Female Infertility: Causes and Risk Factors

You can be a parent in your heart long before you conceive and have a baby. For couples struggling with the reality of infertility, waiting to become pregnant can be a painstaking process. Have hope. We’re here to walk you through the basics of infertility and how you and your partner can work to overcome it together with your expert team by your side.

Infertility 101

According to the CDC, infertility means not being able to get pregnant after one year or longer of trying to conceive a baby. Because fertility is known to steadily decline with age, some providers evaluate and treat people ages 35 and older after six months of not being able to get pregnant. Women are most fertile in their late teens and twenties.

Pregnancy has many steps that must work perfectly for it to happen. To get pregnant:

• An egg must be released from one of the ovaries
• A sperm must join with the egg
• The fertilized egg must go through a fallopian tube toward the uterus
• The embryo must attach to the inside of the uterus

Infertility can arise from a problem with one or more of these steps. Impaired fecundity is a condition related to infertility and refers to difficulty getting pregnant or carrying a pregnancy to term.

Contrary to popular belief, infertility is not confined to women. Both genders can be infertile from a variety of causes. Here, we’ll focus on women’s health, highlighting how to overcome infertility by living healthfully, identifying issues and seeking the right treatment.

How Common Is Infertility in Women?

Among married women in their childbearing years with no previous births, about 19% are unable to get pregnant after one year of trying or are considered infertile. About 26% of women within this group have trouble getting pregnant or carrying a pregnancy to term.

Infertility and impaired fecundity are less common in women with one or more prior births. In this group, about 6% of married women of childbearing age are unable to get pregnant after one year of trying, and 14% have difficulty getting pregnant or carrying a pregnancy to term.

The good news is your doctor can provide female fertility tests as well as male fertility tests. If you’ve been trying to conceive a baby for around a year and haven’t been successful, this may be a consideration for you and your partner.

What Causes Infertility in Women?

There are several different causes of infertility, including issues with ovulation, fallopian tube damage, endometriosis complications and uterine problems. Let’s take a closer look at each.

Problems With Ovulation

Not ovulating enough or not at all is the underlying cause of most infertility cases. Reproductive hormone imbalance can cause ovulation disorders. Here are some of the ovarian disorders and problems that can lead to infertility:

• Polycystic ovarian syndrome (PCOS): PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
• Hypothalamic dysfunction: Two hormones produced by the pituitary gland stimulate ovulation each month: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight or a recent substantial weight gain or loss can disrupt the production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
• Primary ovarian insufficiency: Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from the ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, lowering estrogen in women under age 40.
• Too much prolactin: The pituitary gland can cause excess production of prolactin, which reduces estrogen production and can cause infertility. This can also be caused by medications being taken for another condition.

Damage to Fallopian Tubes (Tubal Infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

• Pelvic inflammatory disease: an infection of the uterus and fallopian tubes typically caused by sexually transmitted infections
• Previous abdominal or pelvic surgery: including surgery for an ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube

Endometriosis

Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also disrupt the implantation of the fertilized egg. The condition also seems to affect fertility in less direct ways, such as damage to the sperm or egg.

Uterine Problems

Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:

• Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
• Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems with becoming or remaining pregnant.
• Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
• Sometimes, the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Fertility Concerns in Women

Certain factors may put you at higher risk of infertility. Some of them can be controlled, while others can’t. Common fertility concerns include:

• Age: Fertility declines in women over time — the quality and quantity of a woman's eggs will decline with age. In her mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer-quality eggs. This makes conception more difficult and increases the risk of miscarriage.
• Alcohol use: Excess alcohol consumption can reduce fertility in women.
• Personal history: Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases the risk of a sexually transmitted infection that may cause fertility problems later.
• Smoking: Smoking increases the risk of miscarriage and ectopic pregnancy. It's also thought to age the ovaries and deplete eggs prematurely. It’s advised to stop smoking before beginning fertility treatment.
• Weight: Being overweight or significantly underweight may affect ovulation. Getting to a healthy body mass index (BMI) might increase the frequency of ovulation and the likelihood of pregnancy.

For the factors you can control, commit to living a healthy lifestyle to increase the likelihood of getting pregnant or for infertility treatments to work well.

How Is Infertility Treated?

For couples who have been trying to conceive without success, there are many treatment options available, including medications that stimulate ovulation, in vitro fertilization, surgical procedures, artificial insemination and fertility treatments using assisted reproductive technology.

Often, medication and artificial insemination are used together. Providers recommend specific treatments for infertility based on the following:

• How long infertility has been experienced
• The couple’s treatment preference after counseling about success rates, risks and benefits of each treatment option
• The factors contributing to infertility
• The woman’s age

It’s important that you talk to your care team to decide which plan is best for you and your family.

How to Increase Fertility in Women

The good news is there are everyday steps women can take to increase their fertility. Certain foods increase fertility, including:

• Fatty fish
• Flax seeds
• Fruits
• Nuts
• Vegetables
• Whole grains

Other common ways to boost fertility in women include:

• Avoiding alcohol
• Cutting down on carbs if you have PCOS
• Eating more fiber and less added sugar
• Limiting caffeine
• Maintaining a healthy weight
• Minimizing refined carbs
• Taking prenatal vitamins

You aren’t alone on this journey — we’re honored to partner with you and your family to help boost your fertility. It’s important that you talk to your doctor before attempting new methods to boost your fertility to keep you and your family safe.

Compassionate Fertility Care Dedicated to You

We know how special it is to become a parent. Although fertility challenges may arise when you begin trying for a baby, we’re here for you through every step.

Visit us here to learn how we can partner with you on this journey. You have what it takes to be an amazing parent.