What Causes Female Infertility? – Definition, Signs & Treatment

By (gynecologist), (gynecologist), (embryologist), (gynecologist), (fertility specialist) and (psychologist).
Last Update: 12/30/2021

Female sterility is the inability to conceive due to problems related to the eggs that impede fertilization and, therefore, pregnancy. The alteration of the reproductive capacity can appear due to a great variety of causes, depending on which the symptoms in the woman will be more or less noticeable.

For this reason, there may be situations in which the woman is not aware of her sterility until she undergoes the relevant fertility tests.

There are two main types of sterility:

Primary sterility
It appears in women who have never been pregnant before.
Secondary sterility
When a couple is unable to achieve a pregnancy even though they already have one or more children in common. In short, sterility appears after having been fertile previously.

Although they are two different types of infertility, the common point between them is the difficulty in achieving the desired pregnancy.

Provided bellow is an index with the 12 points we are going to expand on in this article.

Infertility and sterility in women

Although the terms sterility and infertility are commonly used as synonyms, both by society in general and professionals in this field, it should be noted that their meaning is not exactly the same:

Female sterility
The fusion between the egg and the sperm, i.e. fertilization, cannot take place due to problems related to the egg cell. Also, we talk about sterility when fertilization does occur, but still, the embryo is unable to attach to the endometrial lining. To sum up, it refers to every situation in which pregnancy cannot take place.
Female infertility
Although fertilization occurs and an embryo is obtained as a result of the egg-sperm binding, it cannot continue to develop fully, so a full-term pregnancy would never occur. It causes the woman to miscarry.

Be it as it may, both types hinder a woman's capacity to have a child, and therefore, are used interchangeably when talking about the causes, the signs, and the potential treatments to achieve a successful pregnancy.

Causes of infertility in women

Infertility problems in women can appear due to one or a combination of the following alterations:

Problems with egg production

A leading cause of female infertility is associated with the ovulation cycle. It is known as endocrine factor infertility because the menstrual cycle is regulated by a set of hormones such as GnRH (gonadotropin-releasing hormone), FSH (follicle-stimulating hormone), LH (luteinizing hormone), progesterone, and estradiol.

Variations in hormone levels can lead to:

  • Anovulation or absence of ovulation (egg release)
  • Ovulation taking place earlier or later than expected
  • Egg production failure

In normal menstrual cycles, without endocrine alterations, ovulation takes place halfway through the menstrual cycle (on day 14 approximately), considering as day 1 the day when the menstrual period begins.

For this reason, the most fertile days are the closest to ovulation, that is, the moment when the egg is released by the ovary so that the sperm hopefully reaches and fertilizes it inside the Fallopian tube.

Should a woman present any of the above-listed problems related to ovulation, pregnancy is unlikely to be achieved even if she tried to conceive during her most fertile days.

It should be noted that a sudden alteration in a woman's menstrual cycle does not automatically translate into female sterility. A woman is considered to be infertile when the problem persists over time.

Ovulation disturbance

The absence or the presence of alterations in the ovulation cycle leads to menstrual irregularities or even to amenorrhea (absence of menstrual periods). However, there are certain cases in which menstrual periods are apparently normal even though there exist a series of problems related to hormones that hinder a woman's chances to become pregnant:

Occult form of premature ovarian insufficiency (POF)
It is a type of premature ovarian failure (POF) that prevents ovulation.
Luteal phase defect (LPD)
After ovulation, during the luteal phase of the menstrual cycle, the releasing of progesterone takes place, and its main function is to promote the growth of the endometrium to create an adequate environment for embryo implantation and pregnancy. Sometimes, the endometrial lining does not grow properly due to a poor production of progesterone, which makes the achievement of pregnancy not possible.
Luteinized unruptured follicle (LUF) syndrome
The follicle, which is home to the egg before ovulation, continues developing until the luteal phase begins even though no egg has been released within. Fertilization will not occur, as no oocyte has been released from the ovary.

Some causes of the hormonal imbalances that affect the endocrine system's regulation of ovarian cycles are stress, obesity, anorexia, thyroid problems, certain medications, chemotherapy, radiotherapy, environmental factors...

You will be asked to undergo a workup to examine the development of your ovarian cycle via ultrasound scan and blood testing. By doing this, your gynecologist will be able to analyze your hormone levels and determine whether there exists an endocrine disorder that might be preventing pregnancy.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

You can read in more detail about this in the following article: Female infertility of endocrine origin.

Fallopian tube problems

We use the term tubal factor infertility when referring to alterations or problems in the Fallopian tubes, the part of the female reproductive system where fertilization takes place.

During ovulation, an egg is released from the ovary and travels to the Fallopian tubes, so that a sperm reaches and fertilizes it. After fertilization, the resulting embryo travels through the tubes toward the uterus, where it will implant and give rise to a new pregnancy.

In order for these steps to take place, tubal patency in both Fallopian tubes, or at least in one of them, is necessary. They have to be functional as well. If both tubes are blocked, we consider that the woman suffers from tubal factor infertility.

Abnormalities related to tubal patency can be caused by infections, endometriosis, salpingitis, tubal malformations, hydrosalpinx, surgery, pelvic inflammatory disease (PID), etc.

Hysterosalpingography (HSG) is a diagnostic test that allows us to evaluate the functionality of the uterine tubes.

If you want to learn more, visit the following article: Tubal factor infertility.

Cervical factor

The cervix or cervix is the first place that sperm must pass through on their way to the egg. There may be obstructions in the form of polyps or fibroids that hinder fertilization.

On the other hand, the cervical mucus also helps the spermatozoa to move through the uterine interior, providing them with a medium through which to travel.

Some of the causes that cause infertility in women because they prevent the sperm from reaching the fallopian tubes to fertilize the egg are inflammations, infections or pH changes.

If you are interested in this topic, we invite you to read the following article: Female infertility due to cervical abnormalities.

Infertility of uterine origin

There exist two main causes behind female infertility due to uterine abnormalities: on the one hand, uterine malformations, and on the other hand conditions related to the endometrium.

The endometrium or endometrial lining is the inner layer of the uterus where the implantation and attachment of the embryo take place.

Uterine abnormalities can be congenital, that is, from birth, or appear later in life as a consequence of polyps, myomas, or cysts.

Also, it should be taken into account that endometriosis is an infertility cause of uterine origin as well. It is a condition caused by the inflammation of the endometrial tissue, which grows outside the uterine cavity. Depending on the severity, it can be more or less harmful to a woman's fertility.

Click here if you want to get further information about this: Female infertility due to uterine abnormalities.

Other causes of infertility

There are other factors that affect sterility, but they can occur in both sexes, such as the following:

Unexplained infertility
In spite of having ran numerous fertility tests in the female and the male, no particular disorder causing infertility is detected.
Immune infertility
The most common cause of immune sterility is the presence of anti-sperm antibodies, either created by the female or the male, as well as the Antiphospholipid Syndrome (APS), which generates in the woman's organism a hypercoagulable state that prevents the placenta to work properly and leads to miscarriage.
Psychological distress
Emotions, sensations, and feelings play a major role in a female's reproductive capacity. It is not uncommon for us to see cases of couples who were once infertile, but have achieved a natural pregnancy on the second attempt. A number of experts have linked this situation to the relaxation and elimination of the stress usually derived from infertility.
Vaginal conditions
Vaginismus prevents penetration and therefore ejaculation due to the contraction of the perivaginal muscles.
Genetic causes
Certain genetic and chromosomal alterations can make it difficult or impossible for a couple to conceive. Moreover, they can affect the normal development of a pregnancy, thereby leading to the loss of pregnancy.

Research advances in the field of human fertility lead day by day to the discovery of new causes of sterility, so that it is possible to outline new treatments and drugs to combat all these problems.

Symptoms of infertility in females

Female infertility can go unnoticed or, conversely, certain signs can make it quite obvious.

For example, in cases of female sterility due to endocrine factors, hormonal alterations usually lead to amenorrhea or menstrual irregularities, which are signs that some kind of problem exists, and are reasons why women should visit a fertility specialist.

Also, a blockage in the Fallopian tubes or the presence of myomas in the uterine cavity can cause the woman to feel pain or at least some sort of discomfort. There are, however, cases in which the patient has no noticeable symptoms, and is therefore totally unaware that there is a fertility issue that needs to be supervised by a duly qualified specialist.

Due to this wide range of signs, females, in general, are recommended to attend every routine gynecological consultation, and not to visit the specialist only in case of pain, nuisance, or menstrual alterations.

Fertility of women according to age

Contrary to what happens in men, women do not produce eggs de novo but are born with a finite number of eggs. From puberty and until menopause, ovulation of a large part of them will occur and the rest will degenerate on the maturation path to ovulation.

A woman's fertile period ranges from approximately 16 to 30-35 years of age. From this age, and especially from the age of 40, a woman's fertility progressively decreases until the complete depletion of the egg reserve at menopause.

In fact, Dr. Gorka Barrenetxea, a specialist in Gynecology and Obstetrics, tells us that:

The average age of the women who come to our center is 37-38 years old.

Treatments

Female infertility can be addressed either with fertility drugs to induce ovulation, surgery, or reproductive assistance. The method of choice, however, depends on the cause of infertility and its severity:

Today's lifestyle has led to a delay in childbearing until biologically advanced ages. Therefore, one of the main causes of sterility today is the woman's age.

Infertility treatments

Intrauterine Insemination (IUI), the most common type of artificial insemination used nowadays, and in vitro fertilization (IVF) is the most commonly used assisted reproduction technique used to solve problems related to female infertility or sterility.

While IUI is the method involving the lowest level of complexity, as the sperms are placed inside the uterus, its chances of success are lower and require the woman to meet a series of previous requirements.

On the other hand, IVF involves retrieving mature oocytes from the patient or an egg donor, fertilizing them in the laboratory with the husband's sperm or donated sperm, and transferring the resulting embryos to the woman's uterus.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Female fertility by age

Contrary to what happens in males, women do not produce new eggs: they are born with a limited amount of oocytes. From puberty until the start of menopause, most of them are ovulated, while the remaining degenerate in the process of maturation that leads to ovulation.

A woman's childbearing age starts at 16 and lasts until about age 30-35. From that moment on, and particularly since the age of 40, fertility starts decreasing progressively (i.e. menopausal transition), until the complete depletion of the ovarian reserve, a period called menopause.

Today's lifestyle has led many women to delay motherhood and consider becoming mothers at an advanced age. This is the reason why, nowadays, advanced maternal age is the leading cause of infertility in women.

Treatments

In a situation of female infertility, the treatment necessary to achieve pregnancy will depend on the cause that is causing it. Therefore, specialists recommend that each case be approached individually and that a personalized treatment protocol be developed.

In addition to the origin of the infertility, there are other factors that will influence the choice of the most appropriate treatment, such as the age of the woman and the malefactor, mainly.

Once each case has been analyzed and all the necessary diagnostic tests have been performed, the fertility treatments that a woman or couple can resort to in order to have a child are as follows:

Scheduled intercourse
for cases of mild infertility, such as anovulation in young women. For this purpose, ovulation-inducing drugs are administered and intercourse is scheduled.
Artificial insemination (AI)
is the first assisted reproductive technique to be used when the woman is young and the partner's sperm is of good quality.
In vitro fertilization (IVF)
for more severe female or male infertility, or when AI has not worked after several attempts.
IVF with preimplantation genetic diagnosis (PGD)
in cases of infertility due to genetic causes or when there is a risk of transmission of a hereditary disease.
Ovodonation
when the woman does not have quality eggs in her ovarian reserve, it will be necessary to resort to donor eggs.

Each of these treatments should be adapted to each woman according to her specific characteristics and causes of infertility. If you need more detailed information about this, you can continue reading in the following post: Techniques and treatments to combat female infertility.

FAQs from users

Could I have fertility problems because of my age?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Yes, unfortunately the passage of time has a very negative influence. The fertile age is between puberty and menopause. Within this period, the best conditions are usually up to 35 years of age. As a woman's age increases, her ovarian reserve and the quality of her eggs decreases.

In short, the older a woman gets, the lower her fertility not only translates into a lower probability of pregnancy, but also into an increase in the number of miscarriages due to chromosomal abnormalities and complications during pregnancy.

When is a woman said to be infertile?

By Luis Rodríguez Tabernero M.D., M.Sc., Ph.D. (gynecologist).

A woman is said to be infertile when she is unable to become pregnant within 1 year of having unprotected sexual intercourse regularly, after ruling out male causes.

There are a great variety of causes of greater or lesser severity. That is why in many cases it may happen that the woman is not aware of her problem until the necessary sterility tests are performed, since in many cases she does not show any symptoms.

There are 2 types of sterility:

Primary
is when we have never been able to get pregnant.
Secondary
is when we do not achieve gestation despite having one or more previous children with the same partner.

To know the state of our ovarian reserve, it is best to perform an ultrasound to assess the antral follicle count, and a hormone analysis to determine the levels of FSH and antimullerian hormone.

And finally, it is necessary to know that the period of greatest fertility in women is from 16 to 30-35 years of age approximately, with fertility being clearly affected from the age of 40 onwards.

Is pregnancy possible after oophorectomy?

By Rubén Baltá I Arandes M.D. (gynecologist).

Yes, it is possible. However, there are differing opinions when reviewing the literature regarding ovarian-hormonal function after oophorectomy.

Some studies indicate a lesser effect on female fertility when the procedure is performed at a younger age. Other studies point out that patients with only one ovary respond less to ovarian stimulation with lower oocyte collection and have a higher follicle stimulating hormone (FSH), an indicator of a low response to stimulation in in-vitro fertilization (IVF) protocols.

Up to what age can you become a mother?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

It will depend on each woman and her ovarian reserve. A woman can be a mother naturally until she reaches the menopausal stage. However, as she approaches this stage, reproductive capacity decreases.

In any case and in general terms, we can say that from the age of 35 onwards, female fertility gradually decreases and it does so more markedly from the age of 40 onwards.

How do you know if a woman is infertile?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

In order to know the fertility status of a woman, there are a series of medical tests that help to measure the woman's ovarian reserve and to study her reproductive capacity.

Among them are cytology, physical examination of the female reproductive system, the analysis of hormones such as FSH or AMH, etc.

How can pregnancy with infertility/sterility be achieved?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Depending on the cause of infertility, one solution or another will be provided to achieve pregnancy. Assisted reproduction offers a wide range of techniques and treatments so that women with infertility can become pregnant and fulfill their desire to become mothers.

The most common techniques are artificial insemination, in vitro fertilization (conventional or ICSI), PGD (preimplantation genetic diagnosis), egg and sperm donation, etc.

Suggested readings

Sterility or infertility in women arises from some alteration in the proper functioning of the entire reproductive system for all the reasons we have already discussed. First of all, if you want to know what a woman's fertility consists of and what her ideal development should be like, we recommend you to visit the following post: Fertility in women.

A woman's menstrual cycle is key to achieving pregnancy. To get all the information about what happens in each of its stages, you can read the following article: How is the menstrual cycle?

We make a great effort to provide you with the highest quality information.

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References

Al-Badawi IA, Fluker MR, Bebbington MW. Diagnostic laparoscopy in infertile women with normal hysterosalpingograms. J Reprod Med 1999; 44:953-7.

Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Antimüllerian Hormone Levels Are Strongly Associated With Live-Birth Rates After Assisted Reproduction. J Clin Endocrinol Metab. March 2013, 98(3):1107–1114.

Carvajal R, Alba J, Cortínez A, Carvajal A, Miranda C, Romero C, Vantman D. Niveles de hormona antimüllerina y factor neurotrófico derivado del cerebro como predictores de función ovárica. Rev Hosp Clín Univ Chile 2012; 23: 159-67.

Celik H, Bıldırcın D, Güven D, Cetinkaya MB, Alper T, Batuoğlu S. Random anti-Müllerian hormone predicts ovarian response in women with high baseline follicle-stimulating hormone levels Anti-Müllerian hormone in poor responders in assisted reproductive treatment. J Assist Reprod Genet, 2012; 29:797–802.

E.B. Hook. Rates of chromosome abnormalities at different maternal ages. Obstet Gynecol, 58 (1981)

Guzman L, Ortega-Hrepich C, Polyzos NP, Anckaert E, Verheyen G, Coucke W, Devroey P, Tournaye H, Smitz J, De Vos M. A prediction model to select PCOS patients suitable for IVM treatment based on anti-Müllerian hormone and antral follicle count. Human Reproduction, 2013, 28 (5): 1261–1266.

Pellerito JS, McCarthy SM, Doyle MB, Glickman MG, DeCherney AH. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology 1992; 183:795-800.

Prof. Mary Wingfield (2017). The Fertility Handbook: Everything You Need to Know to Maximise Your Chance of Pregnancy, Gill & Macmillan Ltd, May 29, 2017

Ramalho de Carvalho B, Gomes Sobrinho DB, Vieira AD, Resende MP, Barbosa AC, Silva AA, Nakagava HM. Ovarian reserve assessment for infertility investigation. International Scholarly Research Network. ISRN Obstetrics and Gynecology. Volume 2012, Article ID 576385, 10 pages. doi:10.5402/2012/576385.

Romero Guadix B, Martínez Navarro L, Arribas Mir L. Esterilidad: manejo desde la consulta del médico de familia. AMF. 2002; 8 (6): 304-311.

Royal College of Obstetricians and Gynaecologists. Fertility: assessment and treatment for people with fertility problems. NICE Clinical Guideline. February 2013.

FAQs from users: 'Can abortion cause infertility in the future?', 'Could I have fertility problems because of my age?', 'Can I get pregnant without Fallopian tubes?', 'When is a woman said to be infertile?', 'Is pregnancy possible after oophorectomy?', 'Can Mirena cause infertility after removal?', 'Up to what age can you become a mother?', 'How do you know if a woman is infertile?', 'Does infertility cause divorce?', 'How can pregnancy with infertility/sterility be achieved?', 'Can an infertile woman get pregnant with homeopathy?' and 'Can an infertile woman have periods?'.

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Authors and contributors

 Gorka Barrenetxea Ziarrusta
Gorka Barrenetxea Ziarrusta
M.D., Ph.D.
Gynecologist
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
License: 484806591
 Luis Rodríguez Tabernero
Luis Rodríguez Tabernero
M.D., M.Sc., Ph.D.
Gynecologist
Degree in Medicine and Surgery from the University of Salamanca and Specialist in Obstetrics and Gynaecology via MIR. Dr. Rodríguez Tabernero is responsible for the Human Assisted Reproduction Unit of the Gyaecology and Obstetrics Department of the Hospital Clínico Universitario de Valladolid since 2013 and has also been working in the field of reproductive medicine since 2000. More information about Luis Rodríguez Tabernero
Licence number:474705276
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Rubén  Baltá I Arandes
Rubén Baltá I Arandes
M.D.
Gynecologist
Dr. Rubén Baltá has a degree in Medicine and Surgery from the Autonomous University of Barcelona and a postgraduate specialization in Esthetic and Functional Gynecology and Women's Cosmetic Genital Surgery from the University of Barcelona. More information about Rubén Baltá I Arandes
Medical licence: 070709574
 Zulyma  Blanco Maldonado
Zulyma Blanco Maldonado
M.D., M.Sc.
Fertility specialist
Dr. Zulyma Blanco has a degree in Medicine and a PhD from the Universidad Centro Occidental 'Lisandro Alvarado'. She also holds the title of Specialist in Infertility from the Central University of Venezuela and a Master's Degree in Infertility from the Complutense University of Madrid. More information about Zulyma Blanco Maldonado
License: 202871721
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
B.Sc., M.Sc.
Psychologist
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman
Member number: CV16874

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