Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects an estimated 10-15% of couples globally. When a woman is unable to get pregnant, this condition is medically known as female infertility or female factor infertility. There are various causes of female infertility which can originate from problems in the ovaries, fallopian tubes, uterus or cervix. Common causes include ovulation disorders, blockage of the fallopian tubes, uterine abnormalities, endometriosis, and advanced age. The diagnosis usually involves a medical history, physical exam, ovarian reserve testing and imaging tests. Treatment options depend on the underlying cause and may include fertility drugs, surgery or assisted reproductive techniques like IVF. With advanced technologies, many cases of female infertility can be successfully treated today.
Definition of Infertility
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. It can be due to issues with the female partner, male partner or both. The medical term for when a woman is unable to get pregnant is called female infertility or female factor infertility.
Primary vs Secondary Infertility
There are two types of female infertility:
- Primary infertility – When a woman has never been able to conceive before.
- Secondary infertility – When a woman is unable to conceive after previously giving birth to one or more babies.
Global Prevalence
Female infertility affects an estimated 10-15% of couples trying to conceive globally. According to the World Health Organization (WHO), more than 180 million couples in developing countries suffer from primary or secondary infertility.
Causes of Female Infertility
Female infertility can result from problems in the ovaries, fallopian tubes, uterus, cervix or endocrine system. Some of the major causes include:
Ovulation Disorders
These account for 25% of female infertility cases. Some examples are:
- Polycystic Ovarian Syndrome (PCOS) – Hormonal disorder causing irregular menstrual cycles, absent ovulation, ovarian cysts.
- Primary Ovarian Insufficiency – Low egg numbers due to impaired ovarian function.
- Hyperprolactinemia – High prolactin levels prevent normal ovulation.
- Hypothalamic Dysfunction – Problems with hypothalamus or pituitary leading to lack of ovulation.
Fallopian Tube Damage
Blocked or damaged fallopian tubes account for 25-35% of infertility cases. Causes include:
- Pelvic inflammatory disease
- Previous surgeries
- Endometriosis
- Scarring from infections or adhesions
Uterine or Cervical Causes
These factors contribute to 10–15% of infertility cases. Examples are:
- Fibroids
- Polyps
- Congenital abnormalities of uterus
- Ashman syndrome (damaged cervix)
- Precancerous conditions
Endometriosis
Growth of uterine tissue outside the uterus impairs fertility in upto 30-40% cases.
Other Factors
- Anatomical problems
- Thyroid disorders
- Chronic diseases
- Advanced age – Declining egg quality and number after 35 years.
- Being overweight or underweight
- Excessive exercise or stress
- Smoking, alcohol
- Toxins or environmental factors
- Medications
- Genetic issues
- Unexplained Infertility
Diagnosis of Female Infertility
The evaluation of infertility in women involves –
Medical History
Information about the woman’s menstrual cycles, prior pregnancies, gynecologic surgeries, chronic illnesses, medications, allergies and family history of infertility.
Physical Exam
Pelvic exam to look for any anatomical abnormalities and evidence of hormonal issues.
Ovarian Reserve Testing
Blood tests for follicle stimulating hormone (FSH), estradiol and anti-mullerian hormone levels on day 3 of menstrual cycle. Helps assess ovarian function.
Ovulation Testing
BBT charts, ovulation prediction kits and blood tests to check progesterone levels confirm ovulation.
Hysterosalpingography
X-ray test with contrast media to examine the uterus and fallopian tube anatomy.
Laparoscopy
A minimally invasive surgical procedure to visually inspect pelvic organs.
Imaging Tests
Pelvic ultrasounds or pelvic MRI may be done to check for fibroids, endometriosis or structural issues.
Genetic Screening
Blood tests to analyze chromosomes and look for genetic abnormalities causing infertility.
Other Tests
May include hormonal profile, thrombohilia screening, prolactin levels, thyroid function etc.
Treatment of Female Infertility
The treatment options for infertility in women depend on the underlying cause and may include:
Fertility Medications
Oral drugs like clomiphene or injectable gonadotropins can stimulate ovulation in cases like PCOS or hypothalamic dysfunction.
Surgery
- Laparoscopic surgery to remove endometriosis, scar tissue, fibroids, ovarian cysts.
- Tubal surgeries like tuboplasty or salpingostomy can repair damaged fallopian tubes.
- Hysteroscopic removal of polyps, fibroids, uterine septum.
Intrauterine Insemination (IUI)
Washed sperm are inserted directly into the uterus around the time of ovulation.
Assisted Reproductive Technology (ART)
Includes advanced techniques like IVF, ICSI, egg or embryo donation. Used for severe cases of infertility.
Lifestyle Changes
Weight management, regular exercise, stress reduction, avoiding smoking, alcohol and other toxins is recommended.
Conclusion
Female infertility is a common disorder affecting millions of women globally. While the most common causes are ovulation issues and tubal factors, many anatomical, hormonal and lifestyle factors can impact fertility. With a thorough diagnostic workup, many cases can be successfully treated today using a tailored treatment plan involving fertility drugs, surgery and advanced assisted conception techniques like IVF. Lifestyle optimization also improves the chances of pregnancy. With growing awareness and advancing technologies, there is hope for women facing challenges with conceiving.