What Causes Infertility in Women?

Conceiving a child is a complex physiological process. There are several intertwined parts that work together to produce a baby. For starters, men need healthy sperm and women need healthy eggs. Next, the fallopian tubes must open for the sperm to access the egg. If the sperm can get this far, they must be healthy enough to fertilize the egg. Once fertilized, the uterine lining must have the appropriate environment for embryo implantation. Finally, the embryo must be healthy.

In fertile couples, this process works in harmony. In certain cases, both men and women experience infertility, with women more likely to endure such hardships. To help highlight Fertility Awareness Week (April 18-24), we spoke to Andrea Partida, D.O., an OB-GYN at INTEGRIS Women’s Health Enid, to outline what causes infertility, how to manage infertility in women and how to cope with this difficult condition.

How common is infertility?

Women are largely seen as the most affected by infertility, but men can also experience it. In fact, 11 percent of women and 9 percent of men have fertility issues in the United States, according to the National Institute of Child Health and Human Development. 

For infertile couples, about 35 percent have both a male and female factor, according to the Centers for Disease Control and Prevention. Further, a male fertility issue is the sole problem in about 8 percent of couples. 

Aging plays a role in women’s infertility, mainly due to a decrease in quantity and quality of eggs available for a pregnancy and an increase in miscarriage. Women are half as fertile in their 30s as they are in their 20s. The chances of having a child decrease after the age of 35. Male fertility, on the other hand, declines more slowly.

Dr. Partida says 80 to 90 percent of couples will conceive within one year of attempted conception. Healthy adults under the age of 30, however, have a 40 to 60 percent chance of pregnancy after trying for only three months.

Unfortunately, age is not something that can be changed. There are other factors to monitor to reduce infertility risk. Don’t smoke, limit alcohol consumption and maintain a healthy weight to avoid any potential problems.

Why are some women infertile?

Many things can cause infertility. It can be a problem in the female reproductive system, the male reproductive system or a mix of the two. For women, the ovaries, fallopian tubes and uterus all need to function properly to allow for pregnancy. Any problems with these can cause infertility. 

“Common risk factors for women are age (35 years and older), history of pelvic infections, endometriosis, previous cancer diagnosis, abnormalities of the uterus, autoimmune diseases and genetic causes,” Dr. Partida says.

Ovulation disorders

During a menstrual cycle, an egg is released from the ovary into the fallopian tube. Anovulation is the medical term for when women don’t ovulate. Ovulation disorders account for 25 percent of infertility problems. Here are some common the of ovulation disorders:

Polycystic ovary syndrome (PCOS): PCOS is a hormonal imbalance that causes the egg to either not develop or release during ovulation. This condition affects 10 percent of childbearing women (ages 15 to 44) and is the most common cause of female infertility.

Diminished ovarian reserve (DOR): This condition is a result of the ovaries losing reproductive potential. In other words, there are fewer and poorer quality eggs to get pregnant. A declining egg count is a natural side effect of aging, although it could happen from an injury or a surgical complication.

Functional hypothalamic amenorrhea (FHA): Stress can cause the hypothalamus, which connects the brain to the endocrine system, from producing gonadotropin-releasing hormone (GnRH). GnRH serves as a messenger to the ovaries to produce estrogen. When estrogen production declines, which can happen when someone exercises too much or doesn't eat enough, the menstrual cycle becomes irregular or stops entirely.

Premature ovarian insufficiency (POI): This condition is often referred to as premature menopause where the ovaries no longer produce eggs under the age of 40. Autoimmune disorders or chemotherapy can cause POI. Up to one in 10 women with POI are still able to have a normal pregnancy.

Menopause: A normal part of aging, this generally occurs in women in their 40s or 50s when they don’t have a period for at least one year.

Fallopian tube damage

This anatomical problem occurs when fallopian tubes are damaged or blocked, preventing the egg and sperm from meeting. Scars from abdominal surgery or pelvic inflammatory disease stemming from sexually transmitted diseases such as gonorrhea or chlamydia can cause issues with the fallopian tubes.

Endometriosis

This condition occurs when endometrium (the tissue inside the uterus) grows outside of the uterus instead of inside. The excess tissue can block the fallopian tubes due to scarring. Ten percent of childbearing women have endometriosis.  

Uterine causes

Uterine fibroids, a combination of cells and tissues in the uterus, can block the fallopian tubes or disrupt egg implantation. Although endometriosis affects the fallopian tubes, it can also cause scarring or inflammation in the uterus. Birth defects, such as an abnormally shaped uterus, can also cause future infertility.

Cervical causes

Damage to the cervix can cause it to narrow or shorten, also called cervical stenosis. Other times, the cervical mucus is the culprit, preventing sperm from moving through the vagina and cervix. The mucus can also contain antibodies that mistakenly alert the immune system to attack and kill sperm.

How to know if you're infertile?

In general, an inability to get pregnant is the most common reason couples start to question their fertility. 

“Infertility is defined as the inability of a couple to conceive after 12 months of regular, timed intercourse without contraception in a woman less than 35 years old. For women 35 years old or older, the time frame changes to six months from 12 months,” Dr. Partida says.

Aside from that, infertility in women may not have tell-tale symptoms, which makes awareness even more important. Adding to the potential confusion, many of these symptoms are also linked to other medical problems. 

It’s helpful to contact your doctor if you have experienced any of the following.

• Irregular periods
• No periods at all
• Pain during periods
• Pelvic pain or inflammation
• Multiple miscarriages

In the event of infertility for six months or a year — depending on your age — your doctor can perform many tests to diagnose the problem. 

Female infertility treatment

If you think you may be experiencing female infertility, you should contact your OB-GYN. Your OB-GYN can decide if they can treat your infertility or if they will need to refer you to a board-certified reproductive endocrinologist. Reproductive endocrinologists complete a residency in obstetrics and gynecology followed by a fellowship in reproductive endocrinology and infertility.

“Not all fertility treatments involve expensive procedures,” Dr. Partida says. “There are many treatment options available depending on the possible causes of infertility. Contact your OBGYN to discuss if you may require a fertility treatment and if so, which one.”

The following options are available for treating infertility.

Infertility medications

Prescribing medications to treat fertility issues is usually the first step. In fertile women, two hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — stimulate ovulation. Infertility medications mimic natural hormones and help jumpstart ovulation or increase the number of fertile eggs. 

You should note some fertility drugs increase chances of having multiple children at the same time (twins, triplets, etc.). Pregnancies with more than one fetus have a higher risk of premature birth, which can lead to development problems.

Assisted reproductive technology (ART)

ART is a blanket term to describe artificial or laboratory-assisted fertility treatments involving eggs or embryos. In vitro fertilization (IVF) is a widely known ART treatment. IVF involves combining surgically removed eggs with sperm in a laboratory. The embryo is implanted in the uterus after fertilization. You can read more about this infertility treatment in our recent blog post on what you need to know about IVF.

Fertility surgery

Before IVF became a popular and successful infertility treatment, doctors used surgical procedures to increase the likelihood of a pregnancy. However, surgery to treat infertility is uncommon these days.

Uterine surgery, also called hysteroscopic, is one of the few surgeries still used today. This outpatient procedure uses a thin telescope to correct birth defects and remove uterine lesions. It can also help unblock fallopian tubes if the blockage occurs at the uterus opening.

In the past, surgery was a popular treatment to help correct a fallopian tube blockage and remove growths from the reproductive system. Now, the preference is to remove the fallopian tubes altogether. 

A laparotomy in the abdominal cavity is also rare. Exceptions include some cases of uterine fibroids or severe endometriosis. Laparoscopies used to be a routine part of outpatient infertility evaluation, but they are less common today.

Coping with infertility

Conceiving a child is one of the greatest gifts in the world. Losing the ability to become pregnant has a physical toll, but it also can affect mental and emotional well-being.

Physically, there are ways to reduce risk factors (obesity, smoking and alcohol use) by maintaining an active, healthy lifestyle. Beyond that, don’t ignore emotions. Frustration, anger or sadness are real feelings associated with infertility. It is important to find a way to discuss and express them in a healthy manner.

“I recommend females who face infertility should identify your feelings and the things causing you stress and begin to build coping strategies to overcome these obstacles,” Dr. Partida says. “Recognize that your significant other may not cope the same way you do. Find a tribe of people that you can count on whether they’ve been through similar situations or not.”

Talk through any triggers with a counselor or psychologist, or join a support group. If you’re uncomfortable joining an in-person group, either due to privacy or COVID-19, online groups exist to meet your needs.

In Oklahoma City, you can join an infertility peer support group through RESOLVE: The National Infertility Association. The group meets the third Tuesday of every month at 4900 North Portland, Suite 102. For more information, you can call 405-226-3761.

Dr. Partida’s best advice for women experiencing infertility is to find an OB-GYN physician who will listen to you and your concerns.

“Make an appointment to specifically discuss fertility, as a routine pap smear appointment doesn’t provide enough time for the rather large topic,” she says. “Make sure your partner is willing to participate in the evaluation.”