Illnesses that cause female infertility

By BSc, MSc (embryologist), MD, MSc (gynecologist), (embryologist) and (invitra staff).
Last Update: 11/18/2019

Infertility is the failure to achieve pregnancy after one year or more of regular unprotected sexual intercourse. It affects 15% of couples.

Precisely, in approximately 33% of the cases the infertility cause is of female origin. Many different factors and diseases can cause fertility problems in women, such as alterations affecting the ovaries, fallopian tubes, or uterus.

The different sections of this article have been assembled into the following table of contents.

Hormonal factors

Hormonal factors are one of the causes of infertility in women, as they will cause hormonal imbalances that affect the menstrual cycle.

Hyperprolactinemia

This is a disorder characterized by an increase in the hormone prolactin in the blood, which is produced by the pituitary gland. Prolactin is responsible for the production of breast milk after childbirth and also has an effect on sex hormones.

The pituitary gland is located at the base of the brain and is responsible for the production of growth hormones. It also controls the functions of other glands in the body.

A very common cause of hyperprolactinemia is the appearance of tumor masses in the pituitary gland, known as prolactinoma.

Altering these blood prolactin levels can alter ovulation and the menstrual cycle, which can lead to female infertility.

If you would like more information about hyperprolactinemia, you can visit the link: What is hyperprolactinemia - Causes, symptoms and treatment.

Hypothyroidism

Hypothyroidism is a disorder due to a deficit in the production of thyroid hormones. These hormones interact with the female sex hormones (estrogens and progesterone) maintaining the functioning of the ovaries and the maturation of the eggs inside them.

In general, hypothyroidism can affect female fertility as it prevents the production of eggs, produces irregularities in the  menstrual cycle  and increases prolactin levels in the blood inhibiting ovulation.

When TSH (thyroid stimulating hormone) values of 5mU/l or higher appear in a blood test, it is indicative of hypothyroidism; whereas TSH values lower than 5 mU/l but higher than 2.5 mU/l are associated with failure of implantation and early pregnancy loss.

Ovarian factors

Refers to all disorders that cause alterations in the ovulatory cycle and as a consequence infertility in women.

Below, we are going to detail the different types.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is also called Stein-Leventhal Syndrome and consists of an imbalance of reproductive hormones, which causes problems in ovulation.

Women with PCOS produce more androgens than normal and the regulation of the menstrual cycle is not done correctly. In the ovary, the follicles do not release the eggs due to the lack of maturation of the same and cysts are produced.

For more detailed information on this syndrome, we encourage you to read on here: Polycystic ovary syndrome (PCOS): causes, symptoms, and treatment.

Premature ovarian failure

Premature ovarian failure (POF), also known as primary ovarian insufficiency (POI), is the loss of function of the ovary before the onset of menopause.

It usually appears in women under the age of 40 and premenopausal symptoms or amenorrhea (absence of one or more menstrual periods) begin to be felt.

When the function of the ovaries fails, the necessary amounts of estrogen are not produced and eggs won’t be released. This alteration will result in female infertility.

The most prominent general symptoms of premature ovarian insufficiency are:

  • Absent or alternating menstrual periods, i.e., amenorrhea.
  • Difficulty in carrying out a pregnancy.
  • Night sweats.
  • Vaginal dryness
  • Decreased libido.

Occult premature ovarian failure

Occult ovarian insufficiency is due to ovarian dysfunction and is characterized by regular menstrual cycles and elevated FSH hormone levels. The main cause is the accelerated aging of the ovary.

Unlike POI, in occult ovarian insufficiency there are no symptoms of menopause.

The only way to diagnose this disorder is through a blood test of female sex hormones.

Anovulation

Anovulation consists of an inability to release mature eggs from the ovaries in the woman, so there will be no encounter of the egg and sperm in the fallopian tubes for fertilization to take place.

There are two types of anovulation:

Circumstantial anovulation
also known as sporadic anovulation. It results from periods of stress, after the first menstruation, etc. In principle, in this case there is no need to worry, as menstrual cycles are usually restored.
Chronic anovulation
are women who have long periods of time without ovulation, so it is not possible to perform the union of the egg with the sperm.

Currently, there are treatments to correct this alteration and return fertility to the woman.

Diminished ovarian reserve

Ovarian reserve refers to the quantity and quality of oocytes available to a woman at any given time. There is an inverse relationship between age and ovarian reserve; that is, the older the egg, the lower the reserve and the quality of those eggs.

If the ovarian reserve is good, the chances of achieving a pregnancy are high. On the other hand, if the woman has a low ovarian reserve it will cause a fertility problem.

For this reason, the evaluation of the ovarian reserve by a specialist is essential to establish the reproductive prognosis of the couple. It is carried out by means of a blood test where the Antimüllerian Hormone (AMH) is determined.

If you would like more information, we recommend that you continue reading the article: What is ovarian reserve and how does it affect fertility?

Luteal dysfunction

The luteal phase is one of the phases of the female menstrual cycle that occurs between the day of ovulation, caused by an LH peak, and the last day before menstruation.

Luteal difunction is also known by the name of corpus luteum insufficiencyand it is exclusively ovarian dysfunction or caused by endocrine diseases such as thyroid disorders or hyperprolactinemia.

The symptoms of this alteration are:

  • Bleeding after ovulation
  • Low blood levels of progesterone.
  • Sensitive breasts.
  • Miscarriages.

It is related to female infertility, since the implantation of the embryo in the woman's uterus occurs between 6-10 days after ovulation. So, if there is a deficiency of the luteal phase, the endometrium is not properly prepared and does not have the correct thickness. The final consequence will be a delay in or failure of embryo implantation.

Turner syndrome

Turner syndrome is also known as Ullrich-Turner Syndrome or Monosomy X. It is a chromosomal alteration characterized by the partial or total absence of the X chromosome.

60% of affected people have a 45,X0 karyotype with the absence of an entire X chromosome. The remaining 40% are due to other genetic alterations in the chromosomes.

Women with this disorder present short stature, absence of menstruation, absence of secondary sexual characteristics, etc.. In addition, in 98% of cases, these women have early ovarian failure and absence of eggs, causing infertility problems.

If you want to know more about this topic, we recommend you read the following post: Turner Syndrome: Causes, Characteristics, and Pregnancy

Tubal factors

Tubal factors are responsible for problems in female fertility because the fallopian tubes are essential to the reproduction process.

Therefore, any injury or obstruction in the fallopian tubes will prevent them from performing their functions correctly causing female sterility.

Endometriosis

Endometriosis is a chronic gynecological disease that consists of the appearance and growth of endometrial tissue outside the uterus, especially in the pelvic cavity such as the ovaries, behind the uterus, in the uterine ligaments, in the urinary bladder or in the intestine. This tissue growth may alter the function of the ovary or block the fallopian tubes.

Endometriosis may lead to infertility in women. Specifically, about 40% of women with endometriosis have difficulties in getting pregnant. Some symptoms of this disorder are:

Metrorrhagia
premenstrual bleeding or bleeding between periods.
Dyspaurenia
pain during or after sex.
Hematuria
pain and bleeding when urinating.
Pelvic, abdominal, and lower back pain
associated with menstruation.

If you would like to learn more about the effect of endometriosis on a woman's fertility, read on here: How does endometriosis affect a woman's fertility?

Pelvic inflammatory disease (PID)

This disease is an inflammatory process caused by an infection in the uterus, ovaries, and other female reproductive organs. It causes scarring in these organs, leading to infertility, ectopic pregnancy, pelvic pain, etc.

In most cases, this disease is caused by the bacteria Chlamydia trachomatis and Neisseria gonorrhoeae.

Some of the risk factors are:

In the following link you can read more about this tubal alteration: Pelvic inflammatory disease (PID).

Pelvic adhesions

These are bands of scar tissue that form between the organs of the pelvis (ovaries, fallopian tubes, uterus, bladder, and bowel) and can cause them to attach to each other and lose their function.

Pelvic surgeries and the scars derived from them can also cause adhesions, affecting the functionality of the fallopian tubes.

The effect on fertility is because these adhesions cause the fallopian tubes and ovaries to stick to other nearby surfaces. As a result, the functions are prevented from performing correctly.

If an egg with a sperm is fertilized, pelvic adhesions also prevent the fertilized egg from reaching the uterus. This fact increases the possibility of ectopic pregnancy, that is, that the embryo is implanted outside the uterus.

Salpingitis

Salpingitis is an isolated inflammation due to an infection of the fallopian tubes.

The agents causing the infection are usually Chlamydia trachomatis, gonococcus or Mycoplasma hominis in 60% of cases, while the remaining 40% are due to bacteria that can be found in the vaginal flora.

Vaginal flora are microorganisms that live naturally and without causing damage to the intimate female area, i.e. in the vagina of women.

This disorder may be acute with the worst symptoms or chronic where it may go unnoticed.

Hydrosalpinx

Hydrosalpinx is an alteration resulting from an obstruction in the ends of the fallopian tubes, which causes an accumulation of fluid inside.

The problem with this disease is that the sperm cannot ascend and the egg will not be captured by the tube, so fertilization does not take place. This makes the possibility of a natural pregnancy difficult.

Uterine factors

The uterus is an essential organ for reproduction. For this reason, the uterine factor must be taken into account in female infertility, since any alteration of the uterus will have a consequence in the process of reproduction.

Uterine malformations

Uterine malformations are important for a woman's life because they are the origin of menstrual alterations, sterility and infertility due to abortion, premature birth, etc.

There are several uterine anomalies but not all of them cause infertility in women, only those that prevent the implantation of the embryo and its growth in the uterus.

The malformations that affect fertility are the following:

Müllerian Agenesis
complete missing of uterus.
Unicornuate uterus
smaller uterus with a single Müller duct.
Uterus didelphys
is known as a double uterus because it has two independent uterine cavities.
Bicornuate uterus
as a result of an incorrect fusion of the Mullerian ducts.
Septate uterus
as a result of a fault in the reabsorption of the septum that divides the Mullerian ducts

Mullerian ducts are embryonic structures that appear in both sexes. In women, they give rise to the fallopian tubes and the uterus-vaginal canal; while in men, they give rise to the testicular appendix and a small cleft located in the urethra called the prostatic utricle.

If you want to know more about uterine malformations, you can read on Uterine malformations in women: may they cause infertility?

Uterine synechiae

Uterine synechiae are adhesions that occur on the uterine walls. They're also called Asherman's Syndromeor intrauterine adhesions. The prevention and treatment of this pathology is essential for fertility.

The most severe form of synechia is amenorrhea or hypomenorrhea.

Among the most frequent causes is found:

  • Uterine scraping.
  • Bleeding after childbirth, either cesarean section or natural childbirth.
  • Removal of a fibroid.
  • Infectious endometritis.

Tumors

Various tumors can be found in the uterus, which are usually benign. Among the most important are:

Uterine fibroids
are masses of muscle tissue that are generated around the uterus. Occasionally they may appear on the cervix. Specifically, they occur in the smooth muscle tissue cells of the myometrium (the muscular layer of the uterus).
Adenomyosis
is because endometrial tissue, which lines the uterus, develops in the muscular wall of the uterus. This pathology is going to cause a thickening of the uterus.
Uterine polyps
is endometrial tissue that comes out of the uterine cavity. They're quite sensitive to estrogen.

Other factors

Despite all the factors mentioned, there are others that also cause diseases that cause female infertility. They are detailed below:

Anti-sperm antibodies

Antisperm antibodies (ASA) are the main cause of fertility problems related to immune sterility.

These antibodies can be found in the sperm itself, in seminal plasma, or even in cervical mucus.

An antibody (also called immunoglobulin) is a substance that is produced in the body and is intended to defend against foreign substances.

ASAs bind to sperm and affect their mobility. This prevents sperm from interacting with the egg, causing infertility.

Vaginism

Vaginism is a medical term for vaginal tightness, an involuntary contraction of the perivaginal muscles. It is a barrier to sexual intercourse because it prevents penetration or makes it very painful.

Psychological and gynecological treatment would be a solution to improve sexual life and try to achieve a natural pregnancy. Artificial insemination may also be used. However, there is no surgical or pharmacological treatment.

FAQs from users

What is the difference between premature ovarian failure and occult ovarian insufficiency?

By Laura García de Miguel MD, MSc (gynecologist).

Ovarian insufficiency or ovarian failure is the condition suffered by young women, under 42 years, with malfunction of the ovary due to low ovarian reserve.

All women lose proper ovarian function at some point in their lives, since the ovary is endowed with follicles (which inside have eggs) that are going to decrease throughout our lives, and are not going to regenerate again.

If exhaustion comes at 48 years, it is not a problem, and menopause occurs naturally.

However, in other women, there may be ovarian depletion at a young age. If it is accompanied by alterations in the pattern of the menstruational cycles, an early ovarian failure will occur. If, on the other hand, there are no alterations in the menstrual pattern, it will be called occult ovarian failure.

Do all uterine diseases cause infertility in women?

By Marta Barranquero Gómez (embryologist).

No. The uterine diseases that cause infertility are mullerian agenesis, unicornuate uterus, bicornuate uterus, uterus didelphys or septate uterus.

What are the differences in prolactin values in case of hyperprolactemia?

By Marta Barranquero Gómez (embryologist).

The normal rate of prolactin in women is around 20 µg/l and in cases of hyperprolactinemia the rate exceeds 30 µg/l. This increase causes an inhibition of the function of GnRh, also known as Gonadotropin-releasing hormone , thus blocking the production of LH and FSH.

Does the thyroid influence a woman's reproduction ability?

By Marta Barranquero Gómez (embryologist).

Yes, of course. Thyroid function and TSH are very important for the early stages of pregnancy.

When TSH levels are lower than 5 mU/l but higher than 2.5 mU /l, it is usually associated with embryo implantation failure.

Suggested for you

We have talked about hypothyroidism as a disease that causes infertility in women. If you want more information we recommend that you access the article Hypothyroidism and pregnancy.

On the other hand, if you want to know more about hydrosalpinx, you can access the following link: What is hydrosalpinx - Causes, symptoms and treatment.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

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Brosens C, Terrasa S y Astolfi E. Vaginismo. Evid Act Pract Ambul. 2009; 12(3): 102-103

Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr Rev. 2019 Apr 17. pii: er.2018-00242. doi: 10.1210/er.2018-00242.

Dreisler E, Kjer JJ. Asherman's syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019 Mar 20;11:191-198. doi: 10.2147/IJWH.S165474.

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Harb HM, Ghosh J, Al-Rshoud F, Karunakaran B, Gallos ID, Coomarasamy A. Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis.Reprod Biomed Online. 2019 Mar;38(3):427-441. doi: 10.1016/j.rbmo.2018.12.020. Epub 2018 Dec 25

Kovanci E, Schutt AK. Premature ovarian failure: clinical presentation and treatment. Obstet Gynecol Clin North Am. 2015;42:153-61

Laven JS. Primary Ovarian Insufficiency. Semin Reprod Med. 2016 Jul;34(4):230-4.

López, V, Flores, E, Romeu, A. Estudio de la insuficiencia ovárica primaria (IOP) e insuficiencia ovárica oculta.

Rosas, MR. Infertilidad femenina. Un problema multifactorial. Elsevier. 2008 Septiembre; 27(8):11-133

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FAQs from users: 'What is the difference between premature ovarian failure and occult ovarian insufficiency?', 'Do all uterine diseases cause infertility in women?', 'What are the differences in prolactin values in case of hyperprolactemia?' and 'Does the thyroid influence a woman's reproduction ability?'.

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Authors and contributors

 Cristina Mestre Ferrer
Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information about Cristina Mestre Ferrer
 Laura García de Miguel
Laura García de Miguel
MD, MSc
Gynecologist
Bachelor of Medicine and Surgery from the Autonomous University of Barcelona, with specialization in Obstetrics & Gynecology at Sant Joan de Déu University Hospital. Master's Degree in Human Reproduction from the Complutense University of Madrid. Currently, she is the Medical Director of Clínica Tambre in Madrid, Spain. More information about Laura García de Miguel
License: 280843059
 Marta Barranquero Gómez
Marta Barranquero Gómez
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
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English edition of inviTRA. More information about Romina Packan

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