Conditions that can lead to infertility are usually found in one-third of the male population, one-third of the female population, and the remaining one-third in both parties at the same time. 

Infertility is diagnosed when a couple is unable to conceive after 12 months of unprotected sexual intercourse. Several medical conditions have been linked to infertility in females, in males or both. In some cases, no cause is established despite various investigations.

Types Of Infertility

  • It could be Primary or Secondary Infertility

When a man has never been able to impregnate a woman or a woman has never been able to achieve pregnancy despite unprotected and adequate sexual intercourse, this is considered as the primary.

The Secondary type occurs when a man or woman has previously been able to impregnate a woman or achieve pregnancy, regardless of how the pregnancy ended, but is no longer able to impregnate or get pregnant despite unprotected and adequate sexual intercourse. 

Several conditions can pose as risk factors or causes of in both males and females.

This article will only focus on causes of Infertility in women.

Infertility can be worsened by a number of circumstances, including:

  • Alcohol. Excessive alcohol use might have a negative impact on fertility.
  • Age. The quality and quantity of a woman’s eggs start to deteriorate as she gets older. The rate of follicle loss accelerates in the mid-30s, leading in fewer and lower-quality eggs. This makes it more difficult to conceive and raises the chances of miscarriage.
  • Weight. Ovulation might be hampered by being overweight or considerably underweight. Increasing the frequency of ovulation and the chance of conception by achieving a healthy body mass index (BMI).
  • History of sexual relations. The fallopian tubes can be damaged by sexually transmitted illnesses including chlamydia and gonorrhea. Having unprotected intercourse with several partners raises your chance of contracting a sexually transmitted illness, which can lead to reproductive issues in the future.
  • Smoking. Smoking raises your chances of miscarriage and ectopic pregnancy, in addition to harming your cervix and fallopian tubes. It’s also known to prematurely age your ovaries and reduce your eggs. Before starting fertility therapy, you should quit smoking.

The following are the most common causes of female infertility:

  • Problems with ovulation could account for 25% of all cases.
  • Endometriosis accounts for 15% of all cases.
  • Pelvic adhesions: could lead to infertility by 12%
  • Tubal blockage accounts for 11% of all tubal occlusions.
  • Other tubal/uterine anomalies account for 11% of all cases.
  • Primary absence of menstruation accounts for 7% of the population.

Unknown Cause: This where the cause of infertility is unclear. The actual reasons of infertility difficulties are never determined in roughly 20% of infertility cases.

Problem with Ovulation: This could result from any of the following –

  • Polycystic ovarian syndrome (PCOS)  results in a hormonal imbalance that interferes with ovulation. PCOS is linked to insulin resistance, obesity, abnormal facial or body hair growth, and acne. It’s the most prevalent cause of infertility in women.
  • Primary ovarian insufficiency is a condition in which the ovary is not functioning properly. Early ovarian failure, also known as autoimmune ovarian failure, is caused by an autoimmune reaction or the premature loss of eggs from your ovary, which can be caused by genetics or chemotherapy. In women under the age of 40, the ovary no longer produces eggs and estrogen production is reduced.
  • Dysfunction of the hypothalamus. The pituitary gland produces two chemicals that stimulate ovulation each month: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (LH). Excessive physical or mental stress, extreme body weight gain or reduction, or a recent significant weight gain or loss can all alter hormone production and impact ovulation. The most prevalent symptoms are irregular or nonexistent menstruation.
Pregnancy can be achieved with adequate treatment
Pregnancy can be achieved with adequate treatment

Endometriosis –

Endometriosis is a condition in which tissue that normally develops in the uterus , is found in other parts of the body. Scarring from this additional tissue development — and its surgical removal — can clog fallopian tubes and prevent an egg and sperm from joining.

Endometriosis can potentially prevent the fertilized egg from implanting. Indirect effects of the illness, such as damage to the sperm or egg, appear to have an impact on fertility.

Damage of the pelvis and fallopian tubes:

A significant amount of female infertility is caused by damage of the pelvis and fallopian tubes.

Pelvic inflammatory Disease (PID) is the most prevalent infectious condition that causes pelvic and fallopian tube damage, and also cause abnormalities of the uterus which could result to infertility.

Chlamydia trachomatis is the major microorganism that causes this PID, leading to the most infectious cause of infertility in women.

Damage to the Cervix and Uterus (Womb)

The risk of miscarriage can be increased or the egg’s ability to implant can be interfered with by abnormalities and injury to the cervix and uterus (womb):

  • The uterus frequently develops benign polyps or tumors (fibroids). Some can reduce fertility by preventing implantation or blocking fallopian tubes. But plenty of women with fibroids or polyps do get pregnant.
  • A cervix damage or hereditary abnormality can lead to cervical stenosis, a narrowing of the cervix.
  • Obstacles to establishing or maintaining pregnancy might result from uterine issues that are present from birth, such as a uterus that is abnormally shaped.
  • There are occasions when the cervix is unable to create the ideal kind of mucus to allow the sperm to pass through and enter the uterus.

Risk Factors of Female Infertility 

Sexual Activity – The fallopian tubes can suffer damage from STIs such chlamydia and gonorrhea. Your chance of contracting an STD that might later affect your fertility increases if you engage in unprotected intercourse with several partners.

Being Overweight – Ovulation may be impacted by being severely overweight or underweight. The risk of pregnancy and the frequency of ovulation may both rise with a healthy body mass index (BMI).

Alcohol – Overindulgence in alcohol can lower fertility.

Active & Passive Smoking – Smoking raises your chance of miscarriage and ectopic pregnancy in addition to harming your cervix and fallopian tubes. Additionally, it’s known to prematurely age your ovaries and diminish your egg supply. Prior to starting fertility therapy, stop smoking.

Older Age – With time, a woman’s eggs lose both quality and number. The rate of follicle loss accelerates towards the middle of the 30s, producing fewer eggs of worse quality. This raises the chance of miscarriage and makes fertilization more challenging.

Prevention:

Women who are contemplating pregnancy should keep their weight in check, give up smoking, abstain from alcohol, and manage their stress.

When To Seek For Help

It has been recommended that in couples where the woman is 35 years of age or less, should try getting pregnant without seeking for help for the first 1 year of regular unprotected intercourse. 

Couples where the woman is between 35 – 40 years, should try to get pregnant in the first 6 months of regular unprotected sexual intercourse before going for help with fertility.

Women who are 40 years and above, may go for help with fertility right away if there is no conception after the immediate attempt on their own.

In addition, if you or your spouse has a history of endometriosis, pelvic inflammatory disease, recurrent miscarriages, cancer treatment, or irregular or painful periods, your doctor may want to start testing or treatment right away.

Where To Find Help

The place to visit when trying to get help with achieving conception is important

There various are specialties in medicine; Obstetrics and Gynecology are studied as one unit; however, Gynecology deals with issues regarding women’s reproductive system while Obstetrics is concerned with how to managed pregnancy towards a great outcome. 

Fertility Specialist is an Obstetrician & Gynecologist who is exclusively focused on helping couples achieve conception. Fertility medicine exists  as a subspecialty in obstetrics and gynecology.

Most times, after pregnancy is achieved, the woman is now managed by the general Obstetrician and Gynecologist, Who is not into fertility medicine as a subspecialty.

When seeking for help with fertility, the first place of call is at the Obstetrician and Gynecologist office. Who carries out basic investigation, to determine what could be the reason for the delay in achieving pregnancy. If a condition is found, treatment could be started immediately or whenever the couples are ready.

References

https://www.ncbi.nlm.nih.gov/books/NBK556033/

https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308

https://www.webmd.com/infertility-and-reproduction/guide/female-infertility

https://emedicine.medscape.com/article/274143-overview