By Cristina Mestre Ferrer BSc, MSc (embryologist).
Last Update: 10/27/2014

Infertility affects 15% of couples and approximately in 33% of the cases it is due to female infertility.
There are many factors that could affect female fertility. We are going to explain the most common:

Hormonal origin

Hyperprolactinemia

It’s due to a rise in the blood lactogenic hormone levels. The usual levels for females are about 20 µg/l but in hyperprolactinemia the levels are over 30 µg/l.
These high blood levels of lactogenic hormone could produce disorders in ovulation and the menstrual cycle, and thus cause infertility.

Thyroid gland failure

It happens when the thyroid gland doesn’t produce enough thyroid hormone.

It can have an impact in female fertility, since it may prevent egg production. It also produces an abnormal menstrual cycle and an increase in the lactogenic hormone. High levels of lactogenic hormone prevent ovulation.

Female thyroid gland failure

Ovarian origin

Polycystic ovary syndrome (PCOS)

It is also known as Stein-Leventhal syndrome.
Women that suffer from this disorder have higher levels of androgenic hormone, which prevents the menstrual cycle from being stable. The eggs don’t mature and are not released into the ovary, causing cysts.

Anovulation

Women that have to endure this disorder fail to release mature eggs, which causes an absence of oocytes that can be fertilised.

Anovulation can be either circumstantial or chronic. Currently, there are treatments for this disorder, so that women that suffer from it can be fertile again.

Ovarian reserve compromised

The quantity and quality of oocytes that a woman has, is known as ovarian reserve. The older the woman is, the lower the ovarian reserve is and the worse the quality of the eggs is.

This is directly linked with the woman’s reproductive potential: a low ovarian reserve causes infertility.

Luteal dysfunction

It is also known as corpus luteal insufficiency. It may be caused by an ovarian factor or endocrine illness, such as thyroid dysfunction or hyperprolactinemia.

LH low levels produce low levels of luteal hormone. As a consequence, the endometrium does not have the right size to get pregnant.

Premature menopause or premature ovarian failure (POF)

An early menopause causes the loss of the ovarian function at the age of 40 or even during adolescence.
Ovulation ceases, the woman does no longer have the period and the ovary stops producing estrogenic hormone, which causes infertility.

Premmature menopause

Turner syndrome

It is also known as Ullrich-Turner syndrome or monosomy X. It is a genetic alteration in which women who suffer from it have the karyotype 45X.

Women have to endure this disease manifest an insufficient ovarian development. Most of them have connective tissue instead of ovaries, which means that they cannot produce neither the hormones nor the eggs, that are vital for pregnancy.

Tubal origin

Endometriosis

It is a chronic disease that consists in the apparition and growth of endometrial tissue outside the uterus, especially in the pelvic cavity and the ovaries, behind the uterus, at the uterine ligaments, in the bladder or the intestine. The growth can interfere with the ovarian function or block the Fallopian tubes.
40% of women that have to endure endometriosis have difficulties to get pregnant.

Pelvic inflammatory disease

It is an inflammation produced by an infection, that can be found in the upper part of female’s genitals (Fallopian tubes, ovaries, uterus) and that could also affect other regions such as the ligaments. In most cases it is due to the bacteria Chlamydia trachomatis and Neisseria gonorrhoeae.

Infections may produce scarring of the pelvic organs, and therefore cause infertility and risk of ectopic pregnancy.

Pelvic adhesions

It is scar tissue formed in the pelvic organs (ovaries, Fallopian tubes, uterus, bladder and intestine), causing them to adhere to each other and lose their functionality.

This may affect fertility when happening in the Fallopian tubes or ovaries.

Blocked Fallopian tubes

It could be produced either by salpingitis or hydrosalpinx, or by a previous surgery that has altered the anatomy of the Fallopian tubes. It can also have a congenital cause.

Fallopian tubes must be permeable in order for pregnancy to succeed, which means that women with this disorder will have fertility problems, which must be solved through a surgical intervention.

Blocked Fallopian tubes

Uterine origin

Uterine malformation

Some malformations in the uterus can cause infertility, if the embryo cannot adhere to the walls of the uterus. However, there are some alterations that don’t interfere with fertility.
Malformations that interfere with fertility are: Müllerian agenesis, unicornuate uterus, uterus didelphys, bicornuate uterus and septated uterus.

Cervical origin

Antisperm antibodies

Antisperm antibodies are the main cause of the fertility problems related with immunological sterility. They can be found in sperm, seminal plasma or cervical mucus.

The antibodies adhere to sperms affecting their motility and preventing them from getting to the egg.

Vaginal origin

Vaginismus

It is a sexual dysfunction that consists in the involuntary contraction of the perivaginal muscles, which makes it impossible for the penetration to take place or causes a lot of pain during penetration.

Authors and contributors

 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