Infertility affects millions of people globally, impacting individuals, families, and communities. It’s estimated that approximately 1 in 6 people of reproductive age experience infertility during their lifetime.

Infertility is defined as the inability to conceive after one year of trying for women under 35, and six months for women aged 35 and older. However, infertility can involve either or both partners.

Common Causes of Female Infertility

Female infertility can be caused by a range of issues including ovulation problems, cervical dysfunction, endometriosis, or genetic conditions. Some key causes include:

1. Age

Female fertility declines with age. After the age of 20, monthly fertility starts to decrease. Women at age 35 are twice as likely to have difficulty conceiving as women at age 25. Among women over 40, nearly 65% experience involuntary infertility.

2. Ovulation Disorders

Ovulation disorders are a common cause of female infertility. During a normal menstrual cycle, the endocrine system releases hormones—mainly GnRH, FSH, and LH—to prepare the body for pregnancy.

While cycle lengths may vary, women with regular ovulation typically have a 28-day cycle with one ovulation per cycle. Hormonal imbalances or deficiencies can result in irregular ovulation or anovulation, leading to infertility.

3. Uterine or Cervical Abnormalities

These conditions may interfere with fertilization or embryo implantation, and include:

• Fibroids: Benign tumors in the uterine wall that may block fallopian tubes or distort the uterine cavity, affecting implantation.

• Endometriosis: Occurs when endometrial tissue grows outside the uterus, often affecting ovaries, uterus, and fallopian tubes.

• Polyps: Both uterine and cervical polyps can affect fertility by interfering with fertilization or embryo growth.

• Adhesions: Scar tissue between or within abdominal organs. In the uterus (Asherman’s Syndrome), severe adhesions can distort the uterus and impair full-term pregnancy.

4. Hormonal Imbalance

Successful ovulation and implantation depend on a delicate hormonal balance. Any disruption in this can prevent ovulation or make implantation difficult.

Polycystic Ovary Syndrome (PCOS) is a common cause of infertility related to hormonal imbalance. While thyroid disorders and prolactin issues can also be culprits, PCOS is often linked to excessive insulin, which stimulates the ovaries to produce too much androgen (male hormone). This prevents proper egg development and leads to many small cysts in the ovaries. These cysts are not the cause of infertility but rather a result of hormonal imbalance.

Excess androgens can also cause other symptoms like hirsutism (excess hair growth).

5. Fallopian Tube Damage or Blockage

Fertilization occurs when sperm meets the egg in the fallopian tube. The fertilized egg then travels to the uterus. Blocked or damaged tubes can prevent fertilization and may cause ectopic pregnancy, accounting for about 35% of infertility cases.

Pelvic inflammatory disease (PID), often caused by STIs, adhesions, or endometriosis, can lead to salpingitis (inflammation of the fallopian tubes), which hinders the egg and sperm from meeting. The more infections, the higher the infertility risk.

6. Cancer and Its Treatments

Certain cancers, especially those affecting the reproductive organs, can harm fertility. Radiation and chemotherapy also negatively impact fertility.

7. Sexually Transmitted Diseases (STDs)

Infectious and inflammatory diseases significantly impair female fertility. Among women:

• 24% experience chronic pelvic pain,

• 40% suffer from infertility,

• 45% have pregnancy failures,

• 3% experience ectopic pregnancies.

  
  

8. Uterine and Cervical Abnormalities

Congenital or acquired abnormalities of the uterus or cervix can pose serious challenges to conception and pregnancy. Symptoms like abnormal bleeding, discomfort, and difficulty conceiving are common indicators. Proper diagnosis requires a fertility specialist to evaluate medical history, conduct exams, and run tests.

9. Recurrent Miscarriages

In the U.S., Recurrent Pregnancy Loss (RPL) is defined as two or more consecutive miscarriages confirmed by ultrasound or pathology. Up to 50% of RPL cases have no clear cause. RPL can be:

• Primary (never carried a pregnancy to term),

• Secondary (had at least one successful pregnancy before losses).

Possible causes include:

• Genetic factors

• Anatomical issues

• Endocrine disorders

• Antiphospholipid (APS) antibody syndrome

• Immunological issues

• Environmental factors

Preventing Female Infertility

If you’re considering getting pregnant soon or in the future, the following tips may help:

• Maintain a healthy weight: Being overweight or underweight can affect ovulation. Aim for moderate exercise, as over 5 hours of intense exercise per week can reduce ovulation.

• Quit smoking: Smoking has multiple negative effects on fertility, overall health, and fetal development. Quit as early as possible.

• Avoid alcohol: Heavy drinking lowers fertility. Even small amounts can affect fetal health—avoid alcohol when trying to conceive or during pregnancy.

• Manage stress: High stress can negatively affect fertility treatment outcomes. Try to reduce stress before attempting to conceive.