Identifying The Causes Of Infertility In Women

Author:  Dr. Sai Manasa Darla, Consultant, Fertility Specialist &  Laparoscopic Surgeon

Infertility is a ubiquitous health condition owing to many medical, and lifestyle reasons. 30% of infertility cases are attributed to female fertility factors. Female infertility takes a toll mentally and physically. Identifying and being aware of the causes of infertility in women is essential to address, treat, and thereby help in conceiving.

Exploring the common causes of infertility in women:

– Ovulation Disorders

– Uterine Diseases

– Tubal-related infertility

Ovulation Disorders

Ovulation disorders contribute to the leading causes of infertility in women.

Ovulation is a phase during the menstrual cycle wherein a single mature egg is released by the ovaries which upon fertilization with the sperm results in a pregnancy. Any hindrances in the ovulation process lead to Ovulation disorders. Ovulation disorders contribute to 25% of the infertility problems.

Ovulation disorders may be a result of a variety of factors that interfere with this biological process and contribute majorly to the causes of infertility in women.

Irregularities in ovulation or anovulation (absence of ovulation) can be a result of many causes. Few include:

1. Primary Ovarian Insufficiency (POI):

Also referred to as premature ovarian failure. POI is characterized by the presence of an extremely low number of eggs or in a few cases the ovaries stop producing eggs prematurely in women under the age of 40 due to autoimmune conditions or genetic conditions resulting in one of the causes of infertility in women.

2. Hormone irregularities:

Hormone irregularities are one of the main culprits of irregular ovulation. A complex and delicate balance of hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin play a major role in the ovulation process. Any hormone irregularities impact ovulation and affect conception chances. A few conditions that arise due to hormone irregularities are:

– Polycystic Ovarian Syndrome (PCOS): PCOS is one of the common and major causes of infertility in women. Multiple small cysts (fluid-filled sacs) are formed in the ovaries leading to issues in ovulation. Irregular menstrual cycle, excess production of testosterone, female hormone irregularities, anovulation, and insulin resistance are linked to PCOS.

– High Prolactin levels (Hyperprolactinemia): In a few instances, a dysfunction of the pituitary gland results in the increased production of prolactin hormone. Elevated levels of prolactin negatively affect the FSH and LH levels leading to ovulation disorders and fertility issues.

– Thyroid dysfunction: Endocrine disorders like thyroid dysfunction can lead to an underactive or overactive thyroid gland which causes fluctuations in the thyroid hormone levels. Thyroid dysfunction has a detrimental effect on ovulation and the chances of conceiving.

3. Low egg quality and count:

Female fertility is determined by the egg quality and quantity. Women are born with an definite number of eggs and the quality and quantity of these eggs exponentially deteriorate with the increasing age. As age advances, the eggs develop genetic abnormalities leading to an increased risk of birth defects or recurrent miscarriages.

Uterine Diseases

Uterine health is important for implantation and to carry a pregnancy till term. Uterine diseases prevent embryo growth by obstructing implantation. Even if implantation occurs there is an increased risk of miscarriage.

Uterine diseases such as fibroids, uterine polyps, uterine abnormalities, endometriosis, and scarring of the uterus all affect pregnancy chances.

1. Fibroids:

Fibroids are non-cancerous growths of the uterine muscle. They obstruct the implantation of the fertilized egg or block the movement of an egg or sperm depending on its size and location of growth.

2. Uterine abnormalities:

Few women are born with an abnormally shaped uterus due to congenital reasons. These structural deformities cause problems in conceiving and have a high risk of recurrent miscarriages.

3. Endometriosis:

Endometriosis is one of the major contributors to the causes of infertility in women. About 30% of female infertility cases are because of Endometriosis. It is a condition wherein the inner uterine lining (endometrium) grows outside of the uterus such as ovaries, the back of the uterus, fallopian tubes, and the pelvic region. In severe cases, it results in uterine scarring leaving scar tissue behind. Symptoms of endometriosis include painful and irregular menstrual cycle, severe pelvic pain, pain during intercourse, etc.

It causes blocked fallopian tubes, obstructed implantation, and inflammation of the uterus. If left untreated it might give rise to implantation failures and recurrent miscarriages.

4. Pelvic inflammatory disease (PID):

Pelvic Inflammatory Disease is one of the main causes of infertility in women. The female reproductive organs are infected by sexually transmitted bacteria that spread from the vagina to the uterus, fallopian tubes, and ovaries. Chronic PID causes build-up of the scar tissue and leads to structural complications. Untreated chronic PID is associated with an increased risk of ectopic pregnancy and infertility.

Tubal-related infertility

A blockage in the fallopian tube prevents the sperm from fertilizing the egg. Also, even if fertilization does occur, the embryo cannot be transported to the uterus due to the blockage in the fallopian tube, resulting in an ectopic pregnancy that needs to be terminated.

Sexually transmitted infections such as Chlamydia and Gonorrhea, scarring due to previous surgeries, chronic PID, Endometriosis, Fibroids or Polyps, etc. can damage the tubes and lead to tubal blockage impairing fertility.

Risk factors that affect fertility in women

Apart from the above-mentioned causes, certain risk factors that can influence the chances of conception are:

– Age: Female fertility decreases with age due to a decline in the quality and number of eggs.

– Sexually transmitted infections: As discussed earlier, STIs spread and infect the uterus, cervix, and fallopian tubes causing fertility issues in women.

– Smoking and alcohol consumption: It is one of the major risk factors for infertility in both men and women. It not only affects fertility but also undermines the overall health of an individual.

– Obesity: Being overweight negatively affects fertility and causes difficulty in conceiving.

– Deficiencies and other nutritional factors: Vitamin deficiencies and having an imbalanced diet could render your reproductive system unfit for a pregnancy due to the lack of essential supplements that are important for hormone production and proper functioning of the reproductive system.

– Stress: Stress affects ovulation and leads to decreased sexual drive.

Conclusion:

For couples who are diagnosed with infertility, awareness of the underlying causes of infertility helps in managing the condition better. A proper diagnosis helps in building an effective personalized treatment plan. Thanks to the advances in the field of reproductive medicine, women who are diagnosed with fertility issues can still be able to get pregnant and achieve their dream of motherhood with the help of several fertility treatments such as In Vitro Fertilization, Intrauterine Insemination, In Vitro Maturation, etc. Consult with an expert fertility specialist to address your fertility issues.