It is often assumed that when a couple is suffering from infertility, the cause must lie with the female. This is incorrect! In fact, females account for approximately 30% of infertility in couples.
The most common causes of female infertility are:
Abnormal ovulation or the absence of ovulation (anovulation) are both common causes of infertility in women which ultimately mean you have less opportunities to become pregnant. Ovulation disorders are often the result of hormonal imbalances, thyroid issues or PCOS (see below).
Diagnosis: Ovulatory disorders can be diagnosed via blood test, basal body temperature monitoring or the use of ovulation kits, pelvic ultrasound – or a combination of all these.
Treatment: Drugs such as Clomid can often stimulate ovulation. Others will opt for IVF so that their cycle can be controlled, leaving less room for error.
Blocked Fallopian Tubes
If one or both of a woman’s fallopian tubes are blocked, the egg released at ovulation will not be able to travel down to meet the waiting sperm. Tubes can be blocked because of endometriosis, inflammation such as Pelvic Inflammatory disease or an STI, or in some cases they can be blocked from birth. Often a woman will have no idea her tubes are blocked until she is failing to become pregnant.
Diagnosis: Blocked tubes are normally diagnosed via HSG (hysterosalpingogram), where a dye is inserted into the cervix and an x-ray of the cervical canal, uterine cavity and interior of the tubes is taken.
Treatment: Given that trying to clear the blockage can mean risky and often complicated surgery, generally the best course of action is to bypass the tubes altogether and move to IVF.
Endometriosis is when the cells from the lining of the uterus grow outside the womb and attach to the lining of the pelvic cavity, or in extreme cases the bowel. It can also lead to blood filled cysts on the ovaries. Although it often causes severe pain, painful periods or painful sex, by contrast some women have no symptoms whatsoever. Endometriosis can create a toxic environment in the pelvis, cause tubal blockage, affect egg quality and affect the lining of the womb, reducing the chance of implantation.
Diagnosis: A laparoscopy is the gold standard for conclusive diagnosis of endometriosis. If found, the tissue can also be removed at the same time and can double the chances of a natural conception by giving you a window of opportunity before the cells have a chance to grow back.
Treatment: Extreme endometriosis can be difficult to keep under control and in some cases can have a huge impact on quality of life. Fortunately this is not the case for everyone. In terms of fertility, IVF is generally the best approach, though depending on the severity of the disease and the woman’s age etc, other avenues may be explored first. Interestingly, pregnancy itself keeps endometriosis suppressed, but it will generally come back at some point postnatally.
Polycystic Ovary Syndrome (PCOS)
Polycystic ovaries (many small follicles in the ovaries) are not uncommon and generally do not cause any unwanted symptoms in women – in fact, most would not even realise they have polycystic ovaries. However polycystic ovary syndrome can cause a range of health issues such as weight gain, insulin imbalance, irregular or absent periods, acne, excessive hair growth – and infertility. Some women with PCOS seem to be able to conceive regardless, but it is more common to need help than not.
Diagnosis: Ultrasound to detect the follicles and blood tests to ascertain hormone and insulin levels.
Treatment: For women who aren’t trying to conceive, the most effective treatment for PCOS is the contraceptive pill. It regulates periods, keeps the ovaries settled and also reduces the hormonal effects of PCOS like excessive hair growth and acne.
For women with fertility issues, there are several treatment options available. These include things like Clomid or Letrozole, FSH injections to induce ovulation, ovarian drilling to try to induce natural ovulation or IVF. One thing to bear in mind with IVF is that women with PCOS are at greater risk of OHSS (ovarian hyperstimulation syndrome) so will need close monitoring.
Fibroids are benign tumours that can grow either around or inside your uterus. They are quite common and in most cases will not cause you or your fertility any harm. Sometimes however, depending on where they are located, they can block the fallopian tubes or obstruct the implantation of an embryo and if this is found to be the case, it is recommended they be removed.
Diagnosis: The most common symptoms of uterine fibroids are heavy and/or overly long menstrual bleeding, pelvic pain, frequent urination, constipation and back or leg pain. However many women with fibroids have no symptoms at all, so they can go undetected until such time as a woman is trying to conceive.
Fibroids are generally conclusively diagnosed by either internal examination, ultrasound, hysteroscopy or HSG.
Treatment: Fibroids can usually be removed via laparoscopy, though in extreme cases, open surgery is required. Removal of the fibroids is not always the best course of action and options should be discussed with your treating doctor.
Advanced Maternal Age
Once a woman turns 35, her fertility drops dramatically. That’s not to say you can’t or won’t get pregnant, but it may be more difficult. The quality and number of eggs you have rapidly declines and issues with ovulation and hormones start to become more prevalent. If you are aged 35 or over, it is recommended that you don’t wait more than 6 months trying to conceive before seeking help.
Being Overweight or Underweight
Whether you are overweight or underweight, the implications in terms of fertility are very similar. Weight affects your fertility by causing hormonal imbalances and problems with ovulation. Being overweight can also increase your risk of PCOS. Trying to get into a healthy weight range is definitely something that you should aim for before you try to conceive.
Pelvic Inflammatory Disease
PID is where the organs and tissues of the pelvis become infected and/or inflamed. This can include the cervix, the endometrium, the fallopian tubes, the ovaries and even the appendix. The most common causes of PID are STIs such as chlamydia and gonorrhoea, but the condition can also develop following pelvic procedures such as pregnancy termination, IUD insertion or a bowel infection. Many women do not experience symptoms or their symptoms are very mild. Others have severe pain and can become unwell very quickly. If left untreated (such as in cases where a woman may not realise she has PID), it can cause scarring in the fallopian tubes, permanent tubal damage or completely blocked tubes – all of which can cause infertility.
Diagnosis: PID can be difficult to diagnose, but if symptoms indicate it, a swab can be taken from the vagina and cervix to test for bacteria. Blood and urine tests can also be performed as well as a pelvic examination. In some cases, a pelvic ultrasound is used to view the pelvic area or a laparoscopy can be performed.
Treatment: PID is treated by antibiotics. Early treatment is vital to prevent complications particularly around infertility and future pregnancies. While antibiotic treatment can cure the infection it cannot reverse damage that has already occurred to reproductive organs.
Premature Menopause/Premature Ovarian Failure
Premature menopause/ovarian failure is when women under the age of 40 stop having periods and have high FSH levels
Diagnosis: Diagnosis of POF is made via blood tests of FSH and AMH levels and ovarian antral follicle counts. An FSH level over 30 indicates low ovarian reserve, as does low serum AMH levels and low antral follicle counts.
Treatment: There is no treatment for premature menopause or premature ovarian failure.
Natural Killer Cells
Natural Killer Cells otherwise known as ‘NK’ are becoming more recognized as a cause of recurrent miscarriage, IVF failure and implantation failure. We all have these natural killer cells in our blood stream and they are important part of our immune system to help us ward off inflammation and disease. In terms of pregnancy, NK cells become a problem when they see a developing embryo as a ‘virus’ or a foreign body that they need to attack.
Diagnosis: A simple blood test can detect NK cells in the blood stream, however to detect them in the uterus a biopsy needs to be performed between day 24-28 of the menstrual cycle, when NK activity is at its highest. It is very similar to a pap smear and the results are generally back in about two weeks.
Treatment: If you are found to have elevated levels of NK cells the standard treatment is via steroids (Prednisone) and also Clexane, a blood thinning agent. Generally treatment is continued until 12-20 weeks gestation.
For more information on NK cells, here is a very thorough explanation on Belly Belly Australian website.
General Lifestyle recommendations for female fertility
Lifestyle factors that may affect the chance of conception and a healthy live birth include:
- Balanced diet
- Regular gentle exercise
- Stop smoking
- Reduce caffeine and alcohol intake. There may be an association between high levels of caffeine and fertility problems, and alcohol consumption has also been associated with reduced fertility.
- No recreational drugs and limit environmental pollutants
Please note: All diagnosis and treatment information is a guide. For more in-depth information speak to your Healthcare Professional.