse. For women, there are several common causes of infertility that affect the reproductive system and prevent pregnancy. The main causes can be grouped into four categories:

• Ovulatory disorders
• Uterine or cervical abnormalities
• Fallopian tube damage or blockage
• Endometriosis

Ovulatory disorders, which affect ovulation, are the most common cause of female infertility. Problems with ovulation account for about 25% of all infertility cases. Uterine or cervical abnormalities, such as fibroids or polyps in the uterus, can also impair fertility in women. Structural issues or scarring in the fallopian tubes make it difficult for eggs to travel and become fertilized. Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, is another source of infertility.

Understanding the common causes of infertility in women is important for diagnosis and exploring treatment options. Testing and evaluation by a doctor can help determine which factor is contributing to a woman’s infertility. The specific cause will then dictate what treatments may help restore fertility.

Ovulatory Disorders

Ovulatory disorders are one of the most common causes of female infertility. These disorders prevent the ovaries from releasing eggs regularly or at all, making it difficult or impossible to get pregnant.

The most prevalent ovulatory disorder is polycystic ovary syndrome (PCOS). PCOS causes multiple small cysts to develop on the ovaries. The cysts interfere with normal ovulation by throwing off hormone levels in the body. Symptoms of PCOS include irregular or missed periods, excess hair growth, acne, and obesity. Around 5-10% of women have PCOS, and it accounts for about 30-40% of female infertility cases.

Another ovulatory disorder is premature ovarian failure (POF). In POF, the ovaries stop functioning normally before age 40. The ovaries do not produce normal levels of estrogen or release eggs regularly. POF affects about 1% of women and causes about 10% of infertility cases. Genetic factors, autoimmune disorders, and prior chemotherapy treatment can cause premature ovarian failure. Symptoms include irregular periods, hot flashes, night sweats, vaginal dryness, and fertility problems.

Some common signs and symptoms of ovulatory disorders in general include irregular, absent, or infrequent menstrual periods, difficulty getting pregnant, excess hair growth, acne, obesity, hot flashes, and night sweats. Getting diagnosed and treated for ovulatory disorders is important for improving fertility chances. Medications and lifestyle changes can often help regulate ovulation. Assisted reproductive technologies like IVF may be needed in severe cases.

Uterine or Cervical Abnormalities

The uterus and cervix play important roles in conception and pregnancy. Abnormalities in the shape, structure, or function of these organs can negatively impact fertility. There are several types of uterine and cervical issues that may cause infertility:

Uterine Polyps – Polyps are benign overgrowths that attach to the uterine lining. They range in size from a few millimeters to several centimeters. Polyps may cause infertility by blocking the fallopian tubes, preventing implantation, increasing chances of miscarriage, or disrupting the uterine environment.

Uterine Fibroids – Fibroids are noncancerous tumors that grow in or on the muscles of the uterus. There are several types of fibroids that can affect fertility:

• Submucosal fibroids grow into the uterine cavity, which can obstruct fallopian tubes or interfere with implantation.
• Intramural fibroids grow within the uterine wall muscle, potentially making the uterus less receptive for embryo implantation.
• Subserosal fibroids grow on the outer uterine wall and can compress the fallopian tubes.

Congenital Uterine Anomalies – Some women are born with uterine abnormalities like a septate uterus (uterus divided into two chambers), bicornuate uterus (two small uteruses), or unicornuate uterus (half of a uterus). These anomalies increase the risk of miscarriage, preterm delivery, and other complications.

Cervical Stenosis – This condition is the narrowing of the cervical opening, which can make it difficult for sperm to enter and travel through the cervix. It may be caused by surgery, infection, or congenital abnormalities.

These uterine and cervical problems are often caused by genetics, abnormal development, chronic infections, benign growths, scar tissue formation, or exposure to DES (a drug once prescribed to prevent miscarriage). They can create a hostile environment for conception, embryo implantation and development, or carrying a pregnancy to term. Evaluating and addressing uterine and cervical abnormalities is an important part of diagnosing and treating infertility.

Fallopian Tube Damage or Blockage

The fallopian tubes carry eggs from the ovaries to the uterus. If the tubes become damaged or blocked, it can prevent pregnancy in the following ways:

• Scarring or blockage stops the egg from traveling through the tube. This is often caused by pelvic inflammatory disease (PID), a sexually transmitted infection. PID causes inflammation that leads to scarring and adhesions.

• The fallopian tube is unable to pick up the egg. Tiny finger-like projections called fimbria are located at the end of the tubes. They sweep the egg into the tube. If they are damaged, they may not function properly.

• The fertilized egg gets stuck in the tube. If the tube is blocked, a fertilized egg may get stuck and be unable to reach the uterus. This leads to an ectopic pregnancy, which must be ended through medication or surgery.

• Toxins in the tube can impact fertilization or transport. Smoking, for example, can cause toxin buildup that damages the tubes.

Fallopian tube issues are one of the most common causes of female infertility. Thankfully, many causes can be successfully treated with medications or surgery. However, severe tubal damage may require IVF to achieve pregnancy.

Endometriosis

Endometriosis occurs when tissue that normally lines the uterus grows outside of the uterus, most commonly on the ovaries, fallopian tubes, and tissue lining the pelvis. Each month during menstruation this misplaced tissue breaks down and bleeds, but it has no way to exit the body.

This leads to inflammation, pain, and the formation of scar tissue. It can also lead to infertility in a number of ways:

• Scar tissue can distort and block the fallopian tubes so eggs cannot travel through them to reach the uterus. This can prevent fertilization.

• The misplaced tissue can affect the ovaries and follicles, disrupting egg maturation and ovulation.

• Inflammation in the pelvis can impact sperm motility and function.

• Chemical changes in the uterus from endometriosis may impact implantation of a fertilized egg.

• Damage to fallopian tubes or ovaries from frequent bleeding and inflammation can prevent eggs from being released or becoming fertilized.

Common signs and symptoms of endometriosis include:

• Painful periods, especially cramping in the pelvis, lower back, and thighs

• Pain during or after sexual intercourse

• Pain with bowel movements or urination during menstrual periods

• Excessive bleeding during periods

• Infertility or inability to get pregnant

• Fatigue and nausea, especially during periods

Ovulation Problems

Ovulation problems are one of the most common reasons women are unable to conceive. Irregular ovulation or lack of ovulation prevents the release of eggs needed for fertilization. Some specific causes of ovulation problems include:

• Polycystic ovary syndrome (PCOS) – Condition characterized by hormone imbalance, ovarian cysts, and irregular periods. It’s a frequent cause of infertility.

• Premature ovarian failure – When a woman’s ovaries stop functioning before age 40. Causes poor egg quality and low estrogen.

• Hypothalamic dysfunction – The hypothalamus helps regulate ovulation. Any dysfunction can inhibit proper signaling.

• Excess prolactin – High levels of the hormone prolactin can interfere with ovulation.

Tubal Damage

Damage or blockages in a woman’s fallopian tubes disrupt the pathway for eggs to reach the uterus. Causes include:

• Pelvic inflammatory disease – Infection of the reproductive organs that causes scar tissue and damage.

• Previous reproductive surgeries – Operations like cesarean sections increase risk of scarring.

• Endometriosis – Uterine tissue growing outside the uterus can obstruct the tubes.

Endometriosis

This condition where uterine tissue grows outside the uterus can not only obstruct the fallopian tubes but also impact egg quality and implantation.

Polycystic Ovary Syndrome (PCOS)

As mentioned, PCOS is a frequent cause of ovulation problems. The hormone imbalances and ovarian cysts make conception difficult.

Other Factors

• Age – Fertility declines as a woman ages, especially after 35. Egg quality deteriorates.

• Lifestyle factors – Smoking, alcohol use, poor diet, stress, and being overweight or underweight can reduce fertility.

• Environmental toxins – Exposure to certain chemicals and toxins may disrupt hormones and fertility.

Diagnosing Female Infertility

Diagnosing the underlying cause of female infertility begins with a thorough medical evaluation by a fertility specialist. This typically includes reviewing the patient’s full medical history and performing a physical examination. The doctor will ask detailed questions about the woman’s menstrual cycles, prior pregnancies or miscarriages, gynecological issues, pelvic pain, and other relevant factors.

The physical exam will check for any abnormalities of the reproductive organs, hormone imbalances, or structural problems. If the cause of infertility is not immediately clear from the history and exam, the doctor will order a series of diagnostic tests.

Medical History and Physical Exam

The medical history review and physical examination allow the doctor to identify any obvious causes of infertility. They may reveal irregular cycles, absent periods, hormonal imbalances, or physical blockages that require treatment. Pelvic exams can also detect issues like uterine fibroids, ovarian cysts, endometriosis, or structural abnormalities.

Ovulation Testing

Ovulation testing is important to determine if the woman is ovulating regularly and releasing eggs each month. Common methods include:

• Basal body temperature tracking – Tracking menstrual cycle changes in body temperature can confirm ovulation occurred.

• Ovulation prediction kits – These test urine for the luteinizing hormone surge that precedes ovulation.

• Blood tests – Blood levels of estrogen and progesterone can show if and when ovulation took place.

Imaging Tests

Imaging techniques like pelvic ultrasounds and hysterosalpingograms (HSGs) allow doctors to visualize the reproductive anatomy. These may reveal:

• Ovarian cysts or tumors
• Uterine fibroids, polyps, or other abnormalities
• Blocked fallopian tubes
• Issues with the cervix or uterus

Laparoscopy

A laparoscopy is a surgical procedure that inserts a tiny camera into the abdomen to inspect the reproductive organs. It can accurately identify conditions like endometriosis, adhesions, or damage to the fallopian tubes. Laparoscopy may be followed by a hysteroscopy to examine the uterine cavity.

Ovulation Inducing Medications

One of the most common treatments for female infertility is the use of ovulation inducing medications, which help stimulate ovulation in women who are not ovulating regularly or at all. The two main categories of ovulation drugs are:

Clomiphene Citrate

Clomiphene citrate, often simply referred to as clomid, is an oral medication that encourages ovulation by blocking estrogen receptors in the brain. This causes the body’s natural hormone feedback system to increase production of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which spur the ovaries to release eggs. Clomiphene is often the first line drug prescribed to women with irregular ovulation or polycystic ovarian syndrome (PCOS).

Gonadotropins

Gonadotropins are injectable medications containing FSH, the main hormone responsible for stimulating ovulation each month. Common gonadotropin drugs are Follistim, Gonal-F, and Menopur. These directly provide FSH to induce ovulation in women whose bodies do not produce adequate levels on their own. Gonadotropins require close monitoring as they can lead to ovarian hyperstimulation syndrome and multiple births if too many follicles develop. They are more potent and used when clomiphene alone is insufficient to achieve ovulation.

Ovulation medications are often used together with intrauterine insemination (IUI) to maximize pregnancy chances in infertile women. Proper timing and dosing of these drugs is critical to produce a controlled ovarian stimulation that yields healthy eggs and avoids complications. Women should work closely with their doctor to determine the optimal ovulation induction regimen for their situation.

Surgery

Surgery is often recommended to diagnose and treat certain causes of female infertility. There are two main types of surgery used in infertility treatment:

Laparoscopy

Laparoscopy is a minimally invasive surgery performed under general anesthesia. A thin, lighted telescope called a laparoscope is inserted through a small incision in or near the navel. This allows the surgeon to view the pelvic organs, including the uterus, ovaries, and fallopian tubes.

Laparoscopy can help diagnose conditions like endometriosis, pelvic adhesions, or blocked fallopian tubes. It may also be used to treat issues like removing endometrial tissue or adhesions, unblocking fallopian tubes, or removing benign ovarian cysts.

The procedure usually takes 30-90 minutes. Recovery time is generally 1-2 weeks. Laparoscopy has a low risk of complications and is a common surgery used in infertility treatment.

Hysteroscopy

Hysteroscopy allows the inside of the uterus to be examined. A thin telescope called a hysteroscope is inserted through the vagina and cervix. The surgeon can view issues inside the uterine cavity like fibroids, polyps, or scarring.

Hysteroscopy may be used to diagnose and treat uterine abnormalities. Polyps or fibroids can be removed, adhesions can be cut, and septums across the uterine cavity can be resected. This can improve the uterine environment and support fertility.

The procedure is done under anesthesia as an outpatient surgery. Recovery time is about 1 week. Hysteroscopy is generally safe with few complications. For many women with uterine-related infertility, it can be an effective treatment.

Laparoscopy and hysteroscopy allow surgeons to directly visualize and operate inside the female reproductive organs. For many infertility diagnoses, surgery can be used both to diagnose the underlying issue and to provide treatment aimed at restoring fertility.

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) involves procedures that help couples achieve pregnancy by directly intervening in the fertilization process. These advanced techniques have become popular options for treating infertility, giving hope to those unable to conceive naturally. The two most common types of ART are:

In Vitro Fertilization (IVF)

IVF is the most effective form of ART. It involves fertilizing the eggs with sperm in a laboratory dish. Then, one or more of the resulting embryos are transferred into the woman’s uterus. With IVF:

• The woman’s ovaries are stimulated with injections of fertility drugs to develop multiple mature eggs for fertilization. This is called ovarian hyperstimulation.
• The eggs are retrieved from the ovaries using a minor surgical procedure.
• Sperm is obtained and combined with the eggs to achieve fertilization. This can be from the male partner or a donor.
• One or more embryos are selected and transferred into the woman’s uterus using a thin catheter inserted through the cervix.
• Any extra high-quality embryos can be frozen for potential future use.

The IVF process takes around 3-4 weeks. Success rates vary based on factors like maternal age, but the average is around 30% per IVF cycle. Risks include ovarian hyperstimulation syndrome and multiple pregnancies if more than one embryo is transferred. The cost per cycle typically ranges from $10,000-$15,000 in the United States. Some states mandate insurance coverage for IVF. It’s an intensive process, but can offer hope for pregnancy when other options fail.

Intrauterine Insemination (IUI)

IUI is a simpler, less expensive option that involves placing washed sperm directly into the uterus around the time of ovulation. With IUI:

• The woman may take ovulation-inducing medications to control the timing of ovulation.
• Sperm is washed and concentrated in the lab to isolate the healthiest sperm.
• The processed sperm sample is inserted through the cervix into the uterus using a thin catheter.
• Fertilization then happens inside the body as normal.

The IUI procedure is straightforward and only takes a few minutes. It is generally performed 1-2 times per menstrual cycle. The average success rate is around 10-15% per cycle. Risks are minimal, but include potential discomfort and infection. Costs range from a few hundred to a few thousand dollars. IUI offers a intermediate step between medication/surgery and IVF for couples with unexplained infertility or mild male factor issues.

Complementary Therapies

In addition to traditional medical treatments, many women explore complementary and alternative therapies to improve fertility. These options may be used alone or in conjunction with other interventions.

Acupuncture

Acupuncture is a technique from traditional Chinese medicine that involves inserting thin needles into specific points on the body. Some studies have shown acupuncture may increase fertility by:

• Regulating hormones and menstrual cycles
• Improving blood flow to the ovaries and uterus
• Reducing stress and anxiety

However, results from clinical trials are mixed. While acupuncture is safe when performed by a licensed practitioner, more research is needed on its efficacy for infertility.

Supplements

Certain vitamins, minerals, and herbs may support fertility when taken as supplements. These include:

• Folic acid – Helps prevent neural tube defects in fetus if pregnancy occurs. Recommended prenatally.
• Vitamin D – May improve egg quality when deficient. Requires blood test to confirm need.
• CoQ10 – Thought to improve egg quality. Requires high doses of 600-800mg.
• Omega-3s – Anti-inflammatory. Associated with better embryo implantation.
• Maca root – Traditionally used to enhance fertility. Early research shows potential.
• Vitex (chasteberry) – May regulate ovulation. Small studies show some benefits.

Supplements should only be taken under the guidance of a doctor to avoid interactions or unsafe dosing. While some supplements show promise for fertility, more rigorous studies are needed.

Other Therapies

Other complementary options include massage, meditation, yoga, reflexology, traditional healing practices, hypnosis and more. Some help women relax and destress. Others claim to bring the body into “balance” for pregnancy. Most have limited evidence but are safe if women find them beneficial.

In summary, complementary medicine gives women options beyond medical treatment. While not proven highly effective, they have low risks and may support the body and mind during conception attempts. Some women find them helpful, but they should not replace medical diagnostics and care. More research is still needed on the efficacy of these therapies.

Lifestyle Changes

Making certain lifestyle changes can help improve a woman’s fertility naturally. While lifestyle factors alone may not be enough to overcome infertility, they are an important part of an overall treatment plan and can make other fertility treatments more successful.

Diet

Eating a healthy, balanced diet is important. Focus on getting plenty of antioxidants from fruits and vegetables, lean protein, healthy fats like avocado and olive oil, and whole grains. Try to limit processed foods, red meat, trans fats, sugar and excessive caffeine. Getting to a healthy BMI through diet and exercise can also help regulate reproductive hormones.

Exercise

Moderate exercise like brisk walking, swimming, cycling or yoga for 30-60 minutes per day has been shown to help reduce stress and improve insulin sensitivity, ovulation and overall fertility. However, too much high-intensity exercise can have the opposite effect, so aim for a balance.

Stress Relief

Finding healthy ways to manage stress is key, since high long-term stress negatively impacts reproductive hormones. Try yoga, meditation, deep breathing, journaling, or other relaxation techniques. Getting massages and acupuncture may also help. Consider seeking counseling for any unresolved emotional issues as well.

Making lifestyle adjustments to improve overall health can be an empowering way for women to enhance fertility without medical intervention. While not a magic solution, it provides a sense of control and self-care during an emotionally difficult time. Discuss specific diet, exercise and stress relief strategies with your healthcare provider.

Emotional Support

Experiencing infertility can take a significant psychological and emotional toll on women. The inability to conceive naturally can lead to feelings of isolation, grief, anger, depression, anxiety, and low self-esteem in women struggling with fertility issues. It’s important for women to understand these feelings are normal reactions to the stress and disappointment of infertility. Seeking emotional support and coping effectively are vital to wellbeing.

There are many resources available to provide psychological support through the challenges of infertility:

• Counseling with a therapist who specializes in infertility issues can provide an outlet to process emotions. Counseling allows women to discuss fears, disappointments, and relationship problems in a judgement-free space.

• Support groups enable women to connect with others facing similar struggles. Sharing stories and advice in support groups helps women realize they are not alone. Many clinics and nonprofit organizations facilitate in-person and online support groups.

• Online communities through forums, message boards, and social media groups allow connection with a broader network of women experiencing infertility worldwide. Anonymity provides comfort in sharing deeply personal thoughts.

• Encouragement from family and friends is invaluable. Opening up to loved ones and asking them to provide emotional support rather than just advice can be extremely helpful.

Seeking professional counseling, connecting with support groups, participating in online communities, and being vulnerable with loved ones are all important ways women can get the emotional support needed to cope with the rollercoaster of infertility.

Start as Soon As Possible

The journey through infertility can feel lonely and frustrating, but it’s important to know you are not alone. Approximately 10-15% of couples face challenges conceiving, and the good news is that treatments continue to advance. Today there are more options than ever before to help build your family.

While the emotional toll of infertility should not be discounted, it’s critical to remain hopeful and seek support. Reach out to your doctor, a counselor, online communities, and local support groups. Share your story, allow yourself to grieve, but don’t lose faith.

Treatment for infertility has come a long way. In the past IVF success rates were around 20-30%, but today success rates per IVF cycle are 50% on average for women under 35. And the options continue to grow – from fertility medications to laparoscopic surgery to IVF and beyond. Don’t give up if one treatment is not successful, you still have alternatives.

Focus on staying healthy, reducing stress, and advocating for yourself every step of the way. You have the power to speak up, switch doctors if needed, and explore all possibilities on this fertility journey. The end goal is worth it – to one day hold your baby and become a mother. Believe in the possibilities and take it step by step. There are many couples who have been where you are, and who now hold their beautiful, much desired children in their arms. Your time will come.