Female infertility refers to infertility whose root cause lies with the women. About 1 in 6 couples will experience infertility issues of which the women will cause two-thirds of these infertility problems. Infertility can be classified as either primary infertility or secondary infertility. Primary infertility is when a woman has never been pregnant and secondary infertility is when a woman has been pregnant at least once. Conception and pregnancy are very delicate and complicated processes that require the right conditions and timing in order to be successful, hence infertility will occur if the right conditions are not met.
Symptoms of Female Infertility
The most obvious symptom of infertility is an inability to become pregnant. Diagnosis criteria can be met when attempting to become pregnant with frequent, unprotected sex for at least a year (six months after age 35) unsuccessfully. However, even someone who isn’t actively attempting to become pregnant at the moment may notice signs of infertility. An irregular menstrual cycle that is either too long or too short can also be a telltale sign. Finally, an absent or unpredictable menstrual cycle can indicate that ovulation isn’t taking place. Some women don’t experience any signs of infertility.
Causes of Infertility in Women
Infertility is a complex issue that can have many causes. It’s important to note that infertility is not just a female problem. It’s estimated that female infertility is the cause of 37% of couples experiencing infertility. Age can be a factor for many couples. Accelerated ovarian aging following age 35 is known to contribute to reduced fecundity that is associated with reduced ovarian reserve. As a woman ages, dwindling follicle reserve combined with the accumulation of DNA damage stemming from a lifetime of genotoxic exposure and oxidative burden can reduce fertility.
Fertility care is constantly evolving as the medical world learns more about the underlying mechanisms that contribute to the causes of female infertility. In recent years, the impact of cell-regulating proteins called sirtuins (SIRTs) has gained attention. SIRTs are involved in regulating cellular processes that include cell aging, cell death, and stress resistance. They’re also indicated in cellular homeostasis, energy metabolism, and apoptosis. Here’s a look at the leading causes of female infertility:
- Ovulatory disorders (25%): This can include polycystic ovary syndrome (PCOS), hypothalamic dysfunction affecting follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and primary ovarian insufficiency.
- Endometriosis (15%): Endometriosis is a condition that occurs when tissue that typically grows in the uterus implants and grows in other areas. Dense tissue growth can cause scarring that prevents the egg and sperm from meeting. In cases where egg and sperm do meet, endometriosis can disrupt implantation.
- Tubal blockage (11%): Blocked or damaged fallopian tubes can block passage of ovulatory or fertilized eggs. Tubal impairment can stem from a wide range of causes that can include previous abdominal or pelvic surgeries, pelvic inflammatory disease, and STIs.
- Hyperprolactinemia (7%): Marked by excessive prolactin in the blood, this condition is most commonly caused by a benign tumor in the pituitary gland. It can also be triggered by certain medications, underlying health conditions, or random and unexplained causes. Hyperprolactinemia is considered one of the most treatable causes of female infertility.
- Pelvic adhesions (12%): Pelvic adhesions occur when scar tissue causes the surfaces of organs to fuse together. Infertility-associated adhesions are commonly found in the uterus and cervix. Causes include endometriosis, pelvic infections, STIs, and past abdominal or pelvic surgeries.
- Other tubal/uterine abnormalities (11%): Abnormalities can be caused by both genetic issues and injuries/surgical scarring. For example, a narrow or malformed uterus can make implantation more difficult.
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Female Infertility Treatment
For the millions of people struggling to conceive, female infertility treatments can provide a bright light on the journey to parenthood. The first step in any infertility treatment is diagnosing the underlying causes of female infertility that could be in play for a particular patient. From there, the pathway to treatment is highly individualized based on the health factors and personal goals in mind. It may be determined that surgery for correcting pelvic adhesions, scar tissue, fibroids, endometriosis, or polyps is necessary to increase the odds of pregnancy. Removing barriers to implantation can sometimes be enough to achieve natural pregnancy without further intervention.
In some cases, triggering ovulation using infertility drugs that mimic FSH and LH may be enough to facilitate a healthy pregnancy. Other patients may require intrauterine insemination (IUI) in order to achieve fertilization during ovulation. For patients who don’t find success with female infertility drugs or IUI alone, in vitro fertilization (IVF) that harvests mature eggs to create an embryo for transfer into the uterus is the next recommended step for some causes of female infertility.
Dr. Michael Tahery is a board-certified obstetrician-gynecologist (OB/GYN) and urogynecological surgeon in Los Angeles. Specializing in fibroid tumors, endometriosis, and pelvic pain, Dr. Tahery is committed to helping his patients find the right female infertility treatments to help them get the best outcomes possible. Treatments that address female infertility are also essential for improving overall health and quality of life. If you’ve been struggling to get pregnant don’t hesitate to book a consultation with Dr. Tahery. Contact our office today!