Causes of Female Infertility

Infertility in women means the inability to get pregnant within the first year of trying to conceive when under 30; and the failure to get pregnant within six months of trying under 35 years old, having frequent and unprotected sex.

Thirty percent of the time, infertility has its source in females (female factor infertility). Thirty percent is caused by male inability; in Thirty percent, both partners experience difficulties and, in the other ten percent, the couple experience unknown underlying and undiagnosed issues. Infertility is a somewhat common issue, with about 10 percent of women dealing with it.

The pregnancy process:

Pregnancy is the result of a process. First, the woman must be ovulating, meaning she should release an egg from one of her ovaries. Then, the egg must travel through the fallopian tube to get to the uterus. Along the way, the sperm swims up to the cervix and fertilizes it, and the zygote, which is the fertilized egg, should attach and be implanted inside the uterus. There can be an issue related to each step, which may cause infertility.

The most common causes of infertility in women are:

• Ovulation problems, means ovulating irregularly or not ovulating at all. These cause most cases of infertility in women. The most common disorders associated with this problem are:

• Polycystic ovary syndrome (PCOS): the most common cause of female infertility is a hormone imbalance that interferes with ovulation. It is a condition in which ovaries produce abnormal amounts of androgens, and this imbalance of hormones causes a lack of ovulation. Androgens are male sex hormones that generally are present in a female’s body in small amounts. This condition forms many small cysts in ovaries filled with fluids.
• Hypothalamic dysfunction: a lack of GnRH production can lead to small amounts of FSH, estrogen, and LH hormones which can decrease the chance of fertility in women. This condition might abate the egg quality or stop the release of eggs.
• Primary ovarian insufficiency: or premature ovarian failure, is when the ovaries don’t function as they should. This condition can cease menstruation before the age of 40.
• Excess prolactin: excess levels of prolactin interfere with the production of other hormones like estrogen and progesterone. This condition can lead to missed or irregular periods or stop menstruation altogether.

Most ovulation problems are caused by a hormone imbalance or interference with hormone production. The most common symptoms of these conditions are excessive weight loss/ weight gain in a short period, fatigue, acne, excess body hair (hirsutism), thinning hair or baldness, and ovaries that contain many cysts.

Almost all of these conditions can be treated with the proper medication, but, if necessary, ART treatments (such as IVF, IUD, ICSI, or egg donations) can be used. Consulting infertility centers in Iran can be a helpful way to eliminate further emotional and costly strains of infertility in women who want to get pregnant.

• Uterine or cervical dysfunctions:

Malformations in the uterus can be present from birth or happen during adulthood. Most of the time, women dealing with these conditions have no symptoms and are not aware of this condition until pregnancy.

• Bicornuate uterus: is a congenital abnormality of the uterus. It is a heart-shaped, partially split uterus that usually does not affect a woman’s fertility but can cause miscarriages, preterm labor, and congenital disabilities in children. It happens when the two parts of the womb that usually join together are split. Although this condition itself does not affect one’s fertility, the research shows that it is most common in infertile women. This condition usually does not require any treatment, but if it causes recurrent miscarriages, the doctor might suggest metroplasty, reconstructive surgery to remove uterus abnormalities.
• Septate uterus: This condition happens when tissues part the uterus and create a septum wall in the middle that causes a poor blood supply. The insufficient blood supply can result in recurrent miscarriages and preterm birth but usually not interfere with a woman’s fertility. This condition, too, is a congenital abnormality of the uterus. It can be treated by minor surgery to remove the septum wall, which usually resolves the issue and allows the woman to carry her child successfully.
• Unicornuate uterus: This condition too is a congenital and genetic abnormality of the uterus. This causes a female’s body only to have one fallopian tube instead of two and a smaller uterus. As the uterus size is smaller than expected, this condition can lead to ectopic pregnancy, miscarriage, and preterm delivery. Also, because only one fallopian tube functions instead of two, this can increase the chances of infertility.
• Didelphic uterus: A rare condition in which the female has two separate uteri, each having a different cervix and two vaginas. This condition is genetic and happens before a female is born. Although it does not impair a female’s fertility, it increases the risk of miscarriage and the risk of preterm delivery. The doctor might advise surgical treatment to correct this abnormality.
• T-Shaped Uterus: It is another genetic malformation of the uterus, often associated with the females whose mothers used diethylstilbestrol (DES) medication. This condition can increase the risk of recurrent miscarriages and preterm labor.
• Cervical Insufficiency (Cervical stenosis and poor mucus production in the cervix): when the cervix opening is too narrow or completely closed, the sperm must encounter difficulties fertilizing the egg. This condition can also result in uterine inflammation (hematometra) and increase the risk of endometriosis. The endometriosis and presence of scar tissues can lead to less cervical mucus production, which plays a significant role in providing a suitable environment for the sperm to swim towards the uterus. The most common causes of this complication are prior surgeries in the cervix area, Asherman’s syndrome (the build-up of scar tissues inside the uterus that leads to blockage), cervical or endometrial cancer, infection of the uterus or cervix, or genetics. Treatment options include hysteroscopy, using dilators, or laser treatment.
• Fibroids: Are benign and noncancerous tumors inside the uterus. Not all fibroids cause infertility, but when a fibroid is found inside the uterus cavity (submucosal fibroids) or cervix, it can affect the number of sperms entering the uterus, it can also affect the shape of the uterus and interfere with the attachment of the embryo inside the uterus, it can block the fallopian tubes. It can affect the blood flow to the uterus and diminish the chances of the embryo attaching to the uterus lining. The treatment options include laparoscopic or robotic myomectomy, Hysteroscopic myomectomy, and uterine artery embolization.

Tubal Infertility or Damaged Fallopian Tubes:

• Blocked fallopian tubes: this condition prevents the eggs from reaching the uterus. It mainly occurs by infections (like STIs and PID) or the remaining scar tissues blocking the tubes. It can also happen because of pelvic adhesions, which are scar tissues that cause internal organs to stick to each other. Decreasing the chance of eggs to the uterus diminishes the possibility of pregnancy.
• Pelvic inflammatory disease (PID): this condition is the infection of the female reproductive system, which can involve the vagina, ovaries, uterus, and fallopian tubes. This infection (like STIs) travels from the vagina through the uterus and fallopian tubes. This condition can cause infertility, chronic pelvic pain, and ectopic pregnancy.
• Sexually transmitted infections (STIs): chlamydia and gonorrhea are the most common causes of tubal infertility. They can cause infections and scar the delicate linings inside the fallopian tubes, and decrease the chance of eggs going through the uterus via the fallopian tubes.
• Endometriosis: This condition happens when tissues similar to the linings of the uterus grow outside the uterus, like around the ovaries, fallopian tubes, and pelvis. This can cause scarring between the fallopian tubes and ovary and even may cause infection. The scar tissues can diminish the chance of eggs traveling through the fallopian line.
• Ectopic pregnancy: The embryo grows outside the uterus and mainly inside the tube (tubal pregnancy). It may also happen in the ovary, abdomen, or cervix, although the chances are unlikely. In this condition, although the egg is fertilized, it cannot grow as it was implemented in the wrong place, so the body rejects it, and miscarriages happen. Most women can conceive again after ectopic pregnancies, but some causes and effects of this condition may result in infertility. The most common cause and effect of this condition is the blockage of the fallopian tubes, which prevents the egg from reaching and attaching to the uterus.
• Previous surgery: women with previously ruptured appendix or previous abdominal surgeries have an increased chance of fallopian tube damage (because of the nearness of these organs to the fallopian tubes), leading to infertility.

If the conditions mentioned above involve infections, they may be treated by proper medications. If there is no infection, these conditions can benefit from minimally invasive surgical correction to remove the scar tissues and open the blocked fallopian tubes.

• Egg number and egg quality problems: egg quality can determine if a woman’s eggs can become healthy embryos or not. Usually, when a woman reaches 35, her egg quality decreases significantly. The criteria for an egg to be high quality are its appropriate chromosomes to fuse with sperms and the energy storage to divide and maintain during fertilization. Bad egg quality can determine whether pregnancy can be carried to term or not and whether the baby has any congenital disabilities. The leading cause of bad egg quality is the age above 35, genetic problems, cancer treatments, smoking, endometriosis, obesity, and polycystic ovarian syndrome. Though there is no treatment to improve egg quality, the treatment plan usually involves IVF (In-Vitro Fertilization). This technique allows the specialist to extract multiple eggs to check their quality. Another viable option is using donated eggs and mixing this technique with IVF to achieve higher success rates.

Whether your infertility has its source in hormonal imbalance, tubal infertility, or malformations of the uterus, in most cases, it can be cured by proper medication and mostly minimal invasive surgeries. And if the leading cause of your infertility is poor oocyte quality, you can decide on using techniques such as IVF or even donated eggs. In any case, you can benefit from searching through infertility treatment options in Iran, as IVF treatment in Iran is amongst the most advanced treatment plans. Also, it is crucial for the couple considering IVF treatments and egg donation to feel comfortable about both the costs of the treatment and the process they are going through. This sense of comfort can be achieved during infertility treatments in Iran.