In this article:
What is meant by female infertility?
If a woman of reproductive age is repeatedly unable to conceive a child within a year of having unprotected intercourse or donor insemination, the condition is referred to as female infertility.
The standard definition applies to a woman who is less than 35 years old and is unable to achieve pregnancy following 12 months of attempts, provided that she has normal menstrual intervals, and the couple has no predisposing factors for infertility.
As the woman ages, an evaluation for infertility is recommended after 6 months of attempts at conception and only 3 months after the age of 39.
The term “sterility” is used to represent the inability of a person to have a genetically related child by natural biologic means, such as:
- A woman has undergone a tubal ligation resulting in permanent tubal blockage.
- A woman does not have a uterus, either from birth (congenital) or surgery.
- A man has no sperm in his ejaculate (azoospermia).
- A man has a history of a vasectomy.
What are the significant causes of infertility?
Nearly 15% of all couples struggle with infertility issues. In 35% of such cases, infertility factors pertaining to both the partners are implicated, whereas malefactors are the only identifiable cause in about 8% of the cases.
Following 1 year on an inability, for a couple to conceive, an infertility evaluation will demonstrate an equal percentage of female and male causes, i.e., approximately 40% for both, while unexplained infertility occurs in up to 30% of couples.
Female causes of infertility are divided equally between ovulation dysfunction and tubal blockage, both occurring in approximately 40% of women. (1)
What are the telltale signs of infertility in women?
Great question! Unfortunately, there are not many ways to determine infertility in a woman other than screening for the two essential factors – ovulation and tubal status.
A woman with monthly regular menstrual cycles can check for ovulation by using an over-the-counter urine detection kit.
What are the different types of infertility?
The basics of human reproduction require a woman to ovulate, have at least one open fallopian tube, and have a normal uterine cavity, while the man needs to provide normal-functioning sperm. Hence, the reasons for female infertility are ovulation dysfunction and tubal blockage.
Contributors to female infertility include reasons for ovulation dysfunction, most commonly polycystic ovary syndrome (PCOS), and other less common hormone effects on ovulation.
The man should have normal functioning sperm in his ejaculate. The analysis involves the sperm’s density (numbers of sperm/mL), motility (percentage of normal-moving sperm), and morphology (percentage of normal-shaped sperm).
What is the most accurate way to test infertility in women?
The two most important areas to test for determining the fertility of a woman are ovulation and tubal status, which contribute to 80% of the female factors.
To keep tabs on your ovulation cycle, you can either use at-home urine test kits that are available over the counter or go for a blood test, both of which aim to detect the presence of the hormone progesterone.
Tubal status is determined typically through a hysterosalpingogram (HSG). In this procedure, liquid contrast is slowly injected through the cervix into the uterus, while the movement of the fluid is visualized using x-ray fluoroscopy.
This test gives an inside view of the uterine cavity and highlights any abnormalities that may be causing infertility, such as a blockage in the fallopian tubes.
Ovarian age testing is done by measuring the number of small antral follicle cysts through ultrasound and by measuring the level of anti-Mullerian hormone (AMH) through a blood test.
It is important to know that this test does not predict natural fertility and should not be used as a basis for reproductive potential.
What is the best way to increase fertility in women?
The “holy grail” of questions! A woman can typically only reduce her fertility by engaging in poor lifestyle choices such as:
- Tobacco use
- Having an unhealthy body mass index (BMI) – either too high or too low
- Risking sexually transmitted infections that can result in tubal blockage
- Waiting too long to attempt conception
What are the best home remedies to treat infertility in women?
While many women, men, and couples ask about how they can improve their fertility, there is no easy answer.
Nevertheless, there are lifestyle and behavior choices that can impair fertility, namely, tobacco use, unhealthy body mass index (BMI), and alcohol/drug abuse.
If the woman or couple have no infertility risk factors, they can optimize their ability to conceive by timing intercourse with an over-the-counter ovulation predictor kit.
By having relations the day before, on the day, and the day after the kit detects a positive hormone surge, the couple will maximize chances to get pregnant. Once the kit turns positive, ovulation will occur within 24 to 36 hours.
Do infertile females have menstruation?
One of the most common reasons for infertility in women is ovulation disorders, and the most common cause is polycystic ovary syndrome (PCOS). PCOS is a hormonal imbalance that can result in no or infrequent periods.
Another condition that can prevent menses is an elevation in the hormone prolactin or when a woman has primary ovarian insufficiency (early menopause).
Certainly, women can have infertility for other reasons without affecting their periods.
After what age does it generally get difficult to get pregnant?
Natural fertility for a woman begins to decline after age 30. Prior to this age, the monthly chance for conception (fecundity) is approximately 20%.
Pregnancy rates continue to decline for the remainder of a woman’s reproductive lifespan, with monthly chances reducing to 10% at age 35 and 5% at age 40. (2)
A man’s age can also impair fertility. In men above age 40–45, studies have shown higher rates of infertility, miscarriage, and preterm labor in their partner as well as higher rates of autism, birth defects, and schizophrenia in their offspring. (3)(4)
These findings were further supported by a recent study conducted at the Stanford University School of Medicine.
The study found that men aged 45 years or older are 12% more likely to father children with adverse pregnancy outcomes and 14% more likely to have premature and low-birth-weight offspring, as opposed to fathers in their 20s and 30s. (5)
The older the father, the more likely he is to have babies who need breathing assistance and neonatal intensive care. (5)
What dietary changes would you suggest to help improve fertility?
A healthy diet, lifestyle, and body mass index (BMI) are vital to optimize fertility in men and women.
While there is no definitive consensus, the Mediterranean diet may have fertility advantages for men and women. BMI has effects on reproduction in both sexes.
For women, very low and very high BMI can impair ovulation and, thereby, fertility. In men with an elevated BMI, sperm production can be impaired due to hormonal imbalances.
Thus, healthy choices in lifestyle and diet can reduce stress and improve fertility.
Can suffering from UTIs multiple times lead to female infertility?
Mycoplasma can result in urinary tract infections and has been associated with pregnancy complications, including miscarriage.
Can folic acid increase fertility?
Folic acid supplements are routinely recommended to ensure a healthy pregnancy for both the mother and child.
This key component of prenatal care is known to prevent neural tube defects, provided the mother takes the appropriate doctor-prescribed dosage.
Women who are struggling to conceive are generally recommended a higher dosage, and this intervention has shown great success in treating infertility.
Folic acid supplementation may help women with infertility problems to achieve and sustain a pregnancy. Thus, it not only helps lower the rates of infertility by helping the woman get pregnant, but it also prevents the loss of pregnancy after that.
Why are women nowadays more infertile?
The incidence of infertility remains approximately 15% in couples. However, more women are delaying childbearing for personal (lack of a partner) and professional (career responsibilities) reasons.
As women age, so do their eggs. Thus, the number of women experiencing challenges conceiving will increase due to their attempts at conception at a later age.
Do infertility issues run in families?
Human reproduction requires the woman to ovulate, have at least one open fallopian tube, and have a normal uterine cavity, while the man should have normal sperm function, currently best determined by a sperm analysis.
In general, fertility – or infertility for that matter – is not inherited. Nevertheless, two female diseases reduce fertility and have a genetic component, namely, polycystic ovary syndrome (PCOS) and endometriosis.
While the exact genetic effect is unknown, these diseases can be more present in families.
Can abortion lead to female infertility?
Termination of pregnancy has not been shown to increase the risk of infertility unless a complication occurred that caused scarring inside the uterus as a result of the procedure. Fortunately, this is an uncommon event.
How to deal with female infertility?
Healthcare providers, family, and friends should never underestimate the devastation a woman, man, or couple experiences while enduring infertility.
The emotional impact has been shown in medical research to be analogous to receiving a cancer diagnosis. Infertility is a physical, emotional, and financial investment.
Hence, the patient must always be proactive and be their own advocate toward expediting evaluation, treatment, and, hopefully, a successful outcome.
Expert Answers (Q&A)
Answered by Dr. Shalanda Webb, MD (Obstetrics and Gynecologist)
Several factors contribute to female infertility. A woman may seek stability in careers, marriage, and finances before starting a family. This has led to women getting pregnant at what we call advanced maternal age (AMA), which starts at 35.
Women’s decision to conceive at 35 years of age or older can significantly decrease their chances of conception. At this advanced age, they have an increased risk of having a child with genetic disorders such as Down’s syndrome.
Other factors that affect fertility are contributed by genetics, diet, and overall health. Obesity can affect any woman attempting to conceive.
Weight affects your cycles, causing amenorrhea or heavy periods, which lead to abnormal ovulation cycles. Excess weight is also associated with the polycystic ovarian syndrome (PCOS), hypertension, diabetes, and other medical conditions that significantly impact conception.
Folic acid is a vitamin necessary for early pregnancy. It helps prevent neural tube defects in the fetus. Folic acid has been associated with increasing sperm count in men with low sperm count.
Folic acid has also been studied in women, but no evidence reported improvement in conception.
Coffee is a stimulant and can be addictive. However, one cup of coffee per day will not affect your reproductive health. Any stimulant in excess will affect your overall health and may impact fertility.
Stress affects people in more ways than they realize. Stress can lead to a rise in cortisol levels, which can cause obesity, amenorrhea, anxiety, and several other medical complications. These can all impact a woman’s ability to conceive.
Ovulation symptoms vary from patient to patient. The symptoms a woman may experience prior to releasing an egg include pain, spotting, bloating, and increased sexual desire.
The most common cause of infertility in women is a blocked or damaged fallopian tube (tubal factor). The egg or sperm cannot pass through the blockage.
Tubal factor infertility is caused by exposure to sexually transmitted diseases such as chlamydia, history of abdominal surgery, ruptured appendix, endometriosis, etc.
Yes, a woman can ovulate without a period. However, this does not commonly occur. If a woman does not have regular periods, she needs to see her ob-gyn.
Infertility can be an overwhelming process. It is important not to be stressed when dealing with this problem as stress will only compound the infertility issue.
Women who are less than 35 years of age can have unexplained infertility. If you have not successfully conceived after a healthy regular sex life for one year, seek medical advice.
If you are 35 and older, your ability to conceive has decreased. AMA women who wish to conceive must see a gynecologist immediately.
About Dr. Shalanda Webb, MD (Obstetrics and Gynecologist): Dr. Webb is a board-certified obstetrician and gynecologist and has almost 10 years of experience treating patients.
She also served as a clinical professor at the Michigan State School of Medicine. Her area of interest includes minimally invasive surgeries. She currently resides in Maryland and practices throughout Maryland, DC, and Virginia.