Female infertility: definition, causes, signs and treatment

Female infertility refers to a woman being unable to conceive due to problems related to egg production that make fertilization not possible. In other words, pregnancy cannot be achieved. It can appear due to a wide range of causes, each one associated to more or less noticeable symptoms. For this reason, there may appear some situations in which the woman is not aware that she is infertile until she undergoes a fertility evaluation.

There exist two main female infertility types:

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.

The various sections of this article are assembled in the following table of contents.

Definition of female ‘sterility’ and ‘infertility’

Although the terms sterility and infertility are commonly used as synonyms, both by the 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.

What can cause infertility in females?

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.

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.

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 raise 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 infertility

When entering the female reproductive system, the cervix is the first part the sperm have to go through in their journey toward the egg. There, they might find obstacles such as polyps or uterine myomas that make it difficult for fertilization to occur. Also, the cervical mucus can also help them “swim” inside the uterus, thereby creating a comfortable environment for them to move through.

Inflammations, infections, or changes in the pH can lead to female sterility, as they make it more difficult for the sperms to reach the Fallopian tubes.

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 takes 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 the woman’s fertility.

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

Other causes of infertility in females

There exist other factors that can affect fertility in both males and females, such as:

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 antisperm antibodies, either created by the female or the male, as well as the Antiphospholipid Syndrome (APS), which generates in the woman’s organism an 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 relax 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.

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 factor, 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.

Methods of female infertility treatment

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:

Fertility drugs

Women who are infertile due to ovulation disorders could resort to fertility drugs to regulate or stimulate ovulation and become fertile again. They work like the natural hormones FSH and LH, which trigger ovulation naturally. The list of the most common fertility boosters includes:

Clomiphene citrate
Known as Clomid, it causes the pituitary gland to produce higher amounts of FSH and LH, thereby stimulating the growth of the ovarian follicles that contain eggs.
Metformin
It is used when insulin resistance is the cause of female infertility, for example, in the case of women with PCOS (Polycystic Ovary Syndrome). It can improve the chances of ovulating.
Gonadotropins
They are administrated via subcutaneous injections. They work by stimulating the ovary directly, so that multiple eggs are produced. Examples include Menopur, Gonal-F, Bravelle, Follistim AQ, Ovidrel…
Letrozole
It belongs to a group of drugs called aromatase inhibitors. It is similar to clomiphene, that is, it is used to induce ovulation. It is less frequent, though.
Bromocriptine
This medicine is used when an excess of prolactin (hyperprolactinemia) is the cause of infertility.

The disadvantage of fertility medications is that they carry a number of risks, including but not limited to, increased likelihood of getting pregnant with multiples, Ovarian Hyperstimulation Syndrome (OHSS), and long-term risk of ovarian tumors.

Surgical procedures

Surgery is the method of choice in cases where it is possible for a woman’s fertility to be restored or improved. Surgical treatments include:

Laparoscopy
Laparoscopic surgery can be used in cases of endometrial polyps, fibroids, abnormal uterine shape, pelvic or uterine adhesions, etc.
Tubal surgeries
It can correct problems such as Fallopian tube blockage, or hydrosalpinx (a tube that is filled with fluid). Removing adhesions, creating a new tubal opening, dilating a tube, removing the tubes (salpingectomy), or blocking the tubes close to the uterus are tubal surgeries that might improve a woman’s chances of conceiving with IVF.

Infertility treatments

Intrauterine Insemination (IUI), the most common type of artificial insemination used nowadays, and in vitro fertilization (IVF) are the most commonly used assisted reproduction techniques 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 place inside the uterus, its chances of success are lower and requires 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.

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 lead 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.

FAQs from users

Can abortion cause infertility in the future?

There is no evidence that surgical or medical abortion can cause infertility in females. As long as it is done in a safe setting by a qualified practitioner, abortion should not change a woman’s ability to get pregnant again in the future. However, undergoing multiple procedures might have a lasting effect on the reproductive organs.

Can I get pregnant without Fallopian tubes?

Yes, a woman with no Fallopian tubes can get pregnant by way of IVF (in vitro fertilization). Having no tubes does not translate into not ovulating (i.e. not releasing eggs) unless there is another problem affecting it.

For IVF, her oocytes are collected directly from the ovary through a procedure called ovum pick-up of follicle puncture, and then fertilized at the lab. The resulting embryo or embryos are transferred back to her uterus, so that pregnancy takes place.

Can Mirena cause infertility after removal?

In principle, there is no association between Mirena being removed and female infertility. Many women have reported becoming pregnant almost immediately after the removal of Mirena.

In fact, the recovery rate for fertility levels seems to be higher than with other contraceptives such as Depo-Provera. On the other hand, it is true that it might increase the chances of miscarriage. To sum up, the answer is no, it does not cause infertility, but the chances for complications to appear are higher.

Can stress cause female infertility?

Yes. As a matter of fact, in todays modern, fast-paced society, it is a common cause leading to female and male infertility. In the case of women, the presence of a adrenalin can signal to the body that it is not the right time for conception, thereby preventing pregnancy.

Adrenalin also causes the pituitary gland to produce prolactin. This can cause infertility by inhibiting the releasing of GnRH, a hormone responsible for the production of sex hormones, may suppress ovulation.

Does infertility cause divorce?

There is no direct relationship between infertility and divorce or relationship problems. When a couple realizes one of them is infertile, or even both, it is not uncommon to overreact. It is a normal reaction that normally disappears over time. Many women struggling with fertility issues become obsessed with getting pregnant, and start exhibiting symptoms of depression and anxiety as a consequence.

Men, when their partner or wife reacts like this, might worry that the woman they married will never reappear. Seeking expert counsel is strongly advised to cope with these feelings. Having empathy for each other is a key step toward facing this situation positively. Couples should start by accepting how their partner is feeling, and try to be there for him/her.

Can Chlamydia cause infertility forever?

If untreated, Chlamydia can affect a woman’s fertility in many ways. If the infection spreads from the vaginal canal into the uterus, it can cause pelvic inflammatory disease (PID) and the endometrium to swell and scar. In most severe situations, this scar tissue can prevent implantation or cause an ectopic pregnancy.

Can HPV cause infertility in females?

The human papillomavirus (HPV) alone should not have a huge impact on fertility. Although some studies have found that IVF patients who screened positive for HPV were less likely to have a baby, the reasons behind this affirmation are still unclear.

Some investigations have found that it is because an embryo might find it harder to implant in a woman whose immune system is unable to clear the virus. However, the vast majority are able to get pregnant without problems.

Can an infertile woman get pregnant with homeopathy?

There is no scientific evidence that homeopathy, natural remedies, or Ayurveda can cure female and male infertility.

Can an infertile woman have periods?

Yes, it really depends on the cause of infertility. For example, in cases of tubal factor infertility, the tubes might be blocked or absent, but the woman still ovulates, and that is why techniques such as IVF are feasible. On the other hand, there is also the opposite case, that is, the woman has regular menstrual periods, but is unable to get pregnant.

Suggested for you

This post is a summary of the whole set of causes behind female infertility. If you want to learn the details of each one of the different types of sterility explained above, visit any of the following sections:

Also, you can get a general overview of how both male and female fertility work by visiting this article: Male fertility versus female fertility.

If you have already visited a fertility specialist, undergone the appropriate infertility testing and know what is the cause behind infertility, we recommend you to visit the following post: Guide to infertility treatment options.

8 comments

  1. usuario
    mary sullivan

    Hello there,

    Hope everyone is well on here.

    12 years ago I received chemotherapy and 6 months later my periods stopped… so i was diagnosed with POF. Still havent got my periods back…. We considered IVF but it was rejected… so we find ourselves totally devastated to know that pregnancy is only possible with egg donation or even gestational surrogacy… any ideas?

  2. usuario
    Prachi

    Hello,

    Me n my husband are 35 yrs old and we are planning for a baby. I did check ovulation tests from 8th day to 15th day of my periods. But tests are coming negative. Does it mean I am not ovulating?

    • avatar
      Sandra F.Fertility counselor

      Dear Prachi,

      If it happened just this month, it might be due to a temporary hormonal imbalance, so in principle it’s not a concerning issue. On the other hand, there’s also the possibility that you have ovulated, but the level of the hormone responsible for ovulation was not enough as to be detected through an ovulation test. My advice is that you monitor your menstrual cycles, especially your ovulations, and if this continues to happen and you detect anovulation or any other kind of irregularity, visit your gynecologist.

      I hope this helps,

      Best

      • usuario
        Prachi

        Hello,

        Thank u for replying,

        I did this test this month only. I will surely monitor it next month too. But are these tests 100% accurate?

        • avatar
          Sandra F.Fertility counselor

          Hello again Prachi,

          You are welcome. Ovulation tests are 99% accurate in detecting the LH surge that precedes ovulation – they work similarly to home pregnancy tests.

          Best of luck!

          • usuario
            Prachi

            Thank u so much for replying

          • avatar
            Sandra F.Fertility counselor

            You’re welcome!

            Should you have any further questions, do not hesitate to ask.

            Best wishes

  3. usuario
    Samia hak

    Hello,
    Im married since 11 months.
    My hormones are great. I am thin, im also very healthy, i exercise daily. But im really stressed because im not pregnant yet.
    They diagnosed me with PCO since my cycles are not regular.
    What shall we do?

    • avatar
      Sandra F.Fertility counselor

      Hello Sami,

      My recommendation is that you visit the following website: polycysticovarysyndrome.info There you will find information about polycystic ovaries (PCO) and PCOS, including information about how to achieve pregnancy in spite of it.

      I hope that helps,

      Regards

  4. avatar
    Sofiawest

    HI, ladies!

    My name is Sofia and I am a 31-year-old woman living in Australia. have been working on pregnancy from last few years. 3 years ago I met with my soulmate and married him. I truly believe that it was one of the great days of my life.

    Now I am trying to conceive and trying to make my family with him. I want to make him one of the happiest person on the earth. It’s really hard to notice that someone is working really hard for me but I am not able to give him a child.

    Infertinity really sucks! It really annoying and fustrating. I want to get out of it and want to get a baby. I hope this helps.