Causes of Infertility in women

Motherhood & the ability to give birth to a human life is a special gift to women, but not all women can cherish this gift as easily. The journey to attaining a successful pregnancy can be a long, bitter & exhausting one for women struggling with infertility.

So was the journey of Carol- 3 miscarriages, months of treatments, bouts of grief and loss, multiple visits to the gynaecologist only to be diagnosed with ‘unexplained infertility’. The most dissatisfying and frustrating diagnosis.

Infertility is diagnosed and treatment may be required when you fail to get pregnant after a year of regular, unprotected intercourse. And for a woman over 35, investigations & treatment of infertility may be initiated when she fails to get pregnant after 6 months of trying. 

In our society, Infertility is often considered to be a  woman’s fault, but one must remember that for a successful conception, contribution is required from both the male as well as the female partner. 

So, needless to say, infertility can be a result of problems with either the male or female partner and sometimes, both. 

Research indicates that almost  15-18% of couples may face problems in conceiving and may be diagnosed as having infertility. 

About 37% of these couples have female factor infertility, 35 % have problems with both the partners ie the man & the woman , and about 8% have male factor infertility. In the remaining couples, the cause of infertility maybe unidentified & unexplained. 

This article discusses the common causes of infertility in women and you can refer to the other article published in Maitri for the Causes of infertility in men

The common causes of infertility in women were studied by WHO and they have been identified as follows

1. Ovulation dysfunction
2. Endometriosis
3. Pelvic adhesions
4. Tubal blockage
5. Uterine/Tubal abnormalities

Ovulation disorders

Ovulation disorders leading to irregular release of the egg from the ovary constitute about 25% of the female factor infertility. 

Irregular or absent ovulation affects fertility because in such cases, there is no egg released from the ovary and so fertilisation is not possible. There can be various causes for delayed/absent ovulation

• Polycystic Ovary syndrome (PCOS): The hormonal imbalance in PCOS affects the process of ovulation. PCOS is the most common cause of female infertility. 
• Hypothalamic dysfunction: The hormones produced by the pituitary gland- Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) regulate ovulation. 

The levels of these hormones are affected by different factors like stress, increase in weight or excessive weight loss , extreme levels of exercise & eating disorders which, in turn, affect ovulation. 

• Premature ovarian insufficiency: In this condition there is premature loss of eggs which could be the result of excessive smoking, an autoimmune response or chemotherapy. Smoking is known to be the most important factor that accelerates loss of follicles in the ovary and leading to ovarian insufficiency & premature menopause. 
• Increased prolactin: Increased prolactin reduces levels of estrogen leading to infertility. 

Endometriosis 

Endometriosis is a condition in which the cells of uterine lining ( Endometrium) are found at places outside of the uterus. These may be implanted over the fallopian tubes, ovaries, ligaments of pelvis or at other places in the abdomen.

Every month, just as the uterine lining grows & bleeds in response to ovarian hormones, similarly these cells also grow & bleed. This bleeding , that happens in the region of tubes, ovaries & pelvic tissues , leads to distortion of the structure & placement of the pelvic tissues & ovaries. 

As a result, the normal function of the tubes & ovaries is disrupted and it becomes difficult to attain a pregnancy naturally.

Endometriosis also affects implantation of the fertilized egg and may alter the environment within the uterus , leading to miscarriage. 

Pelvic adhesions

Pelvic adhesions are a result of the scarring of the pelvic tissues that happens in response to pelvic infections or surgeries. 

Pelvic Inflammatory Disease including chlamydia, gonorrhoea, tuberculosis etc constitute an important cause of pelvic adhesions.

Pelvic infections & adhesions may lead to blockage of fallopian tubes, distortion of the relationship between the tubes & ovaries , alter the proper functioning of fallopian tube leading to formation of hydrosalpinx and may adversely affect the uterine environment , making it hostile for pregnancy. 

Fallopian tube damage (tubal infertility)

• Fallopian tube is the site of fertilization of the ovum (egg) by the sperm. The sperm swims up the cervix and the uterus to fertilize the egg in the fallopian tube. Damage to the fallopian affects the passage of the sperm to meet the egg. 
• Fallopian tube can be damaged due to pelvic inflammatory disease, Tuberculosis, endometriosis, sexually transmitted infections like chlamydia, gonorrhea, ectopic pregnancy. 

Uterine and cervical issues 

• Growth of fibroids and polyps in the uterus will affect the implantation affecting fertility. 
• Some women are born with abnormalities in the uterus like presence of a septum in the uterus or an abnormally shaped uterus. 
• Narrow cervix caused by stenosis is another reason for infertility. 

Unexplained infertility

In this case the exact cause cannot be diagnosed. It could be the result of a number of factors together. 

Medications

Certain medications like chemotherapy, ibuprofen, aspirin, marijuana, cocaine, antipsychotic medications can affect fertility in a woman. 

If you are someone struggling to get pregnant reach out to your doctor for help who will help you diagnose the cause and provide the right treatment. 

Actor Anne Hathaway who struggled with infertility captioned a picture of her with her baby bump like this; “All kidding aside, for everyone going through infertility and conception hell, please know it was not a straight line to either of my pregnancies, sending you extra love.” The road may seem long and exhausting but it will always be worth a try.

For more information on Fertility, please check our other videos.