Conception, for some women, is a walk in the park, while for some others it can prove to be a herculean task. The problem of infertility can be extremely distressing and daunting for couples trying to conceive. In the quest for a solution, identifying the root cause of infertility is key to finding the right treatment.
FEMALE INFERTILITY AT A GLANCE
Infertility which is generally defined as the inability to get pregnant with regular intercourse after a year or at least six months of trying (for older women), is a common occurrence. The Centers for Disease Control and Prevention reports that about 10 to 18 percent of women aged 15 to 44 years have difficulty getting and staying pregnant. There are majorly two types of infertility that affects women:
- Primary infertility: Occurs in women who have never conceived or gotten pregnant
- Secondary infertility: This occurs in women who have previously had a child (or children) but have difficulty getting pregnant again.
About 20-30% of most infertility cases are attributed to male causes, 20-35% of the cases are female related, while 25-40% are caused by problems from the two parties. In about 10-20%, the cause of infertility is unaccounted for.
CAUSES OF FEMALE INFERTILITY
The leading cause of infertility in females is ovulation malfunction which usually manifests as menstrual irregularities, female infertility can also result from several other factors. Here are some top female infertility causes influenced by ovulation problems and other factors :
- PROBLEMS WITH OVULATION
Ovulation is an essential part of female reproduction. Pregnancy cannot successfully occur without ovulation. Problems with ovulation can be caused by certain hormonal disorders such as polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), hypothalamic dysfunction, and hyperprolactinemia.
PCOS: Polycystic ovary syndrome is one of the most popular causes of infertility in women. The condition results from a hormonal imbalance that interferes with ovulation function. It causes period irregularities or complete period absence for a couple of months. Sometimes it presents no symptoms and a woman can live with this condition for many years undiagnosed. PCOS is responsible for about 70% of ovulation associated infertility in women.
POI: Primary ovarian insufficiency which is also known as premature ovarian failure occurs when the ovaries stop producing eggs or become depleted before a woman reaches the age of 40 or attains menopause. It is associated with decreased estrogen production and it can also be caused by genetic factors, autoimmune disorders, and chemotherapy.
Hypothalamic dysfunction: The hypothalamus in the brain and the pituitary gland secretes reproductive hormones; follicle-stimulating hormone and luteinizing hormone which stimulate ovulation. Changes in these hormone levels can negatively impact ovulation. Obesity, weight loss, and stress can affect the function of these hormones. It is often marked by menstrual absence or irregularities.
Hyperprolactinemia: The excess production of prolactin by the pituitary gland is referred to as hyperprolactinemia. It causes a substantial decrease in female estrogen levels which can impair fertility. Problems with the pituitary gland and certain medications can result in this condition.
Endometriosis is one of the medical conditions that inhibit implantation. It occurs when the tissues that surround the uterus begin to extend into other parts of the female reproductive system like the uterus, fallopian tube, or in the ovaries.
This extension or growth can irritate these places and cause adhesions. Endometriosis can greatly impede fertility by causing blockage of the fallopian tubes, preventing implantation, causing pelvic inflammation, and by reducing egg quality. Sometimes the surgical removal of this extra tissue growth can cause scarring which may block the fallopian tube and prevent egg fertilization.
- BLOCKED OR DAMAGED FALLOPIAN TUBES
The fallopian tube is crucial to egg fertilization and reproduction. It is the point where the egg unites with the sperm for fertilization to take place. The fertilized egg subsequently travels from the fallopian tube to the uterus where it undergoes implantation. Blocked fallopian tubes can hinder the sperm from getting to the egg or prevent the transportation of the fertilized egg into the uterus.
Sexually transmitted infections such as gonorrhea, pelvic inflammatory disease, and chlamydia if left untreated can cause blockage of fallopian tubes. Pelvic tuberculosis and ectopic surgery can also cause damage to the tubes which can lead to infertility.
Uterine abnormalities such as fibroids and benign polyps can also disrupt the implantation process. Although in most cases, women with fibroids and polyps can get pregnant without any difficulty. Fibroids are non-cancerous clumps of muscular tissue that usually develop within the wall of the uterus. Fibroids may cause reproductive issues based on the number, size, and location in your uterus. Fibroids that are located near the endometrial lining are associated with heavy periods and can cause implantation problems and other complications.
- BODY WEIGHT
Your weight can determine your fertility status. An unhealthy BMI can negatively impact fertility. Being extremely obese or underweight can result in problems with the pituitary gland which can affect ovulation. Obesity also increases the risk of miscarriages and other gestational complications. The good news is, weight associated infertility can be treated by reverting to a healthy weight.
It is true what they say about biological clocks ticking. The longer a woman waits to get pregnant, the lower her chances of actually getting pregnant. It becomes increasingly difficult for a woman to conceive once she hits her late thirties or thereabout. This has to do with declining egg quality as women age. During the twenties, 90% of a woman’s eggs are of good quality, but the quality begins to depreciate as she approaches her forties. By the time she is well into her forties, most of her eggs would have lost their quality.
- ABNORMAL CERVICAL MUCUS
The cervix secretes a fluid called the cervical mucus which helps the sperm to survive in the harsh acidic environment of the vagina. Under normal circumstances, the cervical mucus is thick which prevents the passage of sperm, but before ovulation, the mucus thins and becomes penetrable for sperm to pass through and move to the fallopian tubes where it meets the egg for fertilization.
Abnormal cervical mucus on the other hand does not undergo a change in consistency even with ovulation, it may also permit the entry of harmful bacteria into the vagina which can infect the cervix and cause damage to the sperm. In extremely rare cases, it can contain antibodies that can kill the sperm before it unites with the egg.
- GENETIC FACTORS
Some women are not able to conceive due to genetic reasons like an inherited chromosome abnormality. If a woman’s family members have a significant history of infertility, endometriosis, and the likes, she may be at risk of developing those same infertility problems. Embryos with abnormal chromosomes are mostly unable to undergo implantation in the uterus, and sometimes when they do, the pregnancy may lead to a miscarriage or other abnormal birth defects.
- EXPOSURE TO CHEMICALS
Research indicates that exposure to certain chemicals can cause infertility in women. A study published in 2013 found that harmful exposure to environmental toxins like pesticides, industrial compounds, and pollutants can limit a couple’s chances of conceiving by 29%.
Another study found that some common household chemicals can trigger early menopause and associated fertility problems in women. Some of these chemicals that cause female infertility include PCBs, pesticides, phthalates( often found in cosmetic and beauty products), and furan (a toxic industrial waste). Although exposure to chemicals as a cause of infertility does not directly corroborate a cause and effect relationship, it is worth looking into.
- UNEXPLAINED INFERTILITY
Sometimes, medical investigations to determine the cause of infertility can prove futile. It is not uncommon for fertility tests to turn up normal without any evidence to point at the cause of conception difficulty. Doctors refer to cases like this as unexplained infertility and it affects about 5 to 10 percent of couples struggling with infertility.
SIGNS YOU CAN’T GET PREGNANT
Being able to detect potential fertility issues early on can help you solve the problem of infertility more easily. Infertility warning signs give you a better advantage at defeating infertility. You may have difficulty getting pregnant if:
- You experience pain during sexual intercourse which may point at an underlying health condition such as endometriosis and fibroid that can affect fertility
- You have a painful, heavy, and long-lasting period which may also indicate endometriosis.
- You have irregular menstrual periods. This could point to an ovulation problem.
- You have sudden and severe acne break out. This can be a warning sign for PCOS
- Your menstrual blood becomes darker than usual. Again, this can be a sign of endometriosis
- You suddenly gain unexplained weight or experience sudden hair growth or loss. This can point to issues with hormonal imbalance or PCOS.
CAN YOU FIX INFERTILITY?
Being diagnosed with infertility doesn’t mean you have to kiss the joy of having a child( or children) goodbye. There are a number of female infertility treatment options specific to the cause of infertility that you can employ to treat infertility. Doctors often recommend Infertility treatments based on :
- Cause of infertility (test results can ascertain this in some cases)
- Duration of infertility (how long the patient has been trying)
- The age of the patient
When all of these have been properly considered, infertility can be treated using drugs, surgery, artificial insemination, or assisted reproductive technology. Drugs can be prescribed to help stimulate ovulation. In artificial insemination, healthy and viable sperm are transferred into the uterus during the time of ovulation to assist with fertilization. Uterine problems that cause infertility such as polyps, fibroids, and scarring can be treated with surgery.
In assisted reproductive technology, In vitro fertilization (IVF) is the common technique used. The process involves transferring mature eggs from the uterus into a laboratory dish where they are fertilized with sperm. Several days after fertilization has occurred, the fertilized embryos are implanted into the uterus. Other techniques used include surrogacy, Assisted hatching, and intracytoplasmic sperm injection (ICSI)
WHAT TO DO IF YOU ARE INFERTILE
If you suspect that you may be having fertility issues, make time to see a fertility specialist or your health care provider. They will ask you to run some tests and ask questions regarding your sexual and fertility history. Ensure to provide them with all the necessary information they need without holding back.
This will make it easier to pinpoint the source of your problem. Encourage your partner to go with you to the hospital, because sometimes you may not be the one with the problem. You and your partner should get checked.
Lifestyle changes like limiting caffeine and alcohol consumption, quitting smoking, maintaining a healthy weight, and keeping stress at bay can help you better navigate infertility.