Female Infertility

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MYTH: Fertility problems are more likely to affect women than men.
TRUTH: Men and women are equally likely to experience infertility. Around 1/3 of cases are caused by problems with the man, 1/3 by the woman, and 1/3 by both partners.

 

If you’re having trouble conceiving, it’s natural to wonder what’s causing your difficulties.
Learn what can influence your fertility and whether to consider seeking medical help to get pregnant.

IS IT MY FAULT?

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It’s very common to find it difficult to get pregnant. In fact, 9% of the global population will also have problems conceiving.2
There are many factors that could be causing your infertility and so you shouldn’t focus on whose ‘fault’ it is.

 

 

Around 1/3 of infertility cases are caused by fertility problems in women1
1/3 of infertility cases are due to fertility problems in men1
1/3 of infertility cases are caused by a mixture of male and female problems, or by problems that cannot be determined1
Infertility isn’t necessarily a permanent condition and it doesn’t mean that you’ll never have a child. You may just need a little specialist help to get there.

WHAT ARE THE CAUSES OF FEMALE INFERTILITY?

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Once you and your partner have undergone fertility tests, your doctor will diagnose what’s causing your fertility problems.
Unfortunately, sometimes there is no clear factor and you may be diagnosed with unexplained infertility. In this case, your doctor may recommend undergoing more advanced fertility treatment – ART treatment.
Female age
As you get older, your fertility begins to decline
A healthy 30-year-old woman has around a 20% chance of conceiving each month3
However, a 40-year-old woman has less than a 5% chance of conceiving each month3
It becomes more likely that you’ll need to undergo ART treatment in order to conceive
Ovulation problems
These account for around 25% of fertility difficulties4
Each month, your ovaries must release a healthy egg (ovulation) in order to conceive
If you have irregular or absent periods, are overweight or underweight, you may not be ovulating
Ovulation problems can usually be treated with medication4
Blocked fallopian tubes5
Tubal disease accounts for between 25% and 35% of female infertility6
Your fallopian tubes are very delicate and can easily become blocked or damaged
Blockages can be caused by scarring from a previous infection or previous abdominal surgery
This can prevent sperm from reaching your egg, and interfere with an embryo’s development and its implantation into your uterus lining
Blocked fallopian tubes may be treated with surgery, or you may need to undergo in vitro fertilisation (IVF)

 

Endometriosis
Around 30–50% of women with endometriosis are infertile7
Endometriosis occurs when tissue that usually lines the inside of your uterus grows on your ovaries, fallopian tubes, or on the outside surface of your uterus1
This can cause heavy and painful periods, scarring, and adhesions (organs sticking together)5
A small keyhole surgery (laparoscopy) will determine whether you have endometriosis
It can usually be treated by medication and surgery, and you may have to undergo an ART treatment
Fibroids (myomas or leiomyomas)8
Around 5–10% of fertility problems are caused by fibroids (myomas or leiomyomas)
These are non-cancerous growths made up of muscle and tissue that develop in or around your uterus
They can change the shape of your uterus or fallopian tubes, or cause blockages
This can make it difficult for sperm to reach your egg or an embryo to implant into your uterus lining
The exact cause of fibroids is unknown, and whether they cause symptoms depends on their location, size and number
Fibroids may be treated with medication or surgery
Polycystic ovary syndrome (PCOS)
Between 70−80% of women with PCOS may be infertile9
PCOS causes your ovaries to become enlarged and many small cysts to grow on your ovaries’ thickened surface4
This can cause irregular periods which, in turn, affect your fertility4
PCOS is usually diagnosed via an ultrasound scan
It can be treated with medication or surgery, and you may have to undergo an ART treatment
Cervical problems
Between 3% and 8% of female infertility cases can attributed to abnormalities of the cervix10
Cervical mucus helps sperm to move through your vagina to reach your egg11
Some women may not have enough mucus, it may be too thick and sticky or contain antibodies that are hostile to sperm11
Problems with cervical mucus may be treated with medication, by placing sperm directly into your uterus, or with an ART treatment that brings together your egg and sperm outside of your body
Sexually transmitted infections (STIs)
Sexually transmitted infections (STIs) such as chlamydia or gonorrhoea can cause pelvic inflammatory disease (PID)5
PID can cause blockages in your fallopian tubes, and increase the risk of having an ectopic pregnancy8,12
An ectopic pregnancy occurs when an embryo implants outside of the uterus12
Blockages in your fallopian tubes can potentially be treated with surgery, or you may need to undergo an ART treatment
Early menopause3
The menopause is a natural process that women go through in which their periods stop and they are no longer fertile
Some women undergo an early menopause and their periods stop before they are 40 years old
If you have undergone an early menopause, you’ll need to undergo an assisted reproductive technologies (ART) treatment in order to conceive, or use donor eggs (note that availability may vary between countries as egg donation is not offered in all regions).

IS THE CONTRACEPTIVE PILL WHY I’M INFERTILE?

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MYTH: Taking contraceptive pills for several years increases chances of infertility.
TRUTH: Studies have not shown a link between infertility and using the pill for a long period of time.
Like many women, you may have used the contraceptive pill for several years to carefully avoid an unwanted pregnancy. When you’re ready to conceive, it’s understandable to feel cheated if you don’t get pregnant immediately.
However, studies haven’t shown a link between infertility and using the pill for an extended period of time.13
So while the unknown is frustrating, you shouldn’t worry that you should have stopped using contraception earlier.
For more on Contraception

SEEKING HELP

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Discovering that you may be infertile can be hugely distressing. Feeling overwhelmed about your future is completely normal and you may need extra support from those close to you.

 

You should speak to a doctor about your fertility if:

  • You know that you have any of the conditions listed above
  • You are under 35 years old and have been trying to conceive for 1 year3
  • You are over 35 years old and have been trying for 6 months3

FERTILITY TESTS FOR WOMEN

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What fertility tests will be performed initially?
If you visit your family doctor first, they may conduct some simple and less invasive fertility tests. These may include:

  • General physical examination
  • Weight check
  • Pelvic and genital examination
  • Breast exam
  • Routine cervical screening (smear) test
  • Blood tests

Afterwards, you and/or your partner may be referred to a fertility specialist if there is a need for further or more invasive tests.
What are fertility doctors testing for at the clinic?
Your fertility doctor will check that you and/or your partner have:

  • The right balance of hormones to help eggs to mature
  • Regular ovulation
  • A healthy, functioning uterus and intact fallopian tubes
  • A thick uterus lining that could nourish an embryo
  • Who performs the fertility tests at the clinic?

Your fertility team is made up of a range of doctors and fertility nurses, along with specialists such as reproductive endocrinologists and embryologists, who oversee more complex treatments such as in vitro fertilisation (IVF).
Ask your doctor or fertility team in the clinic about their different roles and how they will be supporting you.

COMMON INVESTIGATIONS AND FERTILITY TESTS FOR WOMEN

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Preliminary tests1,2
Personal history — You will be asked about your medical history and sex life in detail. If you feel uncomfortable discussing anything in front of your partner, ask to speak with your doctor in private
Physical exam — You may have a pelvic examination to check the shape and size of your uterus. Your breasts may also be examined physically, and your weight and body mass index (BMI) measured
Cervical screening (smear) test — You may be asked about your most recent cervical screening test or a new test may be performed. This helps to rule out any infection or abnormal cells on your cervix
Screening blood and urine tests — You will have some routine and some investigational blood and urine tests. Please ask your fertility clinic about the tests that will be done
General health tests — You may be tested for rubella (German measles), chlamydia, hepatitis B and C, and human immunodeficiency virus (HIV). Depending on your heritage, you may also be tested for diseases or disorders that are more common amongst certain ethnic groups, such as sickle cell anaemia or thalassaemia
Regular monitoring
Hormone blood and urine tests — These tests will be taken on specific days of your menstrual cycle to measure different hormone levels.2 These will help to determine if you are ovulating,2,3 as well as the quality and quantity of the eggs produced (your ovarian reserve).4 This can help predict the ovary’s response to IVF treatments
Temperature — Your temperature may also be taken throughout the menstrual cycle to identify when you are ovulating3

MORE ADVANCED FERTILITY TESTS

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Antral follicle count (AFC) — This test uses an internal ultrasound scan to show the number and size of follicles present in the ovaries2
Hysterosalpingogram (HSG) — This test applies a coloured dye inside the uterus to check the shape and size of uterus and fallopian tubes. It will also show the doctor if there are any tubal blockages or cysts5
Laparoscopy — This test involves insertion of a small surgical telescope into the abdomen, under general anaesthetic.5 This can check for any blockages, growths or signs of endometriosis around the uterus and fallopian tubes5


References relating to Female Infertility 1. US Department of Health & Human Services. Female Infertility. Available at: https://www.hhs.gov/opa/reproductive-health/female-infertility/index.html. Accessed: January 2018. 2. Boivin J, et al. New Debate: International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007;22(6):1506–1512. 3. American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018. 4. American Society for Reproductive Medicine (ASRM). Medications for inducing ovulation. A guide for patients. 2016. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_medications_for_inducing_ovulation.pdf. 2014. Accessed: February 2018. 5. Khalaf Y. BMJ 2003;327(7415):610–613. 6. American Society for Reproductive Medicine (ASRM). Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. 2015. Available at: http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/role_of_tubal_surgery_in_the_era_of_assisted_reproductive_technology-noprint.pdf. Accessed: March 2018. 7. American Society for Reproductive Medicine (ASRM). Endometriosis and infertility: A committee opinion. 2012. http://www.fertstert.org/article/S0015-0282(12)00585-7/pdf. Accessed March 2018. 8. American Society for Reproductive Medicine (ASRM). Fibroids and fertility. Fact sheet. 2015. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/fibroids_and_fertility_factsheet.pdf. Accessed: February 2018. 9. Melo A, et al. Clinics (Sao Paulo) 2015;70:765–769. 10. Martyn F, et al. Human Reproduction 2014;29:2092–2098. 11. Maher M, et al. BJOG 2017;doi:10.1111/1471-0528.15003 [Epub ahead of print]. 12. Sivalingam V, et al. J Fam Plann Reprod Health Care 2011;37(4):231–240. 13. Farrow A, et al. Hum Reprod 2002;17(10):2754–2761. References relating to Fertility Tests 1. National Health Service. Infertility, Diagnosis. 2017. Available at: https://www.nhs.uk/conditions/infertility/diagnosis/#questions-your-doctor-may-ask. Accessed: January 2018. 2. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment: CG156. 2016. Available at: https://www.nice.org.uk/guidance/cg156. Accessed: September 2016. 3. Manders M, et al. Cochrane Database Syst Rev 2015;(3):CD011345. 4. Gruijters M, et al. Mol Cell Endocrinol. 2003;211:85–90. 5. Khalaf Y. BMJ 2003;327(7415):610–613.

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