There are many factors within the reproductive system and hormonal system that affect a female’s fertility. As a result, the entire process of getting pregnant and carrying a pregnancy to term is complicated. Infertility is when a female cannot get pregnant after at least a year of unprotected intercourse. 

For women over 35, the consideration of 6 months is taken as the duration. Female infertility can be affected by several hormonal, genetic, environmental, physical and lifestyle factors. 

What are The Causes of Infertility in Females?

A female who has trouble getting pregnant or has been trying for over a year can seek medical help. The medical practitioner will conduct a series of tests based on hormonal profiles and ultrasound scans and assess the female’s medical history. It can help decide the possible treatment based on the cause. Some of the main causes of female infertility include, 

Five possible causes of female infertility to look out for

1. Issues in the Menstrual Cycle

The menstrual cycle is the process of maturation and release of an egg, while the uterus simultaneously gets prepared with the growth of the endometrium. It is controlled by several glands and hormones working in harmony. The menstrual cycle also includes several phases, and disturbance in any of these phases can affect the outcome. 

The part of the brain that controls the hormone production is the hypothalamus. A signal from the hypothalamus instructs the pituitary gland to secrete hormones. These hormones lead to the growth of eggs in the ovaries, eventually leading to maturation and release. The issues with the menstrual cycle which can affect female fertility include,

  1. Amenorrhea- Absence of the menstrual cycle 
  2. Dysmenorrhea- Painful menstrual cycles due to uterine contractions 
  3. Polymenorrhea– Abnormal uterine bleeding and recurrence of the menstrual cycle in an interval of fewer than 21 days
  4. Oligomenorrhea- Irregular menstrual cycles that take more than 35 days to arrive, with light bleeding 
  5. Menorrhagia- abnormally heavy menstrual bleeding, with menstruation lasting more than seven days 

2. Ovulatory Issues

As the female age increases, the number of eggs within follicles in the ovary decreases. The ovary is the organ of the female reproductive system that hosts the growth and maturation of an oocyte or an egg. Some ovulatory issues that can cause infertility include, 

  1. Polycystic Ovarian Syndrome- in a normal ovulatory cycle, the follicle matures in the ovary and the egg is released into the fallopian tubes. In polycystic ovarian syndrome, the follicles fail to ripen and form little cysts at the periphery of the ovaries. These cysts release male hormones that disrupt the hormonal profile and lead to irregular menstrual cycles 

              PCOS is often diagnosed using certain specific hormonal tests and profiles known as      

PCOS profiles

  1. Declining ovarian reserve- the reduction in the number of eggs available for ovulation 
  2. Hormonal issues such as hyperprolactinemia (excessive prolactin that interferes with ovulation), hyperthyroidism (excessive thyroid) or hypothyroidism (lack of thyroid) interfere with the menstrual cycle. 

Hormonal tests such as LH: FSH ratio, Progesterone test, Oestrogen level tests and so on are conducted as female fertility tests.

  1. Early menopause- a condition where menstruation occurs before the age of 40. It is due to genetic factors or chemotherapy treatment 
  2. Chemotherapy- Radiation used in cancer treatments can impair female fertility.

3. Damage to The Fallopian Tubes

The fallopian tubes are the organs that retrieve the mature egg from the ovaries. They also serve as the site of fertilisation, where the sperm meets the egg. Therefore, any damage to these structures can cause infertility. 

Any inflammation in the fallopian tube (salpingitis) can cause blockage or damage. It can be due to pelvic inflammatory disease, a sexually transmitted infection or adhesions. 

4. Uterine Anomalies

Any structural anomalies inside the uterus can prevent proper fertilisation and implantation. Some uterine anomalies include, 

  1. Congenital Mullerian disorders- These are genetic anomalies that include the double uterus, uterus with a dent on the top part, one-sided uterus, uterus with a partition in the middle and absent uterus. 
  2. Uterine myomas- These are uterine fibroids which depend on oestrogen for growth. They have symptoms such as abnormal uterine bleeding, pelvic pressure or discomfort, which is possible to get removed surgically.
  3. Endometrial polyp- the endometrium grows during every menstrual cycle to prepare the uterus to accommodate a foetus. In the case of no fertilisation, the endometrium is shed. An endometrial polyp is a non-invasive uterine growth that can contribute to infertility
  4. Endometriosis– painful disorder where the endometrium grows outside the uterus, invading the fallopian tube 

5. Age and Lifestyle Factors

The age of the female is the most important factor affecting fertility. The increased age leads to a decrease in the number of eggs in the ovaries as well as their quality. In addition, as the female ages, the egg is more prone to genetic anomalies. Therefore, for women over 30, an ovarian reserve test is done to estimate the number of follicles left. 

Lifestyle factors such as weight, smoking, excessive caffeine, drinking, occupational hazards and exposure play a role as they interfere with hormones, and ovulation and affect fertility. Regular exercise and dietary advice is recommended to be followed. Regular consumption of alcohol, smoking, and recreational drugs may interfere with the function of the reproductive system. 

A full body screening test done at regular intervals may help detect certain lifestyle disorders like type 2 diabetes, hypercholesterolemia and lipid disorders that may often interfere with the fertility in females. 

Female infertility Treatment

Many causes can affect a female’s fertility, and to proceed with treatment, a fertility test for women can aid in proper diagnosis. Understanding the cause can lead to the right treatment and medication to solve the issue of infertility. In addition, the patient can take certain measures such as regulating their lifestyle, choosing healthier diets and exercising to regulate the hormones influencing fertility. With the rise in assisted reproductive technologies such as In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI),  advanced treatments are now available for patients who seek solutions to infertility. 

Current advances make treating female infertility possible through medicine, surgery, artificial insemination or advanced reproductive technologies. Hence, starting with investigations to receive personalised and the right treatment is the first step to treating female infertility. 

A major step towards this would include conducting hormonal tests, PCOS profile testing and full body screening to diagnose infertility and treat the underlying cause. 

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