Fertility is the ability of a woman to achieve pregnancy. Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes not being able to carry a pregnancy to term and having a baby. Women under 35 years old who fail to conceive after 12-months of contraceptive-free intercourse are considered infertile.
What are the causes of female infertility?
About one-third of infertility cases are due to problems with the man (male factors) and one-third are due to problems with the woman (female factors). Some of the causes of female fertility may include:
- Problems with ovulation account for some women's fertility problems. Without ovulation, eggs are not available to be fertilised. Signs of problems with ovulation include irregular menstrual periods or no periods. Ovulation problems can be caused by:
- Simple lifestyle factors: Simple lifestyle factors including stress, diet, or athletic training can affect a woman's hormonal balance and ovulation. Much less often, a hormonal imbalance from a serious medical problem such as a pituitary gland tumor can also cause ovulation problems.
- Polycystic ovarian syndrome (PCOS): This is the most common cause of female infertility, where multiple cysts form in the ovaries.
- Hypothalamic dysfunction: Excess stress, being underweight or overweight, or a recent significant weight gain or loss disrupt the balance of the hormones that control the functions of the ovaries.
- Premature ovarian failure: The ovaries stop producing eggs very early, either because of an autoimmune disorder or following cancer treatment.
- Excess prolactin: When prolactin is produced in excess by the pituitary gland, the ovaries secretion of oestrogen hormone reduces.
- Pituitary gland tumour: A hormonal imbalance from a serious medical problem such as a tumour can cause ovulation problems.
Aging is an important factor in female infertility. The ability of a woman's ovaries to produce eggs declines with age, especially after the age of 35. About one-third of couples where the woman is over 35 will have problems with fertility. By the time she reaches menopause, when her monthly periods stop for good, a woman can no longer produce eggs or become pregnant.
- Certain structural deformities in the female reproductive system can also lead to complications with fertility.
- If the fallopian tubes are blocked at one or both ends, the egg can't travel through the tubes into the uterus. Blocked tubes may result from pelvic inflammatory disease, endometriosis, or surgery for an ectopic (tubal) pregnancy.
- The cervical tissue may be preventing the sperm from entering the womb for fertilisation.
- Extra growths such as polyps and fibroids in the uterus can interfere with pregnancy.
- Endometriosis can interfere with implantation and its surgical removal can lead to the formation of scar tissue which can block the fallopian tubes.
- An abnormally shaped uterus will not support a healthy pregnancy.
- Sometimes the cause of infertility is unknown and may be governed by a combination of many minor factors.
Other problems can also lead to complications with women's fertility. If the fallopian tubes are blocked, the egg can't travel through the tubes into the uterus. Blocked tubes may result from pelvic inflammatory disease, endometriosis, or surgery.
Lifestyle factors may also affect female fertility. For example, smoking can damage the genetic material in eggs. A healthy weight can help with fertilization, whilst being both under- and overweight can contribute to infertility.
Signs and symptoms of Female Infertility
The primary sign of female infertility is the inability to conceive and sustain a pregnancy. Some of the symptoms of associated conditions that affect your menstrual cycle and ovulation may include:
- Very long (35 days or more) or very short (21 days or less) menstrual cycles
- Abnormal, irregular or no periods
- Painful periods
- Acne, male pattern hair growth on face and thinning of hair
- Weight gain
- Changes in sex drive and pain during sex
- White discharge from breasts
Who is at risk of female infertility?
You may be at a risk of female infertility if you have the following factors:
- Age: With age, the quality and quantity of the eggs produced by the ovaries declines. By mid-30, your body begins to produce fewer and poorer quality eggs.
- Smoking: Smoking increases your risk of ectopic pregnancy and miscarriage, damages your fallopian tubes and cervix, and ages your ovaries, reducing the number of eggs that it produces prematurely.
- Weight: A healthy weight is important for pregnancy. Being underweight or overweight affects normal ovulation.
- Sexual history: Practicing unprotected sex with multiple partners can increase your risk of contracting sexually transmitted infections, which can in turn damage the fallopian tubes and lead to fertility problems later.
- Alcohol: Excessive alcohol intake can also affect your fertility.
How is female infertility diagnosed?
When you visit the clinic for infertility problems, your doctor will review your medical and sexual histories, and perform a thorough physical examination.
The first step in female fertility testing is to find out if you are ovulating each month. There are several ways to do this. For example, you can keep track of changes in your morning body temperature and texture of your cervical mucous. Another tool is a home ovulation test kit, which can be bought at a pharmacy. Checks of ovulation can also be done in your doctors office, using blood tests for hormone levels or ultrasound imaging of the ovaries. If you are ovulating, more tests will need to be done.
Some common female tests include:
- Hysterosalpingogram: This is an X-ray of the fallopian tubes and uterus after they are injected with a dye. It shows if the tubes are open and the shape of the uterus.
- Laparoscopy: An exam of the tubes and other female organs for disease. An instrument called a laparoscope is used to look inside the abdomen.
- Biopsy: A test done to remove a sample of the inner lining of the uterus for evaluation.
- Ovarian reserve testing: This is performed to determine the number and quality of eggs ready for ovulation.
What are the related disorders that occur with female infertility?
Female infertility can be associated with many other conditions such as PCOS, endometriosis, uterine polyps, pituitary tumours, premature ovarian failure, hyperprolactinemia and cervical stenosis.
What are the stages of female infertility?
There are 2 types of female infertility:
- Primary infertility: you are unable to become pregnant after a minimum of 1 year of having unprotected sex.
- Secondary infertility: you have been able to conceive at least once, but are now unable.
Female Infertility Treatment
What are the consequences of not treating female infertility?
Left untreated, you may not be able to get pregnant and have a baby.
What are the treatment options for female infertility?
Depending on the test results, different treatments can be suggested. Eighty-five to 90% of infertility cases are treated with drugs or surgery.
Various fertility drugs may be used for women with ovulation problems. It is important to talk with Dr Alex Polyakov about the drug to be used. You should understand the drugs benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women.
If needed, surgery can be done to repair damage to a womans ovaries, fallopian tubes, or uterus.
Your doctor may even suggest assisted reproductive techniques (ART) to assist with a particular step in the reproductive process.
- Assisted reproductive technology (ART)
- In vitro fertilisation (IVF)
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
What are the alternative treatments for female infertility?
Some of the alternative treatments for female infertility can include:
- Gestational surrogates: If your pregnancy poses high health risks or if you have a nonfunctional uterus, your pregnancy can be carried by another woman to term.
- Egg donation: ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if you have impaired ovaries or a genetic disease that could be passed on to your baby.
When should I seek help for my infertility?
You may have reason to be concerned if you have been trying to get pregnant for at least one year and:
- You are in your late 30s and have been trying to get pregnant for six months or longer
- Your menstrual cycles are either irregular or absent
- You have painful periods
- You have a known history of fertility problems
- You have a history of pelvic inflammatory disease or endometriosis
- You have had multiple miscarriages
- You have been treated for cancer with drugs and radiation
How can female infertility be prevented?
Some forms of infertility cannot be prevented, but there are a few factors that may increase your chances of becoming pregnant:
- Avoid smoking, drugs and alcohol.
- Limit your intake of caffeine.
- Exercise regularly in moderation.
- Avoid being overweight or underweight.
- Practice safe sex and limit the number of sex partners.
- Consider ways of protecting your fertility from cancer treatment.
What is the current research regarding female infertility?
Extensive research is being done to find better treatment options for female infertility. Some of the recent studies are listed below:
- Vanni VS, Viganò P, Papaleo E, Mangili G, Candiani M, Giorgione V. Advances in improving fertility in women through stem cell-based clinical platforms. Expert Opin Biol Ther. 2017 May;17(5):585-593.
- Melin J, Madanat-Harjuoja L, Heinävaara S, Malila N, Gissler M, Tiitinen A. Fertility treatments among female cancer survivors giving birth a Finnish register-based study. Acta Oncol. 2017 Mar 24:1-5.
What is the percentage of population affected by female infertility?
According to the World Health Organization (WHO), one in every four couples suffer from infertility.
How does female infertility affect you?
Pregnancy results from a chain of events. A womans fertility often depends on her bodys ability to release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus (womb). A mans sperm must join with (fertilise) the egg along the way. The fertilised egg must then attach itself to the inside of the uterus. Female infertility can affect any of these processes and prevent you from conceiving and giving birth to a baby.
Which part of the body is affected?
The female reproductive system is made up of the following parts:
- Vagina: opening of the reproductive system, which allows the entry of sperm towards the uterus
- Cervix: narrow region that connects the vagina to the uterus
- Uterus or womb: where a fertilised egg implants and grows to develop into a baby
- Ovaries: organs on either side of the uterus, which release an egg each month to fertilise with sperm
- Fallopian tubes: narrow tubes that open out at the ovaries to pick up the released egg for fertilisation
These events are controlled by hormones secreted by the ovaries and the brain. Female infertility can affect the ability of these hormones or the reproductive system to function normally to allow and sustain a pregnancy.
Am I a candidate for IVF?
You may be a good candidate for IVF if you any of the below conditions:
- Ovulatory dysfunction
- Blocked, diseased or absent fallopian tubes
- Pelvic inflammatory disease
- Unexplained infertility
- Failed conventional fertility methods with injectable drugs and/or intrauterine insemination (IUI)
- Uterine factors or cervical mucous problems
If you have been trying to conceive, get honest & transparent fertility advice from Dr Alex Polyakov female infertility specialists in Melbourne. Visit Melbourne IVF clinic today or book an online appointment