If you are having trouble getting pregnant, you are not alone. Infertility is fairly common. It affects millions of people worldwide. In the US, about 12% of women of reproductive age experience some difficulties getting pregnant or carrying a pregnancy to term, regardless of their marital status. (1)
In general, infertility is defined as failing to achieve a pregnancy after one year or longer of regular unprotected sex.

In women, many conditions can disrupt the ability to get pregnant. This article will review 6 common causes of infertility in women.

1- Advanced Maternal Age

Advanced maternal age is used to describe a woman of 35 years or older. Advanced maternal age greatly affects fertility. As women age, the quality and quantity of their eggs decline as well as their ability to conceive.

Women are born with a fixed number of eggs in their ovaries (about 1 million). This number gradually decreases until the age of 35, when they decline at a more rapid pace. The egg is also more likely to have abnormal chromosomes, such as balanced translocation, which may increase the risk of miscarriages. At the age of 40, a woman has less than a 5% chance to get pregnant per menstrual cycle.

Besides, aging increases the risk of uterine disorders such as fibroids and endometriosis, which also affects fertility. Once the pregnancy is established, advanced maternal age may be associated with an increased risk of pregnancy complications such as preeclampsia and gestational diabetes (2,3).

Women must have detailed information about how aging affects their fertility. They should also receive proper counseling regarding the risk of pregnancy with advanced maternal age.

2- Primary Ovarian Insufficiency (POI)

Primary ovarian insufficiency (POI) is a condition in which a woman’s ovaries stop working normally long before 40. It affects approximately 1% of women. Some women can develop POI early in life, sometimes even before their periods start. When you have POI, your ovaries stop producing hormones like estrogen. As a result, there is a depletion of eggs, which leads to severely diminished fertility.

Women with POI may experience similar symptoms in premature menopause, but these conditions are not the same. With premature menopause, the periods stop, and there is no possibility of getting pregnant. On the other hand, Women with POI may still have irregular or occasional periods and can even get pregnant even though it is highly unlikely to conceive naturally.

The cause of POI is often unknown. Sometimes, it is related to chemotherapy or radiation therapy. POI can also be caused by autoimmune disease in which your immune system produces antibodies against the ovaries. When this happens, a woman’s menstrual cycles become irregular and stop. Her ovaries stop making estrogen and progesterone, and she stops ovulating regularly or not at all.

Given that there is no proven treatment to restore the function of the ovaries, women with POI who desire to become pregnant may consider In Vitro Fertilization (IVF).

3-Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. It affects about 10% (as many as 5 million) of women of childbearing age in the US. (4,5)
PCOS is a condition in which the ovaries overproduce male hormones (androgens), usually in a small amount. As a result :

  • There is a lack of estrogen, progesterone, and LH, the hormone that triggers ovulation.
  • The ovaries fail to release the eggs.
  • They develop many cysts. The cysts are follicles — the sac that contains the eggs— filled with fluids.
  • Women with PCOS also experience missed, irregular, infrequent, or prolonged periods.

Doctors still don’t know the exact cause of PCOS, but many researchers have pointed to genetic and environmental factors as potential risk factors. As women with PCOS do not ovulate regularly, one of the direct consequences of PCOS is infertility or difficulty in conceiving. Even though PCOS is the most common cause of infertility, this condition is treatable.
Women with PCOS that are overweight are more likely to have their symptoms worsen, including severe anovulation. Weight loss and a healthy diet are often recommended as the first step for women trying to conceive. Studies suggest that only a 5% reduction in body weight can increase their chance to ovulate and improve their menstrual cycle, insulin resistance, and overall fertility. (6)

Your doctor might recommend medications to help balance your hormones or fertility medications to stimulate ovulation. If all the options above fail, you may need IVF treatment to help you conceive.

4- Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs. Most cases of PID are caused by sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. About 10% to 15% of women with endocervical N. gonorrhea or C. trachomatis will develop PID. (7)
Other vaginal infections like bacterial vaginosis can also cause PID. When there is an infection in the vagina that is left untreated, it can spread from the vagina to the cervix and the upper genital tract: the uterus, fallopian tubes, and ovaries.

PID can cause permanent damage to reproductive organs and lead to infertility. According to data, 1 in 10 women with the condition become infertile. That is the equivalent of 100,000 women a year struggling to become pregnant as a result of PID.(8)

The inflammation due to the infection can lead to scar tissue formation throughout the fallopian tubes and create a blockage. This makes it hard for the sperm to meet and fertilize an egg. PID is more likely to lead to infertility if it is related to chlamydia or in case of a delay in treatment.

Fortunately, women with PID and struggling with infertility can successfully become pregnant with fertility treatment available. Sometimes, surgery may be necessary to improve fertility.

5- Endometriosis

Endometriosis occurs when the endometrium, the tissue that usually lines the inside of the uterus, grows outside it. The endometrial tissue can abnormally grow on the ovaries, the fallopian tubes, the bowel, and the lining of the pelvis.

Endometriosis affects 1 in 10 women of reproductive age, and yet it is a wildly misdiagnosed condition. (9)
The signs and symptoms of endometriosis often include abdominal pain, severe pain during periods, dyspareunia, and fertility problems.

Women who have endometriosis are at higher risk of experiencing infertility or difficulties getting pregnant. Research suggests that about 25% to 50% of infertile women have endometriosis, and up to 40% of women with endometriosis are infertile. (10)

The mechanisms behind the impact of endometriosis on infertility include the following:

  • The irritation and inflammation caused by endometriosis can lead to scar tissue formation and adhesions throughout the pelvis. These scars tissues can affect the ovaries and impair ovulation or block the fallopian tubes and prevent the sperm from meeting the egg to be fertilized.
  • Because of the inflammation associated with the condition, many chemicals are released which are toxic for the egg and sperm.
  • There is also a correlation between endometriosis and luteal phase defect, a condition in which the uterine lining fails to become thicker to prepare for a possible pregnancy.

The treatment options to improve fertility in women with endometriosis depend on the severity of the endometriosis, the patient’s age, and infertility duration.

Since some surgical procedures for endometriosis can negatively impact ovarian reserve, egg freezing may be recommended to preserve their eggs for possible future pregnancy.

6- Uterine fibroids

Uterine fibroids —also called myomas—, are benign (noncancerous) tumors that grow on the surface or inside the uterus. It is a common condition. About 70 to 80% of women will develop fibroids during their lifetime. (11)
Fibroids can range from the size of a seed to the size of a watermelon.

Even though most women with fibroids can get pregnant naturally, some women’s fertility can be affected by the fibroids. Many studies have demonstrated an association between fibroids and infertility. Fibroids are found in 5-10% of infertile patients and maybe the main cause of infertility in 1-2.4% of cases (12)

The impact of the fibroids on fertility depends on different factors such as:

  • The location—submucosal fibroids, which develop under the uterine inner lining (the endometrium), can interfere with nidation due to the deformation of the uterine cavity.
  • The size—large fibroids can prevent pregnancy by disrupting the implantation of the egg in the uterine wall.

Fortunately, infertility due to fibroids is rarely permanent. Besides, before treating the fibroids, the doctors may fully consider the patient’s desire for future pregnancy as some fibroids treatment can also negatively impact fertility. It is the case for a hysterectomy ( complete removal of the uterus) and uterine artery embolization (cutting the blood supply of the fibroids).

When it comes to treatment options to improve fertility in women with fibroids, a myomectomy appears to be the best choice. A Myomectomy is a surgical approach to remove the fibroids. Many studies have shown that patients who underwent myomectomy had higher pregnancy rates than patients with fibroids who did not undergo the procedure.(13,14)

References

  1. https://www.cdc.gov/reproductivehealth/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264866/#__sec1title
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106883/
  4. https://www.womenshealth.gov/a-z-topics/infertility
  5. https://www.cdc.gov/diabetes/basics/pcos.html
  6. https://link.springer.com/chapter/10.1007%2F978-1-4939-2059-4_38
  7. https://sti.bmj.com/content/76/2/80#ref-4
  8. https://www.acog.org/womens-health/faqs/pelvic-inflammatory-disease?utm_source=redirect&utm_medium=web&utm_campaign=otn
  9. http://endometriosis.org/news/research/research-priorities-in-endometriosis
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/#Sec2title
  11. https://www.uclahealth.org/fibroids/what-are-fibroids
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608270/
  13. Goldberg J, Pereira L. Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol.
  14. Bulletti C, DE Ziegler D, Levi Setti P, et al. Myomas, pregnancy outcome, and in vitro fertilization
  15. https://www.carolinasfertilityinstitute.com/fibroids-and-infertility/
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About the Author

Hermione M.

My name is Hermione. I am the founder of WomenH and I write about women's health, wellness, mental health, and personal growth. I created this platform to inspire women to take care of themselves mentally, physically, and emotionally to become their best selves. Thank you for stopping by.

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