Overview
Infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year with no success.
Infertility results from female factors about one-third of the time and both female and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
Female infertility causes can be difficult to diagnose. There are many treatments, depending on the infertility cause. Many infertile couples will go on to conceive a child without treatment.
Symptoms
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you’re not ovulating. There might be no other signs or symptoms.
When to see a doctor
When to seek help can depend on your age:
- Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
- If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying.
- If you’re older than 40, your doctor might suggest testing or treatment right away.
Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.
Causes
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:
- One of the two ovaries releases a mature egg.
- The egg is picked up by the fallopian tube.
- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
- The fertilized egg travels down the fallopian tube to the uterus.
The fertilized egg attaches (implants) to the inside of the uterus and grows.
Female reproductive system The ovaries, fallopian tubes, uterus, cervix and vagina, also called the vaginal canal, make up the female reproductive system.
Fertilization and implantation
During fertilization, the sperm and egg unite in one of the fallopian tubes to form a zygote. Then the zygote travels down the fallopian tube, where it becomes a morula. Once it reaches the uterus, the morula becomes a blastocyst. The blastocyst then burrows into the uterine lining a process called implantation.
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.
Ovulation disorders
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.
- Polycystic ovary syndrome (PCOS). polycystic ovary syndrome (PCOS) causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
- Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
- Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age 40.
- Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and can cause infertility. This can also be caused by the medications you’re taking for another condition.
Damage to fallopian tubes (tubal infertility)
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
- Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
- Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube
Endometriosis
Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.
Endometriosis can also disrupt the implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Uterine or cervical causes
Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:
- Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
- Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems becoming or remaining pregnant.
- Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
- Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.
Unexplained infertility In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem can correct itself with time. But you shouldn’t delay treatment for infertility.