Assisted conceptionTrying to conceiveUnexplained infertility

What causes fertility problems in women?

Being diagnosed as infertile is often just the start of a long journey where a couple strives to become parents. As if the diagnosis isn’t devastating enough, often the reasons given for the diagnosis are confusing and peppered with complicated medical terms. This medical jargon can just make the emotional turmoil of infertility even worse, as it feels so alien and detached from what couples are actually feeling and going through.

And that’s if a reason for infertility can be provided at all. Research has shown that up to 30% of cases of infertility are unexplained, whereas 35% of cases can be attributed to the male partner and the remaining 35% to the female partner.

For natural pregnancy to occur, a woman needs to be ovulating (releasing an egg each month), have one or two working fallopian tubes (which carry eggs to the uterus) and she needs to have a uterus in which an embryo is able to implant and grow. A man must produce – and deposit in the vagina – a suitable amount of sperm that function reasonably well. These are the basic ingredients for pregnancy, so fertility problems can usually be linked back to a problem in one of these areas.

To try and help lighten the burden of infertility and to knock down some of the barriers that the complicated medical jargon can cause, we have compiled a guide which explains some of the most common causes of infertility, in simple terms.

Female infertility

In many instances of female infertility, the cause is unknown. And researchers know that in 30-40% of female infertility sufferers there is more than one issue contributing to their difficulty in conceiving. According to two well renowned books – one published in 1988 and the other in 2013 – the common causes of female infertility are:

Advanced female age

As women get older, their chances of getting pregnant get lower. This trend is especially obvious after a woman’s mid-30s, and so this factor is more of a problem in western countries – where women are leaving it later and later to have children. The reasons for this decline in fertility with age are that older women have lower quality eggs and diminished function in their ovaries and uterus. Older women are also more at risk of fertility damaging conditions such as endometriosis.

Ovulatory failure or dysfunction

This is the single biggest cause of female infertility and it occurs when a woman’s natural cycle of releasing an egg each month (ovulation) is stopped or disrupted. Some of the things that can cause ovulatory failure or dysfunction include: low quality eggs, premature menopause, endometriosis, polycystic ovary syndrome (cysts on the ovaries), hyperprolactinemia (the overproduction of the hormone prolactin) and hypogonadotropic hypogonadism (a condition which disrupts the release of the hormones FSH and LH).

Tubal damage

The two fallopian tubes carry eggs from the ovaries to the uterus. If these tubes become damaged they can struggle to function properly – which can cause infertility. Trauma (such as ectopic pregnancy, where an embryo implants in the fallopian tubes) and disease or infection (such as sexually transmitted infections (STIs) and pelvic inflammatory disease) can lead to fallopian tube damage.

Uterine problems

These are problems with the uterus that threaten a woman’s fertility. The uterus may be abnormal or damaged in some way that means is cannot allow for successful embryo implantation or growth.

Cervical problems

Good functioning of the cervix is crucial for a woman’s fertility. Sometimes cervical problems can threaten fertility. For example, sometimes the cervix or cervical mucus prevents sperm from reaching the uterus or sometimes miscarriage occurs because the cervix cannot support a baby inside the uterus.

Immunological problems

Some women produce antibodies – immune system cells designed to attack foreign cells – which damage or kill their partner’s sperm, stopping them from fertilising eggs.

Problems after fertilisation

Even if an embryo is successfully created after fertilisation, later problems can cause fertility problems for women. For example, the embryo could fail to implant into the uterus, could implant in the wrong place in an ectopic pregnancy or miscarriage could occur.

Psychosexual causes

These psychological (or sometimes physical) problems can prevent women from having sex. One of the main issues is Vaginismus – an involuntary tightening of the vagina muscles during sex.

Environmental issues

Environmental factors such as stress and certain prescription and non-prescription drugs can negatively influence a woman’s fertility.

Infections and disease

There are many infections and diseases that can lead to female fertility problems. Of course, STIs – especially chlamydia and gonorrhoea – have a big role in causing female infertility if left untreated. In total, STIs are accountable for 20% of male and female infertility cases.

Treatment

Of course, the good news is that many of the problems mentioned above can be treated. So many women with some of these problems still stand a good chance of becoming a mother. There are many options out there when it comes to infertility treatments. Depending on the nature of the fertility problem, women could be treated using medication, surgery or therapy. And sometimes a change in lifestyle is all that’s needed to fix a fertility issue.

Unexplained infertility

This is by far the most frustrating diagnosis to receive, since a couple can’t pin the blame for their infertility on a named factor. This can also make treatment more difficult. However, scientists believe it is possible that sometimes this diagnosis is falsely given to couples just because incomplete or poorly carried out investigations have failed to unearth the root of the problem. It’s likely that this diagnosis will be given out less and less in the future as we develop new tests for types of infertility and as we learn more about exactly how the male and female reproductive systems work.

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