Causes of Female Infertility: Fertility Factors

Usually, couples not using contraception achieve a pregnancy within 2 years by regular unprotected sexual intercourse. However, if you fail to conceive after 1 year you may have to consult a fertility specialist. About 40% of cases of infertility are due to female factors, 30% are due to male factors, 20% is a combination of both, and in about 10 % the cause is unknown.

Female infertility is taken as a social stigma. Hence, infertile couples in rural areas don’t turn-up for fertility checks. However, about 15 to 17% of couples in industrialized countries seek help for infertility.

Infertility in females may be caused by ovulatory failure, tubal damage or endometriosis, or without a cause. 

What are the social factors causing female infertility?

A woman’s ability to get pregnant can also be affected by:

• Advancing age (decrease in quantity and/or quality of the eggs)

• Sexually transmitted diseases and infections

• Smoking, drinking alcohol or using cocaine and marijuana

• Medications such as antidepressants, tranquilizers, calcium channel blockers, narcotics, and anti-cancer drugs

• Exposure to radiation, lead, toxic fumes and pesticides

How common is female infertility in society?

The prevalence of primary and secondary infertility is 69.5% and 30.5% respectively. Infertility can be primary if you have never conceived. It is called secondary in women who have previously conceived.

Among the various causes of infertility women factors (88.6%) are the highest. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), ovulation dysfunction, uterine factor, fallopian tubes, and cervical factor occur more commonly.

What are the common causes of female infertility?

You can fail to conceive due to endometriosis, ovulation disorders, tubal infertility, and unexplained infertility.

If you are trying to conceive with unexplained infertility you may have to wait for a longer period. For the first 2 to 3 years your cumulative conception rates remain high (27–46%). Afterward, it decreases with the increasing age of the woman and the duration of infertility.

Spontaneous pregnancies can occur without treatment in couples who are considered infertile.

In about 10% to 20% of infertility cases, your doctor doesn’t find a cause. As a result, she calls it unexplained infertility. The rest are caused by ovulatory failure (27%), tubal damage (14%), endometriosis (5%), and other causes (5%).

How endometriosis leads to infertility?

Endometriosis is a progressive destructing disease. If you are having severe pain during menstruation it may be due endometriosis. It occurs when the endometrial tissue lining the uterus grows outside the uterus. This misplaced tissue attaches to the ovaries, fallopian tubes, or other organs in the abdominal cavity. As a result, this progressive disease destroys tissue with each menstrual cycle. The endometrial tissue lining the uterus grows outside the uterus and attaches to the ovaries, fallopian tubes, or other organs in the abdominal cavity. You may have symptoms like painful menstrual periods, abnormal menstrual bleeding, or pain during or after sexual intercourse.  It is a long term condition where the growth of endometrial tissue in areas other than the uterine cavity.

Endometriosis can damage your tubes as a result of the chronic inflammation. Subsequently, approximately 20–30% of women with endometriosis suffer of subfertility.

What are the ovulation disorders leading to female infertility?

Ovulation disorders are the failure of an egg to be expelled from the ovary. This happens because of the malfunction of your ovary. These are a major cause of female infertility. Anovulation, absence of ovulation is a common cause of female infertility. Most often, women who do not ovulate also do not menstruate. Ovulation disorders are a major cause of infertility and can often be corrected with medication.

You are suffering from ovulation disorders if you have infrequent menstruation(oligomenorrhoea). With long term absence of ovulation, you may present with PCOS. This happens when incompletely developed follicles accumulate in your ovary. If you are suffering from PCOS then you may have irregular or absent menstrual cycles. As a result, multiple small cysts on the ovaries (polycystic ovaries) accumulate.  Problems of facial hair growth and infertility are seen in PCOS women. Many women also have increased insulin resistance.

Ovulatory diseases can happen due to an imbalance of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).  If there is an injury to your hypothalamus or pituitary gland (where these hormones are produced) you will have ovulation problems. Pituitary tumors or too little or too much bodyweight are also common causes. Since ovulation is the result of a complex balance and interaction of hormones, any alteration of these mechanisms may influence its function.

The most common cause of ovulation failure includes polycystic ovary syndrome (PCOS). This condition is related to the arrest of the follicle maturation resulting in the formation of small follicles, defective ovulation, and dysmenorrhea. Other causes include malfunctions of the hypothalamus or pituitary gland leading to the production of immature eggs. At times, invasive surgery for repeated ovarian cysts can lead to ovulatory disorders. Outside ovary you may have problems including either hypothyroidism or hyperthyroidism causing dysovulation.

What are tubal factors of infertility?

Tubal infertility is the inability to conceive owing to a blockage in one or both of your fallopian tubes. This is a common cause of infertility. Hydrosalpinges is the abnormal distension of one or both fallopian tubes owing to fluid build-up. This usually happens because of infection in your tubes or surrounding organs. The factors responsible for tubal disease can be many. These may happen from post-infection damage, blockage or even after surgery. In this contest, the pelvic inflammatory disease is a major cause of anatomic and functional disorders of the tubes. This can be predominantly associated with infections by Chlamydia Trachomatis and Neisseria Gonorrhoea. These organisms can ultimately lead to tubal related female infertility.

How can unexplained infertility be managed?

Unexplained infertility is a term used to describe couples with infertility in whom standard investigations don’t show any abnormality. Your fertility profile tests like, tests of ovulation, and tubal patency have failed to detect any gross abnormality. Unknown causes of infertility can be investigated furthermore specifically to find a cause.  In addition to the described major reproductive pathologies, other causes like hormone alterations, of metabolic pathways of reproductive organs, are related to infertility and remain to be assessed in unexplained cases.

What are the Uterine factors of Infertility?

The uterus is the site of embryo implantation and pregnancy. Hence your fertility specialist evaluates various uterine factors before fertility treatment. If your uterus is unable to expand due to adhesion in between then it needs treatment. This can happen due to polyps, submucous fibroids, asymptomatic tumors. All these conditions can lead to recurrent miscarriages. Other endometrial pathologies and infections, may dramatically affect the embryo implantation. Your doctor may need to explore the uterine cavity by hysteroscopy to check pathologies.

Can Cervical causes lead to female infertility?

The cervix plays an important role in reproduction activity. It provides the passageway for sperms, allowing them to access the uterine cavity and then the fallopian tubes. The ability of the sperm to gain access to the upper tract is influenced by the cervical mucus within the cervical canal. Therefore, all conditions modifying the mucosal film of the cervix may concur to prevent the progression of sperms toward the tubes. Your cervical mucosa should be thin enough to allow sperms inside. At times some women have blockage of the cervical canal which will need a small procedure to open. These problems can happen as a defect in development and are present from birth.

Environmental factors of female Infertility

Many environmental and acquired factors also influence fertility and may lead to infertility.

Menstrual and ovulation dysfunction and uterine factors are the most common causes of impairment infertility. These can be related to social and environmental issues.

Environmental conditions associated with reproductive behaviors, such as age at marriage, environmental pollution, smoking, and alcohol abuse, changing in lifestyle and diet can lead to female infertility.

Information about the changes of puberty, menstruation, abnormal milk exit from the breast, sexual desire and sexual activity-related facts are essential to prevent infertility.

The ovulation can be evaluated using ultrasonography and blood tests. The openness of tubes is examined using an X-ray of the uterus and fallopian tubes. If necessary, in some cases, a laparoscopic device is used to examine the peritoneal cavity. You must have sufficient knowledge about these tests and discuss it with your doctor.

Secondary infertility refers to cases in which couples have experienced at least one pregnancy and then after a year of regular sexual life without contraception were unable to have children. This increase could be due to at least four factors: delayed childbearing, alterations in semen quality due to habits such as cigarette smoking and alcohol, changes in sexual behavior and elimination of most taboos.

How common are different causes of female infertility?

Causes of infertility in women occur in different frequency

• menstrual disorders (disorders of cycle length and flow) 62.6%,

• diseases (obesity, thyroid diseases, diabetes) 58.7%,

• impaired ovulation (hormonal disorders, oligoovulation, and anovulation) 50.3%,

• uterine causes 16.7%,

• tubal factor 15.4%,

• cervical causes 7.9%.

Abnormalities in uterine factors, hormonal dysfunctions in ovulation disorders, tubal obstruction in disorders of the fallopian tubes are more common. Other factors like cervical stenosis in cervical factor, dysfunction of cycle length in menstrual disorders, and obesity in diseases occur less commonly among infertile women.

What are the signs of infertility in a woman?

Infertility is defined as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse.

The human desire to have offspring is a natural instinct. Infertility can cause painful emotional experiences throughout life mainly known as quality of life impairment. Infertility may work as a painful emotional experience at all social levels. You can experience a lot of psychological issues including stress, anxiety, depression, diminished self-esteem. Also, declined sexual satisfaction, and reduced quality of life are more commonly seen. An infertile woman may show a relatively high level of frustration and anger which affects her relationship with family, friends. Attitudes toward women’s infertility are often influenced by ethnic and cultural groups.

Can obesity cause infertility in women?

The risk of infertility has been shown to be threefold higher in obese than in non-obese women. Several studies have demonstrated that obese females need a longer time to pregnancy. Inadequate diets as those with poor calories and protein or high carbohydrates can lead to severe thinness or overweight. Weight of woman definitely affect the ovarian function and increase the risk of female infertility. The time to conceive is longer in women with BMI over 25 kg/m2 or less than 19 kg/m2. Obesity and overweight are associated with decreased pregnancy rates. You may have increased requirements for gonadotrophins during IVF treatment if you are obese.

Reproductive issues with obesity

Obesity also leads to IVF failures and higher miscarriage events. High BMI is also associated with complications in pregnancy such as diabetes, high blood pressure, and early delivery. The risk of infertility can be reduced by diet containing foods with low glycaemic content and limited intake of calories.  This helps women with ovulatory disorders. This dietary restriction, indeed, may increase insulin resistance. Fertility in obese women seems to be impaired also in assisted conception programs. In fact, overweight and obesity are also associated with negative outcomes for patients undergoing in vitro fertilization (IVF) due to the poor oocyte quality, as well as the lower preimplantation rate and uterine receptivity.

Smoking and infertility in women

There is a negative influence of smoking resulting in reduced fertility in female smokers. This can act by rapid depletion of ovarian follicles, conception delay, increased risk of spontaneous miscarriage. Both natural and assisted conception cycles are benefited by quitting smoking. You can reduce the risk of birth defects if you stop smoking before conception.                         

Stress and Infertility

Particularly in western countries, there is a larger incidence of depression and anxiety among women. This is partially related to the lifestyle and to a number of stress jobs. Thus, the symptoms related to both depression and anxiety have been reported as more prominent in infertile than infertile women. Infertile women are more likely to experience higher levels of psychological distress and an increased likelihood of anxiety. The general distress levels are lower in the presence of higher socioeconomic status. Stress in women is higher in the presence of jobs, poor economic conditions or missing work. These psychological stress in addition to the social pressure may alter the physiologic maturation of oocytes.

Drugs, caffeine, and alcohol

 There are a number of daily or occasionally assumed drugs that are known to impact fertility. Non-steroidal anti-inflammatory drugs, commonly used to treat pain or inflammation are defined as ovulation inhibitors. You should avoid long term intake of pain killers. Drugs used in anticancer treatments are primarily responsible for ovarian failure in women. On the other hand, if you are taking caffeine frequently you need to reduce it before and during conception. There is an increased risk of pregnancy loss in caffeine users whereas in alcohol abusers stress factors on liver reduce the oocyte maturation.

Physical activity

The excess in physical activity has considerable negative effects on the whole body. It can bring changes in bones and functional derangements in endocrine, cardiovascular, reproductive and central nervous systems. In contrast, sports activities decrease abdominal fat, blood glucose, lipids and insulin resistance. Consequently, it regulates the menstrual cyclicity, ovulation, and fertility. This happens due to the lowered testosterone levels and the increase of sex hormone-binding globulin (SHBG). Too much physical activity in the form of intense agonistic sports may typically produce the ‘female athlete triad’. This is a disease with loss of menstruation, bone loss, and an eating disorder.

Environmental pollutants

Long term exposure to specific chemicals as organic solvents, aromatic amines, heavy metals can decrease fertility. Plant extracted medications like Phyto drugs, vegetal toxins, and others also reduce fertility.  The use of these substances leads to occasional or recurrent abortions. The reason for unsuccessful fertility by these conditions is not known.  The effect of environmental pollutants on female fertility is not so clear and under research.

Can infertility be cured in females?

There are various modes of treatment for female infertility. Clomiphene is a drug used to induce ovulation. Gonadotrophin is used for priming of oocytes before in vitro maturation and in vitro fertilization. Intrauterine insemination is the simplest form of fertility treatment. Laparoscopic ablation of endometrial deposits, laparoscopic ovarian drilling, laparoscopic removal of cysts is some of the fertility-enhancing surgeries. Metformin is also used in PCOS women to enhance fertility. Your doctor may advise certain tubal surgery before in vitro fertilization.

Can infections cause female infertility?

The two most common causes of upper genital tract infections in women are Chlamydia trachomatis and Neisseria gonorrhea, which cause tubal inflammation, damage, and scarring (tubal factor infertility). Other organisms, such as Mycoplasma, Ureaplasma urealyticum, and Trichomonas vaginalis, may also be involved in female infertility.

Assisted reproductive techniques including in vitro fertilization (IVF) are being used increasingly worldwide. Screening for genital tract infections (GTIs) is recommended prior to IVF treatment as their presence may affect the success rate of IVF.  IVF failure in infertile females is also associated with tubal factor infertility and the presence of Mycoplasma species in their genital tract. A decreased concentration of Lactobacillus species can be associated with low fertility. The use of vaginal douches may decrease lactobacillus-dominated bacteria. It is associated with a significant decrease in endometrial receptivity and pregnancy rates.

What are 4 causes for female infertility?

Most common causes of infertility are

• Ovulatory factor (present in about 20% of couples),

• Utero-tubal peritoneal factor (present in ∼30% of couples)

• Semen migration factor (10% of cases)

• Male factor (30% of couples)

Around 40% of all infertile couples exhibit a combination of factors and about 15 % of couples may not display any objective alteration leading to a definite diagnosis.

How can a woman become infertile?

For pregnancy to occur several things have to happen:

• An egg must develop in the woman’s ovary

• The egg has to be released each month into the fallopian tube (ovulation)

• A man’s sperm must fertilize the egg in the fallopian tube

• The fertilized egg must be able to travel through the fallopian tubes and attach (implant) in the lining of the uterus

If any of these events do not happen or is disrupted, infertility will result

Does heat affect female fertility?

Heat stress affects many reproductive functions including endocrine activities in females. High temperature disturbs hormone secretion such as decreasing LH, follicle‐stimulating hormone (FSH). Heat stress can affect ovaries by inhibiting follicular growth and oocyte quality. Heat stress at the time of fertilization also decreases subsequent embryo development. You need to avoid extreme heat conditions as heat stress has detrimental effects on both oocytes and sperm.

How do I know if I am fertile enough to get pregnant?

• Regular periods – Your regular menstrual cycles are an indication of ovulation and fertility.

• Symptoms of hormone fluctuations – You may experience changes in the breast in the form of mild pain after ovulation. An increase in body temperature in the mid-cycle is also a sign of fertility.

• Cyclic Vaginal secretions – Vaginal secretions may change in thickness and become more around ovulatory days.

• Ovulation Pain – Many women experience pain while the egg is being released. This can be mild to moderate in intensity and is considered a reliable sign of fertility.