Female infertility at a glance
- Female infertility is when the female partner is the sole cause of a couple’s infertility, which happens in about one-third of infertility cases, or when she and the male are the joint cause (this occurs in another one-third of cases).
- Infertility in women is caused by the inability to produce a viable egg for fertilization or by structural problems in a woman’s reproductive organs that prevent fertilization, implantation of the embryo or the ability to carry a pregnancy full term.
- A woman’s egg quality also naturally diminishes with age, which affects her fertility.
- The underlying causes of infertility in women are diagnosed with an infertility evaluation that sometimes requires further testing.
What is female infertility?
Female infertility occurs when the female partner is either the sole contributing factor to infertility in couples or is a joint factor along with the male. About a third of infertility cases are due to the female alone, a third are due to both male and female infertility factors and a third are caused by the male alone.
Infertility in women can be caused by problems with ovulation or structural problems preventing fertilization or pregnancy. Problems with ovulation, which is the release of an egg during a woman’s menstrual cycle, may include a woman not producing an egg or releasing an egg unsuitable for successful fertilization. As a woman ages, her fertility decreases because the quantity and the quality of her eggs decreases.
Structural problems in the reproductive organs and process can also cause female infertility. These may involve structural problems inhibiting fertilization of the egg that occurs in the fallopian tubes, issues preventing the implantation of the embryo (a fertilized egg) in the uterus, or a miscarriage after pregnancy has occurred due to uterine problems.
Female infertility conditions related to ovulation
Problems with ovulation are common causes of infertility in women. Women are born with all the eggs they will ever have, which are lost constantly until menopause. The term “ovarian reserve” refers to the remaining egg supply in the woman’s ovaries. When ovarian reserve is low, it means that a woman’s egg count is low.
Diminished egg quality
The quality of a woman’s eggs is particularly affected by age. Diminished egg quality can result in an embryo that does not properly implant in the uterus for a sustained pregnancy. It may also mean that an egg is ovulated but it is not fertilized due to a thickness in its outer membrane (zona pellucida) that prevents the sperm from penetrating and fertilizing it.
Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, is a common endocrine disorder that causes a woman’s eggs to fail to mature and grow normally, causing cysts to form within the ovaries. Over time, these cysts can build up and interfere with the ovaries’ ability to release eggs.
Other ovulation issues
- Drug or alcohol issues
- Hormonal imbalances
- Thyroid gland issues
- Menstrual problems
- Cervical mucus too thick to allow sperm to reach the egg.
Female infertility conditions related to structural issues
Structural issues can occur at birth and involve problems with the uterus or fallopian tubes. Structural difficulties can also occur due to chronic medical issues, previous infections and pelvic inflammatory disease.
Endometriosis, a common cause of female infertility, is the spread of tissue that normally lines the uterus to the outside of the uterus. It sometimes causes infertility, abdominal discomfort or even severe pain.
There are many theories as to how endometriosis is related to infertility, but it is not completely understood. Generally, it seems to mimic inflammation, like an infection. The implants of endometriosis secrete factors that can interfere with eggs, sperm and embryos.
The fallopian tubes are a fragile, intricate part of a woman’s reproductive system. If the tubes become blocked or otherwise damaged, sperm cannot fertilize the egg. In addition, if the egg can be fertilized, fallopian tube blockage can prevent the resulting embryo from traveling to the uterus for implantation. Tubal problems are responsible for 35 percent of infertility cases and can be caused by a variety of factors.
A basic infertility evaluation should always involve an assessment of a woman’s uterus. Irregularities in the uterus, including uterine fibroids, may be the cause of infertility. Problems with the uterus and its lining, the endometrium, can result in failure to implant and also in a miscarriage. Since the uterus is made of soft tissue, it cannot be seen on a normal x-ray, so specialized imaging tests may be used.
Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), sometimes causing abnormal uterine function, leading to infertility. The location and size of the fibroid can also lead to miscarriages.
An ectopic pregnancy is a dangerous situation that occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tube, which can cause the tube to bleed or rupture as the pregnancy develops. An ectopic pregnancy can be caused by an irregular or blocked fallopian tube. Having had an ectopic pregnancy can result in infertility.
Diagnosis of infertility in women
The first step in treating female infertility is to diagnose the condition causing it. A number of conditions can interfere with a woman’s ability to become pregnant. In some cases, a woman may be aware of an existing condition contributing to her infertility, such as endometriosis. More often, infertility conditions require more advanced testing to be discovered.
At Servy Massey Fertility Institute, our new patients undergo standard infertility evaluations following their first consultation. These evaluations look at medical history, ovulatory functions and menstrual history.
In many cases, this information provides doctors the knowledge needed to diagnose female infertility conditions. However, sometimes these evaluations do not provide enough information for a doctor to make a strong diagnosis, so further testing may be performed.
Once testing is complete and a diagnosis has been made, the doctor is able to work with the patient to create a treatment plan for her condition.