For some women, pregnancy occurs naturally or with little effort. However, for many, pregnancy isn’t easily achieved. Around 1 in 6 people experience infertility, which translates into 17.5% of the world’s adult population, according to the World Health Organization.
The good news? Modern medicines and advancements in reproductive technology have opened several treatment options for women with complex fertility issues. Treatment ranges from lifestyle changes, such as losing weight if you have PCOS-related infertility, to medication to regulate your hormones, and more advanced treatments, such as in vitro fertilization.
What Is Female Infertility?
First things first, female infertility doesn’t mean a woman cannot get pregnant. It’s a medical condition that requires proper diagnosis and treatment of the underlying reproductive issue. It’s defined as the inability to conceive after trying unprotected sex for a specific period, usually 12 months for women under 35 and 6 months for older women.
Another important fact is that infertility isn’t just caused by women. One-third of all infertility cases are linked to female factors, another one-third are linked to male factors, and the rest are either a combination of female and male factors or unexplained causes.
Usually, a good fertility expert will always evaluate both partners, as both female and male factors can cause infertility. Infertility can affect anyone, although women with existing hormonal imbalance or known reproductive conditions, such as uterine anomalies, are at a higher risk.
Common Causes of Female Infertility
Pregnancy is a complex process. It involves multiple steps and perfect coordination of all hormones and pelvic organs.
- Your brain sends signals
- Your ovaries mature eggs
- These eggs are released and picked up by the fallopian tubes
- A structurally normal and good-quality sperm fertilizes the egg
- The embryo travels down the fallopian tubes
- It attaches to the uterine lining
If anything doesn’t work as it should, the entire process gets affected.
Let’s review the common causes of female infertility.
Ovulation Disorders
The most common cause that a female fertility expert will evaluate is your ovulation cycles. If you have irregular ovulatory cycles, i.e., you get periods occasionally or skip them altogether, there’s an increased risk of fertility issues.
PCOS
Polycystic Ovarian Syndrome is a hormonal imbalance and one of the common causes of female infertility. During a woman’s menstrual cycle, multiple follicles develop in the ovaries, and one of them matures an egg, which is then released into the fallopian tubes.
In women with PCOS, these follicles form, but they remain underdeveloped. Ovulation may happen, but it’s not predictable. These immature follicles appear as cysts on ultrasounds. Fortunately, it’s also one of the treatable causes of female infertility.
Hormonal Imbalance
From ovulation to implantation, every reproductive process is controlled by specific hormones. Your brain releases FSH and LH, which are responsible for egg maturation.
The right balance of estrogen and progesterone is equally important for thickening and stabilizing your uterine lining. Even hormones that do not seem to be directly associated with reproduction can affect fertility. Thyroid imbalances or high prolactin, for example, can affect ovulation.
Blocked Fallopian Tubes
Think of your fallopian tubes as the tiny, delicate pathways that connect your ovaries to the uterus. Fertilization doesn’t happen in the uterus but in one of these tubes. Once the egg is picked up by either tube, it waits for the sperm. If you have intercourse during this period, the sperm might fertilize an egg.
After fertilization, the egg implants into the uterus and the pregnancy continues. If the tubes are blocked, the sperm can’t reach the egg and fertilization can’t occur. Pregnancy may be possible with a single, functioning tube, but if both are severely damaged, natural conception can be very difficult.
Pelvic Infections
Untreated sexually transmitted diseases, such as chlamydia or gonorrhea, can spread to your reproductive organs. The biggest concern here is that even if the infection itself is treated with antibiotics, the inflammation left behind can cause scars, which can block your tubes.
Endometriosis
Many women assume heavy bleeding or severe pain during or after menstruation to be normal. However, it can be a sign of endometriosis. The condition involves growth of tissues similar to the endometrium outside the uterus.
They bleed every month, just like your normal uterine lining, but have nowhere to go. These tissues can result in inflammation and scar tissue.
Uterine Problems
Your uterus is home to your baby for nine months after implantation. The chances of miscarriage are higher if your uterus isn’t healthy or can’t provide a suitable environment for the embryo to develop. This can happen for many reasons; some are present from birth, while others develop due to hormonal imbalances, infections, or other medical issues.
Congenital abnormalities, such as a septate uterus, occur when tissue divides your uterine cavity into two parts. If the pregnancy develops in the part with poor blood supply, it may result in miscarriage.
Fibroids, benign uterine growths, can develop inside the uterus, distort it, restrict the space available for the embryo, and lead to reduced blood supply, all of which can make implantation challenging. However, not all fibroids affect fertility. Their location matters more than their presence and size.
Age-Related Fertility Decline
Men continue to produce sperm throughout life, but women are born with a fixed ovarian reserve, which usually has one to two million immature eggs at birth. The number automatically falls to 300,000 to 400,000 by the time a woman hits puberty. Every month, several eggs develop, but only one becomes dominant.
As you age, your ovarian reserve depletes, leaving fewer eggs available. Egg count isn’t the only major issue here. Your advancing age also affects egg quality, increasing the chances of chromosomal defects. That’s why age is one of the biggest factors affecting your fertility, as well as the success of fertility treatments.
Premature Ovarian Insufficiency
Premature Ovarian Insufficiency is when your ovarian function decreases drastically much earlier than the age of 40. Symptoms look like early menopause symptoms, such as hot flashes, night sweats, skipped menstrual cycles, and vaginal dryness.
Women with POP may have occasional ovulatory cycles, but they are usually unpredictable. Besides, fertility is significantly reduced.
Lifestyle Factors
Not all fertility issues are due to existing reproductive health issues or hormonal imbalances. Some are also linked to certain habits that can affect your reproductive health. Smoking is the most relevant example.
Heavy smoking is linked to many female fertility issues, such as early menopause, DNA damage, and overall poor egg quality. Overweight can disrupt your hormonal balance, cause insulin resistance, and eventually result in unpredictable ovulation and reduced fertility.
Symptoms of Female Infertility
There are no clear infertility symptoms, except for difficulty getting pregnant naturally. You keep hoping for the positive pregnancy test, but month after month, it never comes.
Many women feel perfectly normal, and their routine tests do not reveal any major underlying issue that could be affecting fertility. Many, even, get periods regularly, but face difficulty conceiving.
Still, a few symptoms can indicate underlying issues that can also be linked to infertility. Let’s take a look at some common female infertility symptoms you must not ignore.
- Irregular or unpredictable menstrual cycles
- Painful periods
- PCOS symptoms
- Recurrent miscarriages
How Female Infertility Is Diagnosed
Infertility is not a diagnosis, but a symptom. When you visit Australian Concept, we order relevant tests to help diagnose the underlying cause of infertility. This helps us plan a personalized treatment that perfectly fits your case.
Infertility can be due to damaged fallopian tubes, fibroids, polyps, endometriosis, PCOS, hormonal imbalances, and other causes mentioned above. Here’s what you can expect at a fertility center.
Fertility Consultation
During the consultation, your doctor will want to know your medical history, such as previous pregnancies, any miscarriages, any invasive treatments, STIs, or even the smallest issues, such as rapid weight gain. They may conduct a physical examination to rule out pelvic abnormalities.
Hormone Testing
Hormone tests give important clues about how your reproductive hormones are working. Elevated levels of prolactin, for example, can stop ovulation altogether. Elevated day-3 FSH means reduced ovarian reserve.
Blood tests that check the levels of FSH, LH, prolactin, estrogen, progesterone, and other hormones can help identify the underlying cause of female infertility. The tests are conducted on day 2, 3, or 4 of your menstrual cycle for more accurate results.
Ultrasound Examination
An ultrasound scan is a non-invasive, highly valuable diagnostic tool for fertility evaluation. During an ultrasound scan, your doctor will examine the uterus, ovaries, endometrial lining, and developing follicles.
These scans are commonly used to detect uterine anomalies, endometriomas, ovarian cysts, and fibroids (to name a few).
HSG Test (Tube Test)
When the above tests look clear, a fertility specialist may recommend Hysterosalpingography (HSG) — another effective test that diagnoses fallopian tube blockages as well as abnormalities in your uterine cavity.
It involves passing special dye through the cervix in order to check whether the dye flows freely through the tubes and reaches the pelvic cavity or gets stuck in the tubes.
Laparoscopy
Although not a routine diagnostic procedure for infertility diagnosis, laparoscopy gives the most detailed and clear look at your pelvic organs. It’s needed when your doctor suspects endometriosis, unexplained pelvic pain, or heavy menstrual bleeding.
It’s performed under anesthesia and is often combined with treatment in many cases. For example, endometriomas, scar tissues, fibroids, and uterine polyps can be removed in the same operation. The doctor can also use it to evaluate your fallopian tubes.
AMH Test
The developing follicles in your ovaries release AMH — a hormone that shows remaining eggs in your ovarian reserve. While it’s quite a reliable test to detect your ovarian reserve, AMH alone can never effectively tell whether you can conceive naturally or not.
Many women with low AMH may have lower ovarian reserve, but high-quality eggs, which can fertilize easily, resulting in natural conception. Others might have a good AMH, but can face difficulty getting pregnant because of other reasons. It’s often combined with other fertility tests for a more accurate diagnosis.
Female Infertility Treatment Options
When you know about infertility, your mind wanders directly to the most invasive treatment option — IVF (In-Vitro Fertilization). That’s not how things work. A fertility specialist evaluates your reproductive health, considers the factors that contribute to infertility, and narrows down the treatment options to the least invasive procedures that offer the highest success rate for your case.
Let’s explore some common fertility treatments and when they are advised.
Fertility Medications
If your infertility is caused by ovulation disorders, fertility medicines can help restore and improve ovulatory cycles. The goal is to encourage your ovaries to mature and release eggs regularly, so that an egg can be fertilized by sperm.
Fertility medication does not guarantee pregnancy. They can only correct your ovulation cycle, but whether or not pregnancy happens depends on many other factors, such as your age, uterine health, egg quality, sperm quality, etc.
Here are the common medications used for ovarian induction:
Clomiphene Citrate: The most commonly prescribed fertility drug, Clomiphene Citrate, works by increasing Follicle-Stimulating Hormone (FSH) production, which in turn produces ovarian follicles. It’s taken orally for five days during your period.
Letrozole: Letrozole is a highly effective fertility drug and is comparatively used more commonly than Clomiphene Citrate. The drug can be highly effective for women with PCOS, and is shown to induce ovulation, resulting in higher pregnancy and live birth rates.
Lifestyle Changes to Improve Fertility
Lifestyle changes can contribute to an increased success rate of fertility treatments, although they alone may not cure all causes of infertility. For example, blocked fallopian tubes can’t magically reopen with diet changes.
Likewise, a distorted uterus due to fibroids or polyps may not get in shape with physical activity or lifestyle habits. They require treatment. Simple lifestyle habits can, however, improve your chances of conception once the underlying cause of infertility is addressed.
- Weight Management: Weight reduction can help improve your chances of natural pregnancy by regulating your hormones and ovulation.
- Fertility-Friendly Diet: Colorful veggies and seasonal fruits, along with healthy food choices involving legumes, nuts, lentils, seafood, lean cuts of meat, etc can contribute to your overall reproductive health.
- Exercise: Moderate physical activity can improve blood circulation and insulin sensitivity, which can positively impact your fertility.
- Stress Reduction: Although stress isn’t directly linked to infertility, it can make your treatment journey overwhelming. It can affect your sleep, eating habits, and activity levels, all of which can make pregnancy difficult.
Intrauterine Insemination (IUI)
IUI is the first ART procedure recommended for women who can’t get pregnant naturally. It’s different from IVF and is usually a less invasive and less expensive procedure.
IUI involves direct placement of the sperm into the cervix after sperm washing. Once the dead sperm cells and debris are removed, the healthier concentration of sperm cells is left inside the cervix.
While the procedure might be effective for some women, it’s not for all. IUI can help if you have mild infertility issues, such as:
- Low sperm count or motility
- Cervical factor infertility
- Mild endometriosis
For IUI, you must have at least one fallopian tube open and in working condition.
IVF Treatment
When lifestyle changes, medicines, and even IUI fail, your doctor may advise IVF — a more invasive procedure that involves egg fertilization outside your body. Here are the treatment steps:
- Ovarian stimulation
- Egg retrieval
- Fertilization in a lab
- Embryo culture
- Embryo transfer
Women with blocked fallopian tubes, severe endometriosis, or unexplained infertility are the best candidates for IVF. It may also be advised for women with a history of recurrent miscarriages due to chromosomal or genetic abnormalities.
IVF can involve natural fertilization, where sperm and eggs are placed in the petri dish and left for a few hours to fertilize automatically.
Or, it can be done through ICSI. It’s a more advanced approach, in which a fertility doctor selects healthy sperm after evaluating them under a high-powered microscope. Using a thin needle, the selected sperm cell is injected into the egg for maximized chances of fertilization.
Surgery for Female Infertility
Some cases of female infertility may require surgical treatment. For example, if you have structural issues that prevent the sperm from reaching eggs or have uterine anomalies, a surgical procedure may be necessary to maximize the chances of fertilization, successful implantation, and pregnancy. Here’s when it may be an ideal choice.
- Fibroid Removal
Finding a fibroid on ultrasound doesn’t mean they need immediate removal. Many fibroids located outside the uterus might not affect implantation or harm your pregnancy once it begins.
Those located inside the uterine cavity, are super large, or have significantly distorted the uterus might affect the pregnancy growth by reducing available space for the growing fetus. They can be removed hysteroscopically, laparoscopically, and in a few cases, through an open abdominal surgery.
- Endometriosis Surgery
A laparoscopic surgery that finds chocolate cysts, also called endometriomas, may also involve their removal. Adhesions are carefully divided to restore the function of your reproductive organs.
Although it may work for mild cases, for severe endometriosis, especially at an older age, the doctor may proceed straight to IVF.
- Tubal Surgery
Mild tubal damage can be repaired with surgery. However, patients with severe tubal blockage may not be ideal candidates for surgical repair, as even with extensive surgery, the function of the fallopian tubes can’t be restored fully.
Which Female Infertility Treatment Is Best?
There’s no simple answer to this question. Female fertility is complex. Two different women who have been unable to conceive naturally may have different underlying causes for infertility.
One could be diagnosed with ovulation disorders, while the other one may have blocked fallopian tubes. They may have the same goals — conception. However, lifestyle changes might be enough for a woman with PCOS, while the one with tubal damage may require a surgical repair or IVF.
Here’s what the best treatment depends on:
- Maternal age
- Cause of infertility
- Fertility history
- Hormone levels
- Egg reserve
At Australian Concept, the treatment is usually tailored to your individual health status and goals.
Female Infertility Treatment Success Rates
Modern fertility treatments have become more patient-centric and personalized, but even the most advanced treatment cannot guarantee a pregnancy. Whether or not you conceive depends on many factors, such as your age during treatment, the fertility center you choose, the doctor’s expertise, and how well you incorporate lifestyle changes to improve your reproductive factors.
Emotional Impact of Infertility
The most overlooked aspect of infertility is the emotional trauma. Difficulty getting pregnant despite trying everything, including conservative treatments, can be frustrating. It gets tougher when your friends and family unknowingly ask questions like “when are you planning to grow your family?” The stress, anxiety, and guilt can all cause emotional exhaustion. It’s important to seek help through counseling, as a positive, clear mind can make your treatment journey smoother.
