What causes Female Infertility?

⥁ Definition, Signs & Treatment

Female infertility refers to a woman who is unable to conceive due to problems related to egg production that make fertilisation impossible. In other words, pregnancy cannot be achieved. It can occur due to many causes, each associated with more or less noticeable symptoms. For this reason, certain conditions may occur in which the woman does not know she is infertile until she undergoes a fertility evaluation. There are two main types of female infertility:

Primary infertility

It refers to a woman who has never been pregnant.

Secondary infertility

When a pregnancy cannot be achieved by a couple, even if they already have one or more children together then we are talking about infertility, which previously did not exist.

What can cause infertility in women?

Problems with egg production

A major cause of female infertility is associated with ovulation. It is known as endocrine factor infertility because the menstrual cycle is regulated by a set of hormones such as GnRH (gonadotropin releasing hormone), FSH (follicle stimulating hormone), LH (luteinizing hormone), progesterone and estradiol.

Hormonal control of ovulation

Fluctuations in hormone levels can lead to:

Ovulation or lack of ovulation (egg release)
Ovulation occurring earlier or later than expected
Failure to produce eggs

In normal menstrual cycles, without endocrine alterations, ovulation occurs halfway through the menstrual cycle (around day 14), taking as day 1 the day on which the menstrual period begins. For this reason, the most fertile days are those closest to ovulation, i.e. the time when the egg is released from the ovary so that the sperm can reach and fertilise it. It should be noted that a sudden change in a woman’s menstrual cycle does not automatically translate into female infertility. A woman is considered infertile when the problem persists over time. The absence or presence of changes in ovulation leads to menstrual irregularities or even amenorrhea (absence of menstrual periods). However, there are some cases in which menstrual periods are apparently normal, although there are a number of problems related to hormones that hinder a woman’s chances of becoming pregnant: Some causes of hormonal imbalances that affect the regulation of ovarian cycles by the endocrine system are stress, obesity, anorexia, thyroid problems, certain medications, chemotherapy, radiation therapy, environmental factors..

Problems in the fallopian tubes

We use the term fallopian tube infertility when we refer to lesions or problems in the fallopian tubes, the part of the female reproductive system where fertilisation takes place. During ovulation, an egg is released from the ovary and travels to the fallopian tubes so that a sperm can reach and fertilise it. After fertilization, the resulting embryo travels through the fallopian tubes to the uterus, where implantation will take place. If both fallopian tubes are blocked, the woman is considered to have tubal infertility.

Blockage in the fallopian tubes: is pregnancy still possible?

Abnormalities related to the patency of the fallopian tubes can be caused by infections, endometriosis, salpingitis, fallopian tube malformations, surgery, etc. Hysterosalpingography (HSG) is a diagnostic test that allows us to evaluate the functionality of the uterine fallopian tubes.

Infertility due to the uterus

There are two main causes behind female infertility due to uterine abnormalities: on the one hand, uterine malformations and, on the other hand, conditions related to the endometrium. The endometrium is the inner layer of the uterus where the implantation and attachment of the embryo takes place. Uterine abnormalities may be congenital, i.e. from birth, or they may occur later in life (polyps, myomas). It should also be borne in mind that endometriosis is a cause of infertility. It is a condition caused by inflammation of the endometrial tissue, which grows outside the uterine cavity. Depending on the severity, it can be more or less harmful to a woman’s fertility.

Other causes of infertility in women

There are other factors that can affect fertility in both men and women, such as:

Unexplained infertility

Although all the assessment tests have been done, no specific disorder causing infertility is detected.

Psychological discomfort

Many studies link psychological stress to infertility.

Symptoms of infertility in women

Female infertility can go unnoticed or, on the contrary, certain signs can make it quite obvious. For example, in cases of female infertility due to an endocrine factor, hormonal alterations usually lead to amenorrhea or menstrual irregularities, which are signs that there is some kind of problem and are reasons why women should visit a fertility specialist. Also, a blockage in the fallopian tubes or the presence of myomas in the uterine cavity can cause a woman pain or some kind of discomfort. There are, however, cases in which the patient has no noticeable symptoms and, therefore, is not fully aware that there is a fertility issue.

Female Infertility Treatment

Female infertility can be treated either with medication or surgery. The method of choice, however, depends on the cause of infertility and its severity:

Fertility drugs

Women who are infertile due to ovulation disorders could resort to fertility drugs to regulate or stimulate ovulation and become fertile again. They work like the natural hormones FSH and LH, which induce ovulation naturally. The list of the most common drugs includes:

Clomiphene citrate

It causes the pituitary gland to produce higher amounts of FSH and LH, thus stimulating follicle development.

Metformin

It is used when insulin resistance is the cause of female infertility, for example, in the case of women with PCOS (Polycystic Ovarian Syndrome). It can improve the chances of ovulation.

Knee-tropins

They work by directly stimulating the ovary so that multiple eggs are produced

Letrozole

It belongs to a group of drugs called aromatase inhibitors. It is similar to clomiphene, meaning it is used to induce ovulation.

Bromocriptine

This drug is used when excess prolactin (hyperprolactinemia) is the cause of infertility.

Surgical interventions

Surgical treatments include:

Laparoscopy

Laparoscopic surgery can be used in cases of fibroids, abnormal uterine shape, pelvic or uterine adhesions, etc.

Tubal interventions

It can correct problems such as blockage of the fallopian tubes or hydrocephalus (a tube that is filled with fluid). Removing adhesions, creating a new opening in the fallopian tubes, dilating a fallopian tube, removing the fallopian tubes (salpingectomy) or locking the fallopian tubes close to the uterus are all tubal procedures that could improve a woman’s chances of conceiving with IVF.

Infertility treatments

Intrauterine insemination (IUI) and in vitro fertilisation (IVF) are the most commonly used assisted reproductive techniques used to solve problems related to female infertility. While IUI is the method that involves the lowest level of complexity, its chances of success are lower and requires the woman to meet a number of prior requirements. IVF, on the other hand, involves retrieving mature eggs from the patient or an egg donor, fertilizing them in the laboratory with the spouse’s or donor’s sperm, and transferring the resulting embryos to the woman’s uterus.

Female fertility by age

Unlike what happens to men, women do not produce new eggs: they are born with a predetermined amount of eggs.

Female reproductive graph

A woman’s reproductive age starts at 16 and lasts until around the age of 30-35. From that time, and especially from the age of 40, fertility begins to decline gradually, until the ovarian reserve is completely depleted and the woman enters menopause. Today’s lifestyle has led many women to delay motherhood and consider becoming mothers at an advanced age. This is why, nowadays, advanced maternal age is the leading cause of infertility.

Frequently asked questions

What can cholesterol cause female infertility?

Several studies have shown that high levels of LDL cholesterol can affect the time to pregnancy. In particular, couples with high LDL blood levels take longer to achieve pregnancy compared to couples with normal cholesterol levels.

Can abortion cause infertility in the future?

There is no evidence that surgical or medical abortion can cause infertility in women. As long as it is done in a safe environment, abortion will not change a woman’s ability to become pregnant again in the future. However, undergoing multiple procedures can have a negative effect on the uterus (formation of adhesions).

Can I get pregnant without tubes?

Yes, a woman without fallopian tubes can become pregnant with the help of IVF. For IVF, eggs are collected directly from the ovary and then fertilised in the laboratory. The resulting embryo is transferred back to the uterus , and so pregnancy can take place.

Can hormonal contraception cause female infertility?

Women who have been using hormonal contraception for a very long time may need a longer period of time to regain normal menstrual cycles and therefore their fertility.

What are the causes of infertility at age 40?

In couples where the woman is 40 years of age or older, it is likely that the cause of infertility is due to ovarian problems associated with advanced maternal age. In addition, the ovarian reserve experiences a significant decline from age 35 onwards.

Can chlamydia cause infertility forever?

If not treated immediately, chlamydia can affect a woman’s fertility in many ways. If the infection spreads to the uterus, it can cause pelvic inflammatory disease (PID) and the formation of adhesions. In severe situations, this scar tissue can prevent implantation or cause an ectopic pregnancy.

Can HPV cause infertility in women?

The human papillomavirus (HPV) alone does not have a big impact on fertility. However, some studies have found that IVF patients who tested positive for hpv were less likely to succeed, although the reasons behind this are not yet clear.

Can an infertile woman have her period?

Yes, it depends on the cause of infertility. For example, in cases of tubal infertility, the fallopian tubes may be blocked or absent, but the woman still ovulates, which is why techniques such as IVF are possible. On the other hand, there is also the opposite situation, that is, the woman may have normal menstrual periods but is unable to get pregnant.