What Can Cause Infertility in a Woman?

Genetic, disease-related or environmental factors may lead to infertility in women.

Infertility is the failure to conceive after unprotected intercourse, irrespective of the cause. Doctors would consider infertility as

• The inability of a couple to conceive after 12 months of regular intercourse without the use of contraception. This occurs in women younger than 35 years. 
• In women aged 35 years and older, it is the inability to conceive after six months of regular intercourse without the use of contraceptives

Infertility affects approximately 10%-15% of reproductive-aged couples. The cause of infertility could be due to issues in one or both partners. In about one-third of infertile couples, the issue is with the male partner, whereas in a third of the couples, there is an issue with the women. In the rest of the cases, it could either be due to an issue with both partners or unknown causes. 

For conception to occur, all the steps involved in ovulation, sperm production, and fertilization have to take place correctly. There are several effective treatment options available for both men and women that can increase the chances of getting pregnant.

Causes of female infertility in women include

• Abnormalities in the cervix, uterus or fallopian tubes: 
  • Benign or malignant tumors of the cervix or uterus. This could prevent the implantation of the fertilized egg in the uterus. 
  • Inflammation of the fallopian tube can cause scarring, adhesions, and blockage of the tube, preventing the sperm from fertilizing the egg. One or both fallopian tubes may be affected. 
  • Surgeries involving the reproductive organs or pelvic areas can cause scarring and adhesions, which can affect fertilization or implantation of the fertilized egg.
• Ovulation disorders: Hormonal disorders such as polycystic ovary syndrome, thyroid disease, and increased prolactin could affect the menstrual cycle and the release of the eggs from the ovary (ovulation). 
  • Several other factors such as excessive physical and emotional stress, eating disorders, obesity, smoking, drug abuse, excessive alcohol, age above 37 years, or tumors may affect ovulation. 
• Endometriosis: A condition in which the tissue that lines the inside of the uterus grows outside the uterus and may affect the ovaries, fallopian tubes, intestine, or other organs, affecting their function. Early menopause:  The ovaries stop working and menstruation ends before age 40 years. The cause is often unknown. It could be due to genetic factors, other underlying medical conditions, chemotherapy, or radiation. 
• Genetic disorders: Chromosomal abnormalities like Turner's syndrome can cause infertility. 

Causes of infertility in men:

• Abnormalities in sperm production and/or function: Sperm production and/or mobility may be affected by several factors. They could be due to undescended testes, genetic disorders, hormonal disorders like diabetes, and thyroid disease. Infections like sexually transmitted diseases (STDs), cancer, cancer treatment, physical and emotional stress can also affect sperm production and mobility.
• Problems with sperm delivery: This could be due to damage or blockage in the reproductive organs due to genetic disorders, structural abnormalities, or infections. Sexual problems like premature ejaculation can also affect sperm delivery. 
• Environmental factors: Exposure to harmful chemicals, high temperature, smoking, and drug abuse can compromise fertility.

The physician takes a detailed history and performs a physical assessment of both the partners. The physician would then advise some specialized laboratory and radiological tests for both partners. 

Tests for women:

• Blood tests to study the level of reproductive hormones and other hormones affecting ovulation
• Imaging studies like hysterosalpingography and pelvic ultrasound may be done to evaluative the reproductive organs
• Genetic testing to rule out genetic disorders
• Hysteroscopy is a test that uses an endoscope inserted through the cervix to study the reproductive organs. 
• Laparoscopy is a minimally invasive procedure in which a small incision is made in the abdomen through which a camera may be inserted to study the status of the reproductive organs.

Tests for men:

• Semen analysis: To study the count and mobility of sperm
• Blood tests to study the levels of testosterone and other hormones affecting fertility
• Genetic testing to rule out genetic disorders 
• Testicular biopsy
• Radiological tests to evaluate structural abnormalities in the reproductive organs 

The treatment and chances of cure for infertility depend on the cause of infertility. There are several treatment options that can help overcome infertility, increase the chances of pregnancy, and lead to pregnancy. Treatment options vary for men and women and maybe a single modal therapy or a combination of treatments planned by the doctor based on the condition. 

• Lifestyle modifications: This is usually the first line of management. This includes increasing the frequency and timing of sexual intercourse, healthy diet, management of physical and emotional stress. Stopping smoking, drug abuse, excessive alcohol consumption, medications that cause infertility will help increase the chances of getting pregnant. These measures can be applied to both men and women. 
• Medical management: Certain medications may improve sperm count or mobility in men and induce ovulation in women.  
• Surgical management: Surgery may be beneficial in patients who have reversible infertility. Surgery can be performed to correct structural abnormalities in men and women to restore fertility.
• Sperm retrieval: These techniques obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid. They may also be used in cases in which assisted reproductive techniques are planned and sperm counts are low or otherwise abnormal.
• Intrauterine insemination (IUI). In IUI, healthy sperms from the male partner or a donor are introduced directly into the uterus during the female partner’s ovulation period.
• Artificial Reproductive Technology (ART): There are several ART techniques, of which in-vitro fertilization (IVF) is the most commonly performed procedure. IVF involves stimulating multiple eggs and retrieving them for fertilization with sperm from the male partner or donor, outside the body in a laboratory. The egg could also be a donor egg. 
• Surrogacy may be considered an option for some couples.
• Adoption may also be considered as an option by some families.

Complications of fertility treatments:

• Some fertility treatments increase the chances of multiple pregnancies, though many hopeful potential parents see this as a positive outcome. 
• Ovarian hyperstimulation syndrome: Overstimulation of the ovaries may cause the ovaries to become swollen and painful.
• Some invasive procedures may cause bleeding, infection and other complications