Explore the common signs and causes of infertility in women and learn about diagnosis methods and treatment options to achieve pregnancy.

Key Facts:

  • Male or female factors can cause infertility, and sometimes no cause is identified
  • Signs of infertility in women include menstrual irregularities, pain, acne, hair changes, or recurrent miscarriages
  • Ovulation disorders are the primary cause of female infertility
  • PCOS affects 8-13% of women of reproductive age and often goes undiagnosed
  • IVF can be an option when the fallopian tubes are severely damaged or nonexistent

Introduction

Approximately 1 in 6 couples worldwide, or 17.5% of all adults wishing to have children grapple with infertility. When family planning doesn't go as expected, a search for reasons begins. However, no one should be blamed for involuntary childlessness. Medical factors, such as sperm quality in men, are as often associated with potential infertility as female factors. In some instances, no cause can be identified (unexplained infertility).

In our article “Signs, Causes, and Treatment of Infertility in Women”, we discuss the factors that can lead to an female infertility and the possible treatments.

When is a woman considered infertile?

A woman is considered infertile if she has not become pregnant after one year of regular, unprotected sexual intercourse. For women over 35, infertility is considered if pregnancy does not occur after 6 months of regular, unprotected intercourse.

Infertility may also be a concern for women who have experienced two or more miscarriages, or unsuccessful fertility treatments.

Women with irregular menstrual cycles, endometriosis, or a history of gynecological issues such as pelvic surgery, ectopic pregnancies, or infections, should consult a gynecologist early if they suspect they may need assistance to conceive.

The journey to pregnancy is complex and multiple factors can present obstacles. It may involve simple issues, like a thyroid stimulating hormone (TSH) level that is too low or too high, which can be easily corrected with medication. Below, we provide an overview of potential signs that your fertility may be compromised.

Does infertility solely affect women?

Infertility affects both men and women. The causes of infertility are discussed in the video below. To play, simply click on the image:

What are the signs of infertility in women?

Infertility symptoms in women can be varied and differ from individual to individual. Menstrual cycle disorders are particularly common. It's normal to have irregular periods when menstruation first starts, as the body needs time to adjust to the hormones. However, once puberty ends, menstrual cycles should be regular (24 to 35 days). Approximately 14% to 25% of women of reproductive age experience menstrual irregularities, a potential infertility warning sign.

Other common symptoms include acne, hair loss, and facial hair, which result from an excess of androgens (male sex hormones). These are typical signs of PCO syndrome (PCOS). The WHO reports that 8-13% of women of childbearing age have PCOS, with up to 70% of cases going undiagnosed.

In the next section we will discuss the potential causes of infertility in women.

What are the causes of infertility in women?

  • Issues with egg maturation
  • Implantation failure
  • Tumors
  • Uterine fibroids
  • Sexually transmitted diseases (e.g. chlamydia infection)
  • Being underweight
  • Being overweight
  • Adhesions or damage to the fallopian tubes
  • PCO syndrome
  • Imbalanced hormone levels
  • Congenital malformations of the reproductive organs
  • Endometriosis
  • Problems with cervical mucus
  • Low egg reserve
  • Poor egg quality
  • Hyperprolactinemia (excess prolactin)
  • Primary ovarian insufficiency
  • Thyroid disease

In about 25% of women, ovulation disorders (irregular or absent ovulation) are the cause of infertility. These disorders can be due to conditions such as a luteal phase defect (insufficient progesterone production), a depleted ovarian reserve, an elevated prolactin level, an excess of male hormones, or disorders of the thyroid gland or pituitary gland/hypothalamus.

Malformations or diseases of the reproductive organs are also significant causes of infertility. In 15% of cases, endometriosis is the cause for infertility, followed by adhesions in the pelvic cavity (12%), blocked fallopian tubes (11%), other diseases of the fallopian tubes or endometrium (11%), and hyperprolactinemia (7%).

How is infertility diagnosed?

  • Anamnesis: The initial step in diagnosing infertility is obtaining a comprehensive medical history. This involves discussing symptoms or cycle-related irregularities with a gynecologist, as well as family history. If your mother suffers from endometriosis or a coagulation disorder, you may also have an increased risk.
  • Gynecological examination: Next is an ultrasound examination. Your gynecologist will examine your fallopian tubes, uterine cavity, and ovaries. Conditions such as PCO syndrome (PCOS), uterine fibroids, or polyps can be detected during this examination. Additionally, any organic abnormalities, like a septum in the uterus or an underdeveloped uterine lining, can also be identified.
  • Blood test: Certain indicators in the blood can impact fertility. For example, the TSH value (thyroid-stimulating hormone) can indicate an overactive or underactive thyroid, both of which could complicate conception. The anti-Müllerian hormone (AMH), which determines your egg reserve, can also be measured in the blood. A fertility blood test can identify other hormones (estrogen, progesterone, prolactin, FSH, and LH), helping diagnose hormonal disorders.
  • Hysterosalpingocontrast sonography (HyCoSy): This procedure checks whether the fallopian tubes are open. A contrast medium is flushed into the uterus using a catheter, and ultrasound is used to monitor fluid distribution and passage through the fallopian tubes into the abdominal cavity.
  • Laparoscopy: A laparoscopy can diagnose uterine fibroids, ovarian cysts, or endometriosis lesions and remove them simultaneously. A small incision is made near the navel and a laparoscope is inserted for visual inspection.
  • Hysteroscopy: This procedure can be performed similarly to a laparoscopy for diagnostic or surgical purposes. While a diagnostic hysteroscopy can be performed without anesthesia, a surgical one requires general anesthesia due to cervical dilation. During a hysteroscopy, fibroids can be removed, tissue samples taken, or mucous membrane removed.
  • Fertility test for men: A fertility test for men is also recommended. A semen analysis examines the man's sperm cells in detail to assess fertility.

What are the treatment options for infertility?

  • Surgery: These are used to remove adhesions or endometriosis lesions that block the fallopian tube or impair its function. Minimally invasive laparoscopic procedures are now possible due to advanced techniques.
  • Hormone therapy to induce ovulation: If ovulation is absent or irregular, it's often due to a hormonal disorder. In such cases, ovulation can be induced with medication. Hormone therapy can also alleviate other endocrine problems.
  • Intrauterine insemination (IUI): The stimulation of egg cell growth and triggering of ovulation can be combined with intrauterine insemination (IUI). IUI is a relatively simple assisted reproductive technology (ART), where prepared ejaculate is introduced directly into the uterine cavity. This shortens the sperm's path to the egg and bypasses the cervical mucus, addressing issues with sperm count and motility.
  • In vitro fertilisation: In vitro fertilisation (IVF) is the most common fertility treatment when the fallopian tubes are severely damaged or non-existent, as well as in cases of unexplained or male-related infertility.

Takeaway

Infertility in women can have many causes and present various symptoms, but these don't always necessarily result in infertility. Hormonal disorders like excess prolactin, progesterone deficiency, or abnormal TSH levels can be well managed. Other causes like endometriosis, cysts, fibroids, or polyps might require surgery to restore fertility.

If you've noticed one or more of these signs or suspect you might have difficulties getting pregnant, consult your gynecologist. In many cases, a detailed medical history, ultrasound scan, and blood test are enough to identify the cause of your infertility. If your doctor suspects conditions such as endometriosis or other gynecological abnormalities like fibroids or cysts, they will likely recommend a laparoscopy and/or hysteroscopy to diagnose and, if necessary, perform minimally invasive surgery.

If pregnancy doesn't result from medical or surgical treatment, modern reproductive medicine can help women and couples to fulfill their desire to have children. Through hormone treatment, insemination (IUI), or in vitro fertilisation (IVF), there's a high chance of achieving a successful pregnancy.

At our fertility centre, we offer comprehensive, personalised advice. We take the time to understand your wish to have children. Through our fertility check, we identify the exact reasons for your unfulfilled parenthood desires and discuss the most suitable treatment options with you.

Do you need more information? Simply book your free consulation with our fertility experts here.