Female Infertility: Everything You Need to Know

Learn about female infertility, its causes, risk factors, and what treatments are available.

Fertility problems affect people of all sexes and ages. Each year in Switzerland, around 7000 couples seek assistance to conceive a child due to infertility or genetic diseases. Infertility may arise due to issues with either partner. Whatever the reason, understanding your fertility is the first step to acknowledging and improving your reproductive health.

This article talks about why some women may struggle to get pregnant, what might cause it, when it could happen, and which treatments can help.

What is female infertility?

Female infertility is a condition in which a woman is unable to become pregnant after trying to conceive for one year or more, even after having regular, unprotected sexual intercourse during the time of ovulation. This medical condition can result from a variety of factors and may require specialized treatment in order to improve the chances of successful conception.

Infertility can be categorized into two types: primary infertility and secondary infertility. If a woman has never been able to get pregnant, it's called primary infertility. But if she's had a baby before and can't get pregnant again, it's called secondary infertility.

In some cases, infertility is considered idiopathic, meaning that the cause of the infertility is unknown and cannot be identified in either partner. Despite this, unexplained infertility can still be addressed.

How common is female infertility?

Infertility is a common issue faced by couples. According to available data, between 48 million couples and 186 million individuals have infertility globally. Even though female factors are responsible for or contribute to approximately 50% of infertility cases, it is often portrayed as a social burden for women alone.

As a woman gets older, the likelihood of experiencing infertility increases due to natural aging processes. This means that it becomes harder to get pregnant and carry the baby to full term. For this reason, it is a good idea for women over the age of 35 to see a doctor after six months of trying to conceive.

What are the causes of female infertility?

The cause of female infertility can be challenging to diagnose because many factors affect female fertility and a lack of pregnancy may also be related to male factor infertility.

Here are several factors that can cause female infertility:

Ovulation disorders. These involve hormone imbalances that impact the release of the female sex cell (the egg). There are many ovulation disorders:

• Polycystic ovary syndrome (PCOS). This condition involve too many male sex hormones (androgens). It can cause problems like gaining excess weight, growing hair in unusual areas, and developing acne. Even though it is the primary cause of infertility in women, it can be treated by medical professionals.
• Primary ovarian insufficiency (POI). Previously referred to as premature ovarian failure, POI is a condition where the ovaries stop properly functioning before the age of 40 and no longer regularly produce eggs or adequate amounts of sex hormones. POI differs from menopause because women may still have periods and have eggs.
• Hypothalamic dysfunction. The pituitary gland produces two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are essential for ovulation. External factors such as physical or emotional stress, weight changes, or extreme body weight can affect hormone production, ultimately leading to irregular or absent periods. It is important to recognize these signs of hormone imbalance and seek medical attention to address the underlying issue.
• Hyperprolactinemia. When a person has an excess of prolactin hormone, it can lead to various health issues. Prolactin is a hormone that aids in the production of breast milk. However, having too much of it can cause a decrease in estrogen levels, which may make it more challenging to conceive. The main cause of hyperprolactinemia is a prolactinoma (a noncancerous tumour on the pituitary gland), although certain health conditions and medicines, like antidepressants or medication for high blood pressure, may also be responsible.
• Thyroid Conditions. Both an excess (hyperthyroidism) and insufficient amount (hypothyroidism) of thyroid-stimulating hormone (TSH) can cause ovulation disorders.
• Functional hypothalamic amenorrhea (FHA). The term 'amenorrhea' means the absence of menstruation. In this condition, which is also characterised by a lack of ovulation (anovulation), the absence of a period is due to issues with the hypothalamus. This may happen if you intensely exercise too much, experience a lot of stress, lose a lot of weight, or a combination. Sometimes, this condition is linked to eating disorders like anorexia.

Damage to the fallopian tubes. When the fallopian tubes are damaged or blocked, it can cause problems with fertility. This is because sperm can't reach the egg, and even if the egg is fertilized, it might not be able to travel to the uterus. Damage or blockage to the fallopian tubes can happen for a few reasons:

• Pelvic inflammatory disease (PID). This prevalent infection affects female reproductive organs. It can be caused by sexually transmitted diseases like chlamydia and gonorrhea, as well as other infections such as bacterial vaginosis or surgical procedures. If left untreated, PID can lead to serious complications such as infertility or chronic pelvic pain. It is important to seek medical attention if one suspects they may have PID or any related symptoms.
• Polyps or cysts. Benign polyps or cysts can block the fallopian tubes or interfere with implantation.
• Surgery. Fallopian tubes may get blocked by scar tissue from surgery, including surgery for an ectopic pregnancy, which is when a fertilized egg grows somewhere other than the uterine lining. Additionally, this scar tissue can also cause pain and discomfort in the pelvic region, and can lead to other reproductive health issues such as endometriosis. It is important to consult with a fertility specialist if you have a history of surgery or ectopic pregnancy.

Endometriosis. In endometriosis, tissue that would usually grow inside the uterus grows in other parts of the body. When this happens, it can cause scarring that blocks the fallopian tubes and makes it hard for an egg and sperm to come together. It can also disrupt the implantation of a fertilised egg in the lining of the uterus.

Structural abnormalities or medical conditions that affect the uterus or cervix. Some women are born with an unusually shaped uterus, which can make it hard for a fertilised egg to implant. Uterine fibroids, which are noncancerous growths in the uterus, can also make it difficult to conceive. Cervical stenosis, where the cervix is too narrow, can cause problems with fertilisation. It may be caused by an inherited issue or damage to the cervix.

Poor quality cervical mucus. This can prevent how efficiently sperm travel through the cervix into the uterus.

Pelvic adhesions. These bands of scar tissue that bind organs can form blockages, making it difficult for a fertilised egg to implant in the uterus. They can form after pelvic infections, endometriosis, appendicitis, or abdominal or pelvic surgery.

Cancer and related treatments. Cancer in the pelvic region or that impacts the releases of reproductive hormones can impact fertility. Chemotherapy and radiation can also make it hard for women to have kids.

What are the common signs of female infertility?

Some health problems increase the risk of infertility. Beyond being unable to conceive a baby, there are additional indications of infertility. If you have any of the common signs of infertility, it's important to talk to your doctor.

• Ovulation problems in the form of irregular or no periods.
• Very painful menstrual cycles in the form of pelvic pain and cramping.
• Endometriosis symptoms in the form of painful intercourse, painful bowel movements, constipation, or nausea, especially during periods.
• Pelvic inflammatory disease (PID) symptoms in the form of pain in the lower abdomen and pelvis, bleeding during or after sex, painful intercourse, or painful urination.
• More than one miscarriage.

Who is most likely to be at risk?

Some factors can put women at a higher risk for fertility problems. These can include:

• Age. A woman's peak reproductive years are between the late teens and late 20s. By age 30, fertility begins to slowly decline, more intensely decreasing once you reach your mid-30s. By age 45, fertility has declined considerably, making natural conception unlikely for most women.
• Smoking. The available data indicates that up to 13% of infertility may be attributable to smoking. According to one study, exposure to smoking (passive smoking) may also impact the time it takes to conceive.
• Excessive drinking. Research suggests that you may find it more difficult to conceive if you have moderate to heavy alcohol use while trying to get pregnant.
• Weight. Being overweight, obese, or significantly underweight can put your reproductive health at high risk. Weight loss has been associated with increased fertility for women who are overweight.
• STIs. Certain sexually transmitted infections can inflame, scar, or damage the reproductive system.
• A previous ectopic pregnancy. Ectopic pregnancies are usually detected early on with monitoring by an OB-GYN (a doctor that specialises in pregnancy). After an ectopic pregnancy, a woman's chances of having a successful future pregnancy are typically related to the health of her fallopian tubes.

How is female infertility treated?

When it comes to treating infertility, specialists look at a few different things. They consider what's causing the infertility, how long it's been an issue, the age of the people involved, and what kind of treatment the couple wants after talking about the pros, cons, and success rates of each option. Some of the treatment options include taking medicine, having surgery, doing artificial insemination (like IUI), or using assisted reproductive technology.

Surgery, such as a laparoscopy, can improve fertility by unblocking the fallopian tubes, removing fibroids, and correcting an irregularly shaped uterus.

Medications can improve fertility by regulating hormone production, encouraging or regulating ovulation, improving insulin resistance, and treating medical conditions such as PID or PCOS.

Assisted reproductive technologies (ART) are ways to help people have babies when they're having trouble getting pregnant. These treatments involve taking eggs out of a woman's body and handling them in a lab. The most common type of ART is called in vitro fertilisation (IVF). Other types include frozen embryo transfer and intracytoplasmic sperm injection (ICSI). ART can be pretty expensive and take a lot of time, but it's helped lots of couples become parents when they might not have been able to otherwise.

We've asked an expert, Dr. Nurit Winkler, what is her best advice on choosing a fertility treatment in 2024, and this is what she said:

The best fertility treatment for 2024 is the fertility treatment that meets your core values, is the least invasive, and has the highest success rate.

What are holistic treatments for infertility?

Alternative treatments are sometimes used by individuals or couples who want to manage their stress and mental health during fertility treatments. Natural therapies can include holistic techniques, such as yoga or acupuncture.

Acupuncture

Acupuncture is a commonly recognized alternative treatment for those trying to get pregnant. A form of traditional Chinese medicine, it involves placing needles into particular points on the body. According to the Chinese tradition, these points run along the lines of energy, or meridians.

The research on whether acupuncture improves the chances of getting pregnant is conflicting and unclear. However, acupuncture can promote relaxation and relieve stress, which can be beneficial when going through fertility treatments, such as IVF.

Yoga

Yoga incorporates breathing techniques for relaxation and stress reduction. Although studies on yoga as an infertility treatment are limited, research has shown that yoga can effectively reduce infertility-related stress. In one study on women undergoing IVF, attending a six-week yoga program was associated with reduced anxiety and depression.

Vitamins and Supplements

When it comes to promoting female fertility, there are many vitamins and minerals that can be beneficial. Some examples include folate, zinc, vitamin C, vitamin E, and iron. Additionally, supplements such as N-Acetyl Cysteine (NAC) can improve overall wellness. Speaking with a specialist before taking any supplements is important.

What are some lifestyle changes to improve fertility?

If you're a woman who wants to have a baby, there are some things you can do to improve your chances of getting pregnant:

• Maintain a healthy weight. Being either too heavy or too thin can make it harder to ovulate. If you need to lose weight, try switching to healthy foods and doing some moderate exercise.
• Stop smoking. Smoking can harm both your fertility and the health of your baby, so it's best to stop before you try to get pregnant or start fertility treatments.
• Avoid drinking too much alcohol. Drinking heavily may reduce your chances of conceiving.
• Manage your stress. High levels of stress can interfere with fertility treatments and make it more challenging for couples to conceive. Therefore, it is important to take steps to reduce stress in your life before attempting to conceive. This may involve engaging in relaxation techniques such as meditation or yoga, getting regular exercise, and ensuring that you are getting enough sleep.
  Seeking support from a therapist or counselor can be beneficial in managing stress and developing coping mechanisms to deal with infertility challenges. It is important to prioritize one's mental health during this difficult time. By taking these steps, you can increase your chances of successfully conceiving and starting a family.

What are ways people cope with infertility?

Experiencing infertility and receiving treatment can be highly stressful. It can interfere with many aspects of life, including work, family, and relationships. The feelings and reactions to infertility may include a range of emotions, from anger and sadness to shame and grief. Couples may feel isolated and stigmatized and find being around other couples with children challenging. Mental health care, such as psychotherapy or infertility counselling, has been shown to help reduce the stress associated with infertility and treatment.

Tips for Coping

• Give yourself permission to cry and be angry. Don't try to shut off your feelings.
• Give your spouse/partner permission to feel and cope differently than you.
• Tell your spouse/partner how you want to be helped. It can be difficult to remember that everyone has a different way of coping with stress. Having clear and open communication about your needs allows your partner to support you in the best way.
• Get more information. One of the worst aspects of infertility is uncertainty about the future. By learning about the many options that are out there for fertility treatment, you may be able to better manage your uncertainty.
• Connect with others. Seek out support groups that can help you connect with others who understand.

Takeaway

Female infertility affects many women around the world. Various factors, including age, hormonal imbalances, and medical conditions, can cause it. The cause of female infertility may also be unknown; in all instances, your health care provider will work with you to decide the most fitting course of action based on your medical history, risk factors, and preferences.

Infertility may be treated with medicine, surgery, artificial insemination, and assisted reproductive technologies. Natural treatments and lifestyle changes can also help improve fertility outcomes and manage stress.

If you are experiencing infertility, being gentle with yourself and your partner is important. Allow yourself time and space to grieve, and seek support from a therapist, a support group, or your friends and family.

Discover the range of fertility treatments available, or get a consultation with our compassionate team of fertility specialists. Reserve your spot for a free consultation today.