Did you know one in every four couples are affected with infertility in developing countries? Infertility is a common and serious health concern worldwide.

Infertility is when the couple is unable to conceive despite having unprotected sex for at least a year. This can be caused by problems in the woman, man or both partners. A combination of factors or some unknown causes can lead to infertility. The cause of infertility will determine the treatment approach.

The cause of infertility in women can be difficult to diagnose, as there are a number of factors involved. One of the main factors is aging; a woman’s ability to get pregnant reduces after the age of 30.

In this article, we discuss what other factors cause infertility in women, and what are the potential solutions.

Causes of Infertility in Women

For a couple to conceive a baby, the process of fertilization should occur properly. For this process, one of the two ovaries must release a mature egg, which attaches to the fallopian tube. The sperm released during sexual intercourse should travel up the cervix and uterus, then into the fallopian tube, where fertilization occurs. The fertilized egg then travels down and implants into the wall of the uterus and grows. If any of these steps is disrupted, it could lead to infertility.

Infertility can occur due to any of the following factors or conditions:

Ovulation disorders: This refers to the conditions where the woman does not ovulate or ovulates infrequently. These disorders occur in one in four couples with infertility. Ovulation disorders can be caused by problems in the ovary or with the regulation of reproductive hormones by the pituitary gland or the hypothalamus. Some of the ovulation disorders include:

• Polycystic ovary syndrome (PCOS): In this syndrome, the follicles produced in the ovary do not ripen and form little cysts at the periphery of the ovary, which usually releases male sex hormones. PCOS causes hormonal imbalance and is associated with abnormal hair growth on the face and/or body, insulin resistance, obesity, and acne. This syndrome is the most common cause of infertility.
• Hypothalamic dysfunction: Ovulation is stimulated by two main hormones produced in the pituitary gland – luteinizing hormone and follicle-stimulating hormone. Factors such as very low or very high body weight, recent significant weight loss or gain, excess physical or emotional stress, can disturb the production of these hormones and thereby affect ovulation. The common signs of hypothalamic dysfunction include irregular or absent periods.
• Premature ovarian failure (or primary ovarian insufficiency): This condition involves premature loss of eggs from ovary due to autoimmune response, genetic factors or chemotherapy. The ovary does not produce eggs, which reduces estrogen production in women less than 40 years old.
• Hyperprolactinemia: In this condition, excess prolactin is produced by the pituitary gland, which decreases estrogen production, leading to infertility. Excess prolactin can be produced due to problems in the pituitary gland or caused by medicines taken for other diseases.

Damage to fallopian tubes (tubal infertility): The fallopian tubes can get blocked or damaged due to various causes, which prevent the sperm from reaching the egg or obstruct the fertilized egg. Some of the causes of damaged fallopian tube include:

• Pelvic inflammatory disease, an infection of the female reproductive organs due to gonorrhoea, chlamydia, or other sexually transmitted infections.
• Pelvic tuberculosis, a bacterial infection in the pelvic organs, is a major cause of tubal infertility worldwide.
• Previous pelvic or abdominal surgery.

Endometriosis: Endometriosis is a condition in which the tissue lining the uterus migrates to other location in the pelvis. This tissue and the surgical removal of it can damage the fallopian tubes, ovaries, lining of the uterus, which disrupts the movement of egg and sperm, affects fertilisation and embryo implantation.

Uterine or cervical problems: The uterine or cervical causes of infertility, which affect implantation of the embryo or increase the risk of miscarriage include:

• Uterine fibroids or benign polyps/myomas, which can block fallopian tubes and affect implantation.
• Structural abnormalities in the uterus, such as abnormal shape of the uterus, which can cause problems in pregnancy.
• Cervical stenosis (narrowing of the cervix) can occur due to damage to the cervix or inherited malformation.
• The type of mucus produced in the cervix can prevent the sperm from travelling into the uterus.

Unexplained infertility: In some cases, the exact cause of infertility is not determined. Several minor factors can lead to unexplained fertility problems.

Possible Solutions of Female Infertility

The treatment depends on the cause of infertility. There are several treatment options available; some are discussed below.

Surgery: Some of the obstructions or abnormalities in the reproductive organs can be corrected by surgical procedures. These obstructions include fibroids, polyps, endometriosis, ovarian cysts, and abnormalities in the uterus.

Ovulation induction: Several oral or intravenous medicines can be used to induce ovulation. An oral medicine, called Clomiphene works by adjusting the levels of natural hormones and stimulating the ovary to release one or more eggs. This action can also be obtained from synthetic gonadotrophins, intravenous drugs which mimic the action of natural hormones that stimulate ovulation. Women on drugs to induce ovulation should be closely monitored, as it can lead to ovarian hyperstimulation syndrome and the response to the medicines are unpredictable.

Assisted reproductive technologies: Assisted reproductive technologies (ART) are procedures performed to retrieve eggs from the ovaries. These technologies include in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). In these procedures, the ovaries are stimulated using synthetic hormones to produce 10–15 eggs, which are retrieved in an ultrasound-guided procedure.

In IVF, the retrieved eggs are mixed with sperm from the male donor in an artificial environment in the laboratory. Whereas in ICSI, the egg is injected with a single sperm in the laboratory. After two to five days, a thin tube is inserted through the woman’s cervix into the uterus to transfer the embryo.

ART is associated with certain health problems, such as ovarian hyperstimulation syndrome, increased risk of multiple pregnancies, low birth weight, premature labour, caesarean delivery.

The above-mentioned treatment options involve a lot of complications and results are unpredicted. Hence, before making the decision, talk to a healthcare professional about all the options for parenthood, including adoption.

What Can I Do to Improve Fertility?

When you are trying to get pregnant, people around you may suggest different ways and methods to improve fertility. Some may be helpful, some may not. The best way to improve fertility is to consult a doctor and get medical treatment for the underlying cause.

While undergoing treatment, the doctor may suggest some lifestyle measures; like:

• Maintain a healthy body weight
• Add more fruits, vegetables and whole-grain products to your diet
• Limit foods with added sugars, high cholesterol and saturated fat, and processed foods
• Exercise regularly
• Avoid smoking and passive smoking
• Limit alcohol intake

Reference:

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2. Katole A, Saoji AV. Prevalence of primary infertility and its associated risk factors in urban population of central India: A community-based cross-sectional study. Indian J Community Med 2019;44:337-41
3. Office on Women’s Health. Infertility. https://www.womenshealth.gov/a-z-topics/infertility. Accessed on 21st September 2020.
4. Female Infertility. Harvard Health Publishing Harvard Medical School. https://www.health.harvard.edu/a_to_z/female-infertility-a-to-z. Accessed on 21st September 2020.
5. Infertility in Women. Victoria State Government. https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/infertility-in-women. Accessed on 21st September 2020.
6. NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/infertility. Accessed on 21st September 2020.
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