The causes of infertility for couples may originate in the man (30%), in the woman (30%) or sometimes both, but in this IVI blog article we are focusing on infertility in women. The causes of infertility are many and varied. They range from anovulation resulting from physical stress, to hormonal disturbances. Some of the most common reasons for infertility, are endometriosis and polycystic ovary syndrome, among a variety of other medical issues.
Of course one of the best-known causes of infertility in women is the approach of the menopause. However the onset of the menopause is not a cliff edge where fertility suddenly ceases, but more of a gradual process in which a woman’s fertility declines during the preceding years up to the point where it ceases altogether. In this article we look at the whole range of reasons for infertility and, crucially, what treatments are available so that women who are affected may be able to see their dreams of parenthood come true.
Excluding ageing, what are the main causes of infertility in women?
Infertility affects a significant proportion of the population and around 1 in 7 couples have difficulty conceiving. In spite of these statistics demonstrating how common it is, the experience of infertility can come as a major shock to young women. Naturally, many of those affected are not aware that there may be a problem until they are actively trying to conceive. It can feel like a betrayal by one’s own body, especially when a great deal of a woman’s previous attention has focused more on contraception than on its opposite. Equally, for most the decision to start a family feels like a major life choice and so the feelings of shock and loss can be quite overwhelming.
However, there’s plenty that can be done, and the first thing is to understand the reasons for infertility. Aside from the ageing process, the main causes of female infertility are endometriosis, obstructions in the Fallopian tubes, polycystic ovary syndrome and ovulation problems. Risk factors include myomas also known as fibroids, sexually transmitted diseases, some chronic diseases such as diabetes and cancer, and some medications including antidepressants. Here we take a look at the first four of these in more detail, since they are the most frequent causes of infertility in women, especially younger women.
Endometriosis and its role in infertility in women
Endometriosis refers to the presence of the tissue that lines the uterus (the endometrium) outside its normal location in the womb, from which it is shed each month in the menstrual cycle. It can be found in the ovaries, the Fallopian tubes, the ligaments supporting the uterus or the lining of the pelvic or abdominal cavity. There is quite a strong correlation between endometriosis and infertility since it is experienced by 35% of infertile women compared to 10% of women generally. The most common symptoms are pain and infertility which can arise from changes occurring in the pelvic anatomy during the menstrual cycle.
Endometriosis can be treated with medication or surgery and, depending on the ovarian reserve and the response capacity of the affected ovary, IVF can be an appropriate treatment for sterility associated with endometriosis where other techniques have failed.
Fallopian tube injuries: one of the causes of infertility in women
Around 25% of cases of infertility in women are due to some abnormality of the Fallopian tubes. Under normal conditions the tubes behave like a fishing rod, picking up the ovum that has been released from the ovary during ovulation, transporting the sperm towards the ovum and guiding the fertilised egg to the uterus. Partial damage to the tubes due to an adhesion, or more serious damage due to a complete obstruction of the tubes, prevents this transport and as a result fertilisation cannot take place.
Tubal damage can occur as a result of infections rising from the cervix or uterus towards the tubes (pelvic inflammatory disease, PID), or else from the abdominal cavity, for example in the case of appendicitis. The infections most frequently involved in PID are gonorrhoea and chlamydia among other pathogens. Previous pelvic surgery can also cause adhesions to form on the tubes or trigger endometriosis.
Treatment can include surgery to repair the tubes or break up scar tissue, making it easier for eggs to pass along them, with success rates depending on the extent of the damage. If surgery is inappropriate or unsuccessful, IVF would probably be the recommended treatment.
Polycystic Ovary Syndrome (PCOS)
Around 20% of women have polycystic ovaries. The term refers to an increase in the number of small cysts (antral follicles) that can be seen on the surface of the ovary when analysed with an ultrasound scan. The increased number of cysts may not in themselves cause any damage and there are a great many women with polycystic ovaries who have no problems ovulating and becoming pregnant. However, some women also have the condition known as Polycystic Ovary Syndrome (PCOS) and this can be one of the causes of female infertility. For women with PCOS, the result can be irregular menstrual cycles or even a complete lack of menstruation. Therefore they will have problems conceiving because they do not ovulate.
Reasons for infertility: other ovulation problems
Anovulation is when ovulation (and therefore periods) stop completely. Among the factors that can cause this situation are stress, significant weight gain or loss and polycystic ovaries, which are particularly important due to their complexity and frequency of occurrence. It can also be caused by excessive production of prolactin, the hormone responsible for producing breast milk. This probably explains the widely held belief (which has a grain of truth but does not always hold true) that women cannot become pregnant while breastfeeding.
Of course the most decisive, inevitable and natural reason for anovulation and thus most common of the reasons for infertility is the menopause. This brings us to a consideration of how the ageing process affects fertility and, even though there is no ‘cure’ for menopause, how a woman’s fertility may nevertheless be protected during the preceding decade or two.
What causes infertility: the major factor that is ageing
We all know that fertility declines with the passing of the years. In fact from the age of 35 onwards reproductive potential drops, and beyond 40 years of age the likelihood of pregnancy is less than 10%. Before the age of 30, the normal recommendation is to seek assistance if regular unprotected sex has not resulted in pregnancy within 12 months. However for women over the age of 30 or 35, it is advisable to seek help after six months because of the narrowing window of opportunity for assisted reproduction to be successful. In a great many cases of declining fertility, where there are no other problems, In Vitro Fertilisation (IVF) will be the recommended course of action.
In the current social and economic climate, many young women are deciding, for perfectly understandable and valid reasons, to delay motherhood until the time is right. In many cases this can turn out to coincide with the years of declining fertility. In such situations, more and more people are considering protecting their fertility by means of the vitrification of oocytes. This is also an entirely sensible precaution in the case of women about to undergo treatment for cancer. If you would like a preview of what is involved in this technique, we have an explanatory video on our IVI YouTube channel.
Vitrification of Oocytes: a way to preserve your fertility
The vitrification of oocytes takes place as an additional step in the course of the normal IVF process. In IVF, ovarian stimulation takes place so that eggs can be obtained in order for them to be fertilised with sperm which has been prepared in the laboratory. When the vitrification of oocytes technique is used, it allows the mature eggs obtained following ovarian stimulation to be cryopreserved so that they can be used at a later date, when the patient decides she is ready, with the same prognosis as at the point when they were vitrified. Due to the fact that ice crystals do not form, oocyte survival rates are high, allowing motherhood to be postponed with reasonable guarantees of success.
Apart from this intervention, when the process is resumed at the time that is right for the patient, the IVF process is conducted in the normal way with fertilisation in the laboratory and then placement of the embryos in the woman’s uterus. For a ‘refresher’ on what is involved in the normal IVF process, have a look at the IVF/ICSI video on our IVI YouTube channel.
Contacting us at IVI
The causes of infertility in women are many and varied, and one or more of them affect a great many people. But we have seen that there is a variety of options available for treatment including medication, surgery and assisted reproduction techniques. If any of these issues affects you directly and you would like to talk to us, do get in touch. You can call us on 08 000 850 035 from the UK or +34 960 451 185 from other countries. Alternatively you can use our online contact form and we will get straight back to you.