The truth about female infertility

The truth about female infertility

Before starting any treatment, your reproductive endocrinologist (RE) will typically review your and your partner’s medical histories and examination results to diagnose the reason you’re struggling to conceive. Female infertility can occur for many reasons, but age is a common factor.

How age affects fertility

As women get older, fertility naturally begins to decline. At 30, a healthy woman has around a 20% chance of conceiving each month; by the time she is 40, her chances have dropped to 5%.

As the female reproductive system ages over time, women can expect: 

  • Fewer eggs
    Women are born with all the eggs they’ll ever have: around 1 to 2 million. At 37 years old, there are only around 25,000 eggs remaining.
  • Poorer egg quality
    Aging eggs have a higher chance of having an abnormal number of chromosomes, which can affect the health of embryos.
  • Irregular ovulation
    A woman’s menstrual cycle can become shorter and irregular over time.
  • Gradual exposure to diseases
    The reproductive system is exposed to more diseases that can affect fertility, such as endometriosis.
  • Decreased sex drive
    Intercourse may happen less frequently as women get older.

There are also pregnancy health risks to consider. Women over 35 are more likely to develop diabetes or high blood pressure, have a miscarriage, or have a baby born with chromosomal problems—although advances in prenatal care and genetic testing allow many older women to have healthy pregnancies. 

If you’re over 35 and hoping to conceive, don’t lose hope—but it's important to act. Today more couples are becoming parents at an older age than ever before. If you’ve been trying for at least 6 months, it’s worth speaking to a doctor about fertility options as soon as possible.

Did you know

About 25% of female infertility is caused by problems with ovulation 

There is a range of fertility treatment available, including surgical procedures, ovulation induction, assisted conception, and assisted reproductive technology (ART) like in-vitro fertilization (IVF). As women get older, they are more likely to need multiple ART cycles to become pregnant—so talking to a doctor and beginning treatments sooner may make the chance of pregnancy more likely.

11 other causes of female infertility

Ovulation problems

Around 1 in 4 women with infertility have problems with ovulation.

In order to conceive, the ovaries must release a healthy egg—a process called ovulation. Irregular or absent periods may indicate a problem. Ovulation can also be affected by weight gain and weight loss. 

How is it treated?
Ovulation induction (OI) medications help a woman ovulate more regularly, increasing her chance of getting pregnant. These medications may also improve the lining of the womb or uterus.

Blocked fallopian tubes

Blocked or damaged fallopian tubes cause up to 35% of female infertility.

Delicate fallopian tubes can easily become blocked or damaged by scarring from infection or previous abdominal surgery. This can prevent sperm from reaching the egg, and interfere with embryo development and its implantation into your uterine lining. 

How is it treated?
Some women with blocked fallopian tubes may be treated with surgery. For others, in-vitro fertilization is the best way to become pregnant. 

Endometriosis

30% to 50% of women with endometriosis have trouble getting pregnant.

Endometriosis occurs when tissue that usually lines the inside of the uterus grows on ovaries, fallopian tubes, or on the outside surface of the uterus. This can cause heavy and painful periods, scarring, and adhesions (organs sticking together). 

How is it treated?
Your doctor will perform a small keyhole surgery called laparoscopy to confirm diagnosis. Medication and surgery can usually treat the condition, but some women may still need to undergo assisted reproduction treatment (ART) to get pregnant. 

Fibroids

Around 5% to 10% of fertility problems are caused by fibroids.

These non-cancerous growths, sometimes called myomas or leiomyomas, are made up of muscle and tissue that develop in or around the uterus. They can block or change the shape of the uterus or fallopian tubes, making it difficult for sperm to reach an egg or an embryo to implant into the uterine lining. The exact cause of fibroids is unknown, and whether they cause symptoms depends on their location, size, and number. 

How is it treated?
Fibroids may be treated with medication or surgery.

Polycystic ovary syndrome (PCOS)

As many as 80% of women with PCOS may be infertile.

The exact cause of PCOS is unknown, but factors like inflammation, high insulin, and heredity are thought to play a role. The condition may cause ovaries to become enlarged, leading to irregular ovulation. Women with the condition may also have elevated levels of androgen, a male hormone. Obesity is associated with PCOS and can cause symptoms to be more severe.

How is it treated?
PCOS is usually diagnosed with an ultrasound scan. Lifestyle changes, medications, and sometimes surgery are the most common forms of treatment. OI medications can be given to help regulate ovulation, but some women may need to undergo ART procedures in order to become pregnant. 

Cervical problems

Between 3% and 8% of female infertility problems are caused by abnormalities of the cervix.

Cervical mucus helps sperm move through the vagina to reach the egg. Some women may not have enough mucus, or it may be too thick and sticky for sperm to swim. Cervical mucus sometimes also contains antibodies that are hostile to sperm. 

How is it treated?
Problems with cervical mucus may be treated with medication, by placing sperm directly into the uterus, or with ART treatments like IVF that bring eggs and sperm together outside of the body.

Sexually transmitted infections (STIs)

Chlamydia and gonorrhea are types of STIs that can cause a disease called pelvic inflammatory disease (PID). PID causes blockages in the fallopian tubes, which increase the risk of an embryo implanting outside the uterus. This is called ectopic pregnancy. 

How is it treated?
Blockages in your fallopian tubes can potentially be treated with surgery. Other women may need to undergo ART treatment to become pregnant.

Early menopause

As a woman ages, her period eventually stops, and she is no longer fertile. This is called menopause.

Some women undergo early menopause. This means their periods stop before they are 40 years old.

How is it treated?
Women who have gone through early menopause will need to undergo ART treatment in order to conceive. They may also need to use donor eggs.

Tubal ligation

Surgery that cuts, ties, or seals the fallopian tubes is called tubal ligation. It prevents a woman from getting pregnant by blocking the path between the ovaries and the uterus. This prevents sperm from fertilizing the egg, and the egg from reaching the uterus. 

How is it treated?
In rare instances, tubal ligation may be reversed, but it’s more common for women to be counseled to try IVF instead because of rising success rates and potentially less risk of ectopic pregnancies.

Thyroid disease

One in 8 women will have a thyroid disease in her lifetime. These diseases are common in those of childbearing age, and even more common in women with fertility challenges.

Women who have a thyroid disease either make too much or too little thyroid stimulating hormone (TSH). Problems with the thyroid can affect hormones that cause ovulation, making it more difficult to become pregnant.

How is it treated?
Thyroid disorders are typically treated with medicine before and during pregnancy. After a woman conceives, regular thyroid function tests will help ensure the health of mother and baby.

Some studies have reported high-normal TSH levels in many infertile women—meaning that levels are within the higher limits of the normal range. Although current guidelines don’t recommend treatment for these patients, some doctors may prescribe thyroid medication anyway.

Cancer

Cancer affects around 800,000 US men and women of reproductive age.

Treatments like radiation and chemotherapy may harm egg quality or decrease egg quantity, or cause early menopause. Some cancers may require removal of the uterus, fallopian tubes, or ovaries.

How is it treated?
Women are encouraged to preserve eggs or embryos before beginning treatment for cancer. Egg donors or surrogates are also good options for some women.

Does multiple sclerosis cause infertility?

According to the National Multiple Sclerosis (MS) Society, there’s no evidence that MS causes fertility challenges or an increase in miscarriages, stillbirths, or birth defects. In fact, studies have shown that pregnancy is no different for women with MS than for those without the disease.

Women with MS also shouldn’t be worried about the effects of pregnancy on their condition. Carrying a baby has actually been shown to reduce MS relapses, especially in the second and third trimesters—although relapse is possible after the baby is born.

In the know: Fertility

Your guide to human reproduction, getting help, and infertility treatment. 

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