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Aug 20, 2022


Infertility in women is defined as trying to get pregnant with frequent, unprotected sex for at least a year without success. Nearly 1 in 7 couples are infertile. One-third of infertility is a result of female factors while another third is a result of male factors. In a third of the cases, the cause is either unknown or a combination of both male and female factors. For pregnancy to occur naturally, a healthy sperm from a male ejaculate must meet a healthy egg and deliver healthy genetic material. Any breakdown in the process leads to infertility and inability to get pregnant. 

The Process of Female Fertility

The female reproductive system is made up of external and internal structures. The external reproductive structures, also known as the genitals, allow sperm to enter the body, and also protect the internal genitals from infections and injury. The external structures include the labia majora (encloses and protects the rest of the external reproductive organs), labia minora (surrounds the opening of the vagina and urethra), Bartholin’s glands (located next to the vaginal opening and produces mucus), and clitoris (a sensitive part covered by a fold of skin and also where the two labia minora meet).


The internal reproductive organs include the vagina (canal that joins the cervix to the outside of the body), the uterus or womb (where a developing baby resides), ovaries (small, oval-shaped glands that produce eggs and hormones), and fallopian tubes (pathway for the egg to travel from the ovaries to the uterus).


The monthly hormonal cycle known as the menstrual period starts for most females around 11 to 16 years of age. With each cycle, a woman’s body prepares for pregnancy, and if fertilization does not occur, the uterine lining sheds and a woman has a period. An average period lasts 28 days and is made of three phases – follicular phase (development of egg), ovulatory period (release of egg), and luteal phase (hormone level decrease if egg is not implanted). A woman’s menstrual cycle also involves four major hormones – follicle stimulating hormone, luteinizing hormone, estrogen, and progesterone). These hormones have a different role in each stage of the menstrual period as well as in the reproductive cycle.

For a baby to be conceived and for pregnancy to occur, the following must happen:

  1. One of the two ovaries releases an egg
  2. The fallopian tube picks up the egg
  3. Sperm swims up the cervix into the fallopian tube to reach the egg
  4. The egg is fertilized and travels down the fallopian tube to the uterus
  5. The fertilized egg (embryo) attaches to the inside of the uterus
  6. The egg starts to grow

This is considered pregnancy. If the released egg is not fertilized, it passes through the uterus and the lining of the uterus breaks down and sheds, causing the onset of a new menstrual cycle.

Causes of Female Infertility

Several factors contribute to female infertility, including ovulation disorders, endometriosis, damage to the fallopian tubes, uterine problems, and cervical problems, though in some cases, there are unexplained reasons why it happens.

Ovarian disorders – several ovarian disorders can contribute to infertility in women, including too much prolactin (causes hormonal imbalance), primary ovarian insufficiency (premature loss of eggs from the ovary or failure of the ovary), polycystic ovary syndrome (PCOS – causes hormone imbalance that can affect ovulation), and hypothalamic dysfunction (causes hormonal imbalance). Of these four causes, PCOS is the most common reason for infertility in women. Symptoms of PCOS include abnormal hair growth, insulin resistance, and obesity.


Endometriosis – when the tissue that typically grows in the ovary grows abnormally in other places, it is usually surgically removed. This surgery can cause scarring that can block the fallopian tube and prevent the sperm from reaching the egg, thus leading to infertility.


Uterine and Cervical disorders – these can be a result of problems from birth such as an abnormally shaped uterus or narrowed cervix (cervical stenosis). It can also be from the cervix not producing enough mucus to facilitate the motility of sperm through the cervix. Other uterine and cervical causes include fibroids, which can block the fallopian tubes or disrupt implantation.

Symptoms of Female Infertility

One of the first signs of female infertility is the inability to get pregnant. Other signs and symptoms indicate that a woman may not be ovulating and is not able to get pregnant naturally include:

  • Long periods (35 days or more)
  • Short periods (less than 21 days)
  • Irregular periods
  • Absent periods

Complications of Female Infertility

Dealing with infertility of any kind, for both men and women, can be challenging. Most couples who are unable to have a child can find their relationship tested in so many ways, and this can put a lot of stress on the relationship and overall quality of life. For women who choose to get help, reproductive techniques can be expensive, emotionally draining, and time-consuming. Fertility treatment also has unpleasant side effects including bloating, headache, mood swings, upset stomach and the risk of a multiple pregnancy.

Diagnosis of Female Infertility

Infertility is often caused by so many factors, making it crucial that both the male and female trying for a baby without success see the doctor to determine the right diagnosis and best treatment. Diagnosing female infertility starts with completing a physical exam and getting an accurate medical history. Fertility tests include:  

  • Imaging tests – pelvic ultrasound to detect uterine or fallopian tube disease
  • Hormone tests – check ovulatory, thyroid, and pituitary hormones
  • Ovulation tests – using over-the-counter products or laboratory blood tests to check for successful ovulation
  • Hysterosalpingography – to check for any problems with the uterus
  • Ovarian reserve tests – to determine the quantity and quality of the eggs
  • Genetic tests – to determine any gene involvement in infertility
  • Laparoscopy – to check for any problems with the fallopian tubes, ovaries, and uterus

Treatment for Female Infertility

Fertility treatment depends on age, the cause of infertility, length of infertility, and personal preference. Due to advancements in medicine and science, fertility treatment can be non-invasive with the use of fertility drugs or more complex with surgery. Since infertility is a complex disorder, treatment will require some significant commitment of time and resources. Infertility also has a psychological component that should be addressed as part of a fertility treatment protocol. The mainstay for treating most female infertility problems is fertility drugs; however, women can still get pregnant using advanced medical techniques.


Some treatment options for infertility in women include:

Medications – fertility drugs stimulate and regulate ovulation for women who do not ovulate or have regular ovulation. Fertility drugs also try to stimulate the production of better-quality eggs or extra eggs. Common fertility drugs include Clomiphene citrate, metformin, gonadotropins, and letrozole.

Assisted Reproductive Technology (ART) – Most women opt for assistance with reproduction either through intrauterine insemination (IUI), where millions of sperm are placed in the uterine during ovulation, or through in vitro fertilization (IVF), where mature eggs are harvested and fertilized outside the body in a laboratory and one or more fertilized eggs (embryos) are then transferred directly into the uterus after fertilization. Pregnancy occurs if any of the embryo implant in the lining of the uterus. IVF is the most common ART used in fertility clinics. It can be pricey and typically takes several months to complete. IVF has many steps and is a combination of fertility medications to induce ovulation, several blood tests, ultrasounds, and a minor surgical procedure typically done at a fertility clinic or doctor’s office. Some women may get pregnant with just one round of IVF while others might need more than one round to successfully conceive a baby.


Surgery – this is usually reserved for cases where medication will not be effective. Surgery could involve removing polyps, fibroids, and adhesions to the pelvis and uterus. Surgery could also be used to correct uterine abnormalities and fix any fallopian tube problems where applicable.


Other options for pregnancy (using different ART methods) include:

  • using donor eggs and sperm when the couple’s egg or sperm has a known problem
  • gestational carrier, where the fertilized eggs are placed in the uterus of a female carrier for the duration of the pregnancy
  • assisted hatching where the outer covering of the embryo is opened to facilitate better implantation into the uterus
  • sperm injection, where the sperm is directly injected into the mature egg

Complications of Fertility Treatment

Fertility treatment carries some risks, including:

  • rare but possible bleeding and infection from invasive procedures, especially from ART
  • pregnancy with multiple babies which can lead to premature labor and delivery
  • overstimulating the ovary (also known as ovarian hyperstimulation syndrome) which can lead to abdominal symptoms including nausea, bloating, and pain
  • increased risk of ovarian tumors, especially with long-term use of fertility drugs


Who is at Risk for Female Infertility?

Although any female could face infertility, some are more at risk. Certain circumstances can increase the risk of infertility in women, including:

  • Smoking – smoking damages the fallopian tubes and cervix. It also ages the ovaries and prematurely depletes the body of eggs. Smoking increases the risk of ectopic pregnancy and miscarriage as well.
  • Weight – weight plays a role in pregnancy. Being underweight or overweight can reduce ovulation and decrease the chances of getting pregnant.
  • Alcohol – excessive alcohol consumption can decrease fertility
  • Age – the older the age, the higher the risk of infertility. The quality and quantity of eggs declines with age, making conception a lot more challenging while increasing the risk of miscarriage
  • Sexual history – having multiple partners can increase the risk of sexually transmitted infections which can lead to decreased fertility

Preventing Female Infertility

Although some fertility problems cannot be preventable, there are some behaviors that can reduce the risk of infertility and increase the chances of getting pregnant.

  • Reduce stress – stress can affect fertility negatively
  • Alcohol use – alcohol use can lead to infertility. Alcohol may also cause birth defects in the fetus, sometimes before you even know you are pregnant
  • Tobacco – smoking affects fertility and your general health
  • Weight – being underweight or overweight can affect ovulation

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