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Infertility (the inability to conceive a child) is a reproductive problem that can cause a lot of distress.1,2,3 Many women around the world struggle with it.2 Research shows that one in six people experience infertility at some point in their lifetime.2
The uterus, fallopian tubes and ovaries form part of the female reproductive system. During a process called ovulation,5 an ovary releases an egg into one of the fallopian tubes every month, where it could potentially be fertilised by sperm.5
If the egg is fertilised, it will implant itself in the uterus and the woman will become pregnant.5 This is called conception.6 If the egg is not fertilised, the woman will have her monthly period.5
The journey of the egg being released by the ovary (ovulation) and becoming fertilised by sperm (conception) is illustrated below. The fertilised egg develops into a blastocyst, which, if it successfully implants in the uterus, is the beginning of a potentially successful pregnancy.6
Infertility in women can be caused by:
Did You Know? Tubal factor infertility (TFI), which is often caused by STDs, makes up more than 85% of female infertility cases in parts of sub-Saharan Africa, compared to only 33% of cases worldwide.9 HIV infection can also reduce fertility.11
Untreated STDs are a major health problem among South African women in rural communities.8,10
Factors that may increase the risk of infertility in women include:
If a woman of reproductive age has been unable to conceive a baby after one year of unprotected sex or after artificial insemination, she is considered to be suffering from infertility.1 Reproductive age is defined by the World Health Organisation as 15 to 49 years.15
Infertility and its underlying cause may be diagnosed through a variety of tests, including:16
Struggling with infertility can have a major psychological impact on a woman, causing feelings of:17
Did You Know? Women with a history of depression have a greater risk for infertility. This means that psychological support like counselling is an important part of the fertility journey, both before and during treatment.18
The type of treatment used will depend on the underlying cause of infertility and on the patient’s age.1 The ultimate goal of treatment is to establish a healthy pregnancy that results in a healthy delivery.1
Lifestyle habits that can improve fertility include:1
Common assisted fertility treatments (AFTs) include intrauterine insemination (IUI) and in vitro fertilisation (IVF).19
In cases where infertility is caused by problems with ovulation like PCOS, hormone therapy or medications to stimulate ovulation can be used to restore fertility.1 This can be followed with timed sexual intercourse or IUI.1
IVF is considered the best option for women with abnormal fallopian tubes and those with endometriosis-related infertility.1 Egg donation via IVF is also an option for women with age-related infertility and/or a low number of eggs available.1 Ovarian stimulation may also be used, although success often depends on the patient’s age.1
Unfortunately, the high cost of fertility treatments like IVF is a major barrier to those seeking treatment in developing countries.20 Infertility will continue to be a problem in countries with low resources if fertility treatments do not become more accessible.20
1. Drakeley A, Chong D. Infertility in women – Symptoms, diagnosis and treatment. BMJ Best Practice US. Last updated December 12, 2023. Accessed August 9, 2024. https://bestpractice.bmj.com/topics/en-us/498
2b. WHO. Infertility prevalence estimates, 1990–2021. 2023. Accessed July 26, 2024. https://iris.who.int/bitstream/handle/10665/366700/9789240068315-eng.pdf?sequence=1
6b. Blastocyst: definition, stage & implantation. Cleveland Clinic. Accessed August 13, 2024. https://my.clevelandclinic.org/health/body/22889-blastocyst.
