Different Causes of Infertility in Females
Female infertility is a common medical condition that affects many women who are trying to conceive. The inability to become pregnant after one year of regular unprotected sexual intercourse in women under the age of 35 is defined as female infertility. For women over 35, difficulty conceiving after six months of trying may indicate an underlying fertility issue related to their menstrual cycle. Secondary infertility occurs when women face challenges conceiving again after having had at least one successful pregnancy. Understanding the possible causes of infertility in females is an essential first step toward proper diagnosis and effective treatment.
It is important to note that infertility is a couple-based condition affecting both infertile couples and their partners, meaning that both female factors, such as cervical mucus, and male factors should be evaluated during diagnosis, including a physical exam. Getting pregnant and carrying a pregnancy to term is a complex biological process that depends on hormonal balance, egg quality, reproductive anatomy, and overall health. In this article, we provide a clear and comprehensive overview of the most common causes of infertility in females, helping readers better understand where problems may arise and when medical evaluation is recommended.
Some Facts About Infertility
In general, about 40% of infertility cases are related to female factors, 40% to male factors, 10% to both male and female factors, and 10% have no identifiable cause, commonly referred to as unexplained infertility. This unexplained infertility often leads to emotional stress for those affected.
How Pregnancy Happens (and Where It Can Go Wrong)
The pregnancy process must follow these steps:
- The ovaries release an egg.
- The released egg moves through the fallopian tube to the uterus.
- The sperm meets the egg.
- The fertilized egg attaches to the uterine wall, and pregnancy occurs, although some women may unfortunately face issues like secondary infertility or complications related to the number of chromosomes if they are unable to conceive after a previous successful pregnancy.
Even minor disruptions in hormone balance, egg quality, or uterine receptivity can interfere with this process. If there is a problem in any of these steps, infertility may occur.
What Are the Common Causes of Infertility in Females?
You may wonder: What are the main causes of infertility in females? Let’s review the most common reasons.
Ovulation Disorders as a Cause of Infertility in Females
Ovulation disorders, often related to the pituitary gland, are one of the common causes of infertility in females and occur in about 40% of women with fertility issues. Problems with the regulation of reproductive hormones by the pituitary gland can contribute to ovulation failure. Ovulation failure can result from several factors, including ovarian and gynecological conditions, endocrine disorders such as thyroid diseases, lifestyle or environmental factors, and issues affecting the male reproductive system.
In addition, diminished ovarian reserve, in which the quantity or number of eggs and quality of eggs is lower than expected for a woman’s age, can significantly reduce the chances of conception even when cycles appear regular.
Fallopian Tube Disorders and Female Infertility
If the fallopian tubes are blocked, eggs cannot move from the ovaries to the uterus, and sperm cannot reach the egg. Therefore, pelvic inflammatory disease and fallopian tube disorders, often associated with pelvic pain, are an important cause of infertility in females. Reducing alcohol consumption and other lifestyle modifications may help address some risk factors associated with infertility.
One of the most common causes of tubal damage is pelvic inflammatory disease (PID), which may result from untreated infections and can lead to scarring, blockage, or permanent damage to the tubes, often accompanied by pelvic pain.
Problems of the Reproductive System
Structural problems in the female reproductive system can prevent pregnancy. These include:
- Endometriosis
- Uterine fibroids
- Ovarian cysts
- Polyps
- Scarring of the uterus caused by previous injuries, infections, or surgeries
- An abnormally shaped uterus in the female reproductive system.
- Uterine fibroids
- Polyps
- Scarring of the uterus caused by previous injuries, infections, or surgeries
- An abnormally shaped uterus
Even small structural abnormalities can interfere with embryo implantation or increase the risk of miscarriage.
How Endometriosis Affects Female Fertility
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterine cavity. This condition can cause infertility in several ways, especially in those with a family history of the disease. It alters the structure of the female reproductive organs and can lead to conditions such as polycystic ovarian syndrome. Additionally, chemical changes in the uterine lining caused by endometriosis can make it difficult to maintain a pregnancy.
Endometriosis may also affect egg quality and create an inflammatory environment that reduces implantation success.
Immune System Problems
Immune system problems occur when the body’s immune system attacks normal tissues. Autoimmune disorders such as lupus, Hashimoto’s thyroiditis, other forms of thyroiditis, and rheumatoid arthritis may negatively affect fertility.
These conditions can interfere with ovulation, implantation, or early pregnancy through chronic inflammation or hormonal disruption.
Hormonal Disorders That Cause Infertility in Females
Hormonal disorders in women are generally divided into two main categories.
Polycystic Ovary Syndrome (PCOS)
PCOS is one of the most common causes of infertility in females. In this condition, the ovaries and adrenal glands produce higher-than-normal levels of androgens. These elevated hormone levels interfere with ovarian follicle development and disrupt ovulation, similar to how birth control methods can affect hormone levels.
Primary Ovarian Insufficiency (POI)
This condition occurs when the ovaries stop producing eggs and hormones prematurely. As a result, abnormal ovarian and pituitary hormone levels develop. Although fertility is reduced, pregnancy may still be possible in some cases.
Hormonal imbalances such as elevated prolactin levels (hyperprolactinemia) can also suppress ovulation and are sometimes associated with abnormal breast discharge.
Other Causes of Infertility in Females
- Obesity or being overweight
- Alcohol consumption and smoking addiction
- Sexually transmitted infections
- Thyroid disorders
- Occupational exposure to chemicals
In some women, all tests appear normal despite ongoing infertility. This condition is referred to as unexplained infertility and is relatively common.
Impact of Body Weight and Eating Disorders on Fertility
Body weight plays a significant role in female fertility, as both underweight and overweight conditions can disrupt hormonal balance and ovulation. Women who are underweight may experience irregular menstrual cycles or even amenorrhea, which is the absence of menstruation. This can hinder their ability to conceive, as ovulation is critical for fertilization. Similarly, obesity can lead to conditions such as polycystic ovary syndrome (PCOS), which is characterized by hormonal imbalances that affect ovulation. Maintaining a healthy weight is crucial for optimizing reproductive health and enhancing fertility.
Eating disorders, including anorexia nervosa and bulimia, can have profound effects on a woman’s reproductive system. These disorders often result in significant weight loss or fluctuations that can lead to hormonal disruptions. The psychological impact of eating disorders also contributes to stress and anxiety, further exacerbating fertility issues. Women struggling with these conditions may find it challenging to conceive, and addressing both the physical and emotional aspects of eating disorders is essential for improving fertility outcomes. Overall, a balanced diet and a healthy lifestyle are vital for supporting reproductive health.
How Is Infertility Diagnosed in Females?
Gynecologists diagnose infertility through physical examinations and a review of medical, reproductive, and sexual health history. The choice of diagnostic tests depends on a woman’s age, symptoms, and medical history.
Diagnostic tests for infertility in females and male infertility issues may include:
- Menstrual cycle evaluation, to assess cycle regularity and ovulation patterns
- Physical exam and ultrasound imaging (sonography), to examine the ovaries, follicles, uterus, and conditions such as PCOS, fibroids, or cysts
- Hysterosalpingography (HSG), an imaging test used to determine whether the fallopian tubes are open or blocked and to assess the shape of the uterine cavity, can be supplemented by a physical exam.
- Hormonal tests, including:
- AMH, which helps evaluate ovarian reserve
- FSH, usually measured early in the menstrual cycle, to assess ovarian response and any potential issues like ovarian cysts
- TSH, to check thyroid function
- Prolactin, especially when abnormal breast discharge or ovulation problems are present
Early diagnosis allows for more targeted treatment and improves the chances of successful outcomes.
What Are the Symptoms of Infertility in Females?
Symptoms may include abnormal menstruation, such as bleeding that is heavier or lighter than usual, irregular cycles, sudden cessation of menstruation, or painful periods. Hormonal imbalances can also prevent pregnancy.
Signs of hormonal changes may include skin changes such as acne, increased or decreased libido, excessive hair growth on the upper lip, chest, or chin, hair thinning or loss, weight gain, milky breast discharge unrelated to breastfeeding, pain during intercourse, and potential pregnancy complications due to medical conditions during this period.
How to Treat Infertility in Females?
Treatment depends on several factors, including age, duration of infertility in infertile couples, and the overall health of the couple, as well as potential issues related to the male reproductive system. In many cases, one treatment method or a combination of methods may be used, especially since couples over age 35 may face higher risk of infertility challenges.
In general, infertility treatment options follow a step-by-step approach. Doctors usually begin with the least invasive options and move to more advanced treatments if pregnancy does not occur.
Treatments for Infertility in Women
Common treatment options include:
- Ovulation stimulation with medication, which is usually the first-line treatment for women with ovulation disorders such as PCOS and insulin resistance, and may be complemented by ovarian reserve testing, as well as the use of ovulation predictor kits to enhance tracking and timing of conception efforts.
- Intrauterine insemination (IUI), which may be recommended for unexplained infertility or mild male factor infertility when ovulation is normal, is often considered a part of assisted reproductive technology.
- In vitro fertilization (IVF), often advised for blocked fallopian tubes, severe endometriosis, a result of hypothalamic dysfunction, diminished ovarian reserve, or when other treatments have failed, is a cornerstone of assisted reproductive technology.
- Intracytoplasmic sperm injection (ICSI), typically used in cases of severe male reproductive system factor infertility or previous IVF failure.
Treatment usually starts with ovulation induction or IUI, and if these methods are unsuccessful, advanced techniques such as IVF or IVF with ICSI may be recommended based on the underlying cause.
Advanced treatments such as IVF and ICSI allow many women to achieve pregnancy even when other methods have failed.
To improve and accelerate treatment, CarefulTrip works with leading gynecologists, subspecialists, and professors of gynecology in Iran to help patients schedule appointments and access high-quality fertility care, including IVF in Iran.
Complications Associated With Infertility Treatments
Infertility treatments can lead to various complications that may affect a woman’s physical and emotional health. These complications can include ovarian hyperstimulation syndrome (OHSS), which can occur after fertility medications are used to stimulate ovulation, leading to swollen and painful ovaries. Additionally, procedures such as in vitro fertilization (IVF) can carry risks of multiple pregnancies, which can result in premature birth and associated health issues for both the mother and babies. Other potential complications may involve surgical risks, such as infections or damage to surrounding organs during procedures. Emotional and psychological stress due to the pressure of treatment and the outcomes can also pose significant challenges, highlighting the need for comprehensive support throughout the infertility treatment journey.
Mental and Emotional Impact of Infertility
Psychological Effects and Social Stigma
Infertility often leaves deep mental health and emotional scars on individuals and couples striving to conceive. Many experience feelings of isolation due to the social stigma surrounding fertility challenges, leading to anxiety, depression, and emotional stress. The psychological toll may stem from the relentless pressure to succeed in reproduction, compounded by societal expectations. Emotional stress can result in strained relationships, impacting self-esteem and causing a ripple effect on overall well-being. Support networks, counseling, and open dialogue about reproductive health are essential to navigate these complex emotions successfully.
Frequently Asked Questions (FAQ) About Causes of Infertility in Females
What is the most common cause of cases of infertility in females?
The most common cause of female fertility problems and infertility is ovulation disorders. Conditions such as polycystic ovary syndrome (PCOS), hormonal imbalances, and diminished ovarian reserve can prevent regular ovulation, making it difficult for pregnancy to occur naturally. These various conditions can lead to significant fertility problems affecting many women.
Can a woman get pregnant with blocked fallopian tubes?
If both fallopian tubes are blocked, natural pregnancy is usually not possible because the sperm cannot reach the egg. However, in vitro fertilization (IVF) allows pregnancy by bypassing the fallopian tubes entirely, making conception possible for women in the general population who are experiencing similar issues, including various medical conditions.
Does age affect female fertility?
Yes, age has a significant impact on female fertility. According to reproductive medicine experts, fertility gradually declines as a woman gets older, especially after the age of 35, due to a decrease in both the quantity and quality of eggs. According to the American Society for Reproductive Medicine (ASRM), this decline also increases the risk related to the number of chromosomes, consequently raising the risk of miscarriage.
Can hormonal problems cause infertility even if periods are regular?
Yes, hormonal problems, including hypothalamic dysfunction, can cause infertility and impact mental health even when menstrual cycles appear regular. Hormonal imbalances may affect egg quality, ovulation timing, or the number of chromosomes during implantation, which can reduce the chances of pregnancy despite having predictable monthly periods.
What tests are usually done to diagnose female infertility?
Common tests for diagnosing female infertility include blood tests to check hormone levels, pelvic exams, ultrasounds, and blood test hysterosalpingography (HSG) to assess the uterus and fallopian tubes. These evaluations help identify underlying conditions affecting fertility and guide appropriate treatment options.
Is infertility always permanent in women?
No, infertility is not always permanent. Many causes of infertility in females, often surrounded by social stigma, are treatable with medication, lifestyle changes, or assisted reproductive technologies (ART) such as IUI or IVF. With proper diagnosis and treatment, many women successfully achieve pregnancy.
When should a woman see a fertility specialist?
A woman should see a fertility specialist or a healthcare provider if she is under 35 and has been trying to conceive for one year, or over 35 and has been trying for six months. Earlier consultation is recommended for irregular cycles, known reproductive conditions, or the absence of ovulation, and a transvaginal ultrasound may be included in her evaluation.
Are genetic factors among the causes of infertility in females ?
Genetic factors can significantly contribute to female infertility. Conditions like Turner syndrome, polycystic ovary syndrome (PCOS), and chromosomal abnormalities can affect ovulation, cervical mucus, and reproductive health. Understanding these genetic influences is essential for diagnosing and managing infertility issues effectively.
Final Words on Causes of Infertility in Females
Female infertility can result from a wide range of factors, including ovulation disorders, hormonal imbalances, fallopian tube damage, and structural or immune-related conditions. While the experience can be emotionally and physically challenging, it can also significantly impact mental health. Many causes of primary infertility and other forms of infertility in women are diagnosable and treatable with modern medical care. This includes primary infertility, which is when a woman is unable to conceive after a year of trying if she is under 35 years old.
Early evaluation by a healthcare provider, such as a gynecologist or fertility specialist, plays a key role in identifying the underlying cause and selecting the most effective treatment approach in fertility care. With accurate diagnosis, personalized fertility care, and professional support, many women are able to overcome infertility and move closer to achieving a successful pregnancy.
If you are facing challenges with infertility, getting the right diagnosis from a healthcare provider and treatment plan is crucial. CarefulTrip connects international patients with experienced gynecologists and fertility specialists who utilize advanced reproductive health technologies in Iran, helping them access advanced diagnostic services and evidence-based fertility treatments.
From initial medical consultation and clinic coordination to travel arrangements, accommodation, and on-ground support, CarefulTrip simplifies every step of the process for the general population, including considerations for pregnancy complications and cervical mucus, so patients can focus on their treatment with clarity and confidence.
References
- World Health Organization (WHO). Infertility. According to the World Health Organization, infertility can be described as the inability to become pregnant, maintain a pregnancy, or carry a pregnancy to live birth. (Link)
- American Society for Reproductive Medicine (ASRM). Evaluation and treatment of infertility in women. (Link)
- Centers for Disease Control and Prevention (CDC). Infertility in the United States. (Link)
- National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment (CG156). A clinical definition of infertility includes the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. (Link)
- American College of Obstetricians and Gynecologists (ACOG). Female infertility. (Link)
- European Society of Human Reproduction and Embryology (ESHRE). Female infertility and reproductive disorders. (Link)
- Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female and the associated social stigma. Fertility and Sterility. (Link)
- National Center for Biotechnology Information (NCBI). Female Infertility and its social stigma. (Link)
- World Health Organization (WHO). Infertility and social stigma. (Link)
- Centers for Disease Control and Prevention (CDC). Infertility. (Link)
- American College of Obstetricians and Gynecologists (ACOG). Female Infertility. (Link)