Causes of Female Infertility and Treatment Options
results from disease and anatomical problems, age, hormonal imbalances
affecting the menstrual cycle, and/or other problems preventing conception or
full-term pregnancy. Exposure to radiation or certain chemicals can cause
infertility and women who smoke cigarettes can have enough nicotine in their
cervical mucus to kill sperm. Others who have very low ratios of body fat to
muscle from excessive exercise or eating disorders may have irregular periods
and/or fail to ovulate. The most common female-related causes of infertility
Read the descriptions
below to learn more about these causes of female infertility.
Age is the single most
important factor affecting a woman’s fertility. As she matures, the chance
for pregnancy decreases and the odds for miscarriage increase. At 25, a woman
has a 25% of becoming pregnant during unprotected sexual intercourse. This
percentage begins to decrease between the ages of 32 and 34. After that, the
decline is steady so that the chance for pregnancy is only 5 to 10% per
menstrual cycle after a woman reaches age 40.
Although older women may be more likely to experience scarring and blockages
caused by endometriosis or other medical conditions, these are not significant
contributors to infertility. Instead, infertility often is the result of
age-related changes occurring in the reproductive hormones that stimulate egg
development, trigger ovulation
and support pregnancy. Perhaps most important, is depletion of a woman’s ovarian
reserve - the eggs she is born with. During her reproductive years, some
eggs never mature and others are released during her menstrual cycles. Those
remaining age with her and the older she is, the more likely they are to have
hard shells (zona
pellucida) that keep sperm from penetrating or genetic defects that
prevent fertilization or cause miscarriage. When the store of healthy eggs is
depleted, menopause occurs.
Treatment Options for
– used to remove scar tissue and blockages from endometriosis and
other conditions, or repair structural defects that prevent conception
Induction (OI) – prescribed to regulate a menstrual cycle,
stimulate the development of multiple eggs and/or trigger ovulation when
irregular periods or ovulation problems occur. This may be used with
Vitro Fertilization (IVF) – recommended when conception is
more likely to occur in vitro (outside the body) rather than in vivo
(inside). With IVF, hormones usually are used to stimulate development
of multiple eggs. Retrieved directly from the ovary, they are fertilized
with the partner’s sperm and a limited number of embryos are
transferred into the uterus.
A laboratory-based procedure, intracytoplasmic
sperm injection (ICSI), is used with IVF if the eggs have a hard
shell and/or sperm problems are a factor. ICSI involves injecting a
single sperm directly into the egg’s core. When IVF is an option and
certain genetic abnormalities are suspected, preimplantation
genetic diagnosis (PGD) - examination of a single cell from a
developing embryo – can help identify affected embryos so they are not
donation – required when there are no eggs
available or pregnancy is unlikely due to their number, age or
condition. With donor IVF, eggs are retrieved from a young female whose
follicles have been stimulated by fertility medications. If they are
fertilized in the laboratory by the male partner’s sperm, the embryos
are transferred into the recipient’s uterus, which has been prepared
by fertility drugs.
Although IVF may be the best
or only treatment for age-related infertility, outcomes decrease with age.
This is supported by the 1988 national data reported to the Society for
Assisted Reproductive Technology and the federal Centers for Disease Control.
For women under 35, 32% of 1988 non-donor IVF cycles resulted in a live birth.
Success was achieved by 26% of women age 35 to 37, 18% of those between 38 and
40, and 8% of those over 40. Most clinics require donor cycles beyond a
certain age cut-off because of the poor chances for pregnancy with a woman’s
The fallopian tubes carry
eggs from the ovaries to the uterus. When tubes are blocked by scar tissue
from endometriosis, surgery or infection, the egg and/or the sperm cannot
travel through. If a fertilized egg is trapped in the fallopian tube, the
result is an ectopic pregnancy, which must be treated with
medication or surgery. Tubal problems include:
– sexually transmitted diseases, gonorrhea and chlamydia, often go
unnoticed and untreated, causing pelvic
inflammatory disease (PID). Serious infection can cause scar tissue
and damage the cilia, or small hairs lining the tubes to help the eggs
move through. Symptoms of sexually transmitted diseases include
inflammation and abnormal discharge. PID can result in pelvic or
abdominal pain and severe, untreated infection has been linked to
cervical and other cancers, chronic hepatitis and cirrhosis of the
– this condition is caused by a severe blockage - a hydrosalpinx
– resulting from infection. It greatly reduces the chance of pregnancy
without IVF because it stretches or distorts the fallopian tubes to the
extent that they cannot be opened and/or repaired. When the tubes fill
with fluid, there is a chance that it can leak back into the uterus.
Because this fluid is toxic to embryos placed into the uterus during IVF,
physicians often remove or surgically block the tubes before a cycle to
improve embryo implantation rates.
– tissue lining the uterus (endometrium) grows and
thickens during a menstrual cycle to receive a fertilized egg (implantation).
Without a pregnancy, the lining sheds and is discharged with blood
during a menstrual period. Endometriosis occurs when this tissue grows
outside the uterus and the shedding process deposits blood and tissue in
the abdomen. As a result, scar tissue can form in the fallopian tubes,
adhere to the ovaries and/or cause misalignment of the organs,
preventing natural conception. Although some women have no discomfort
even with severe endometriosis, others experience abnormal menstrual
bleeding and pain, tenderness in the abdomen and pelvis, and/or painful
– a form of birth control, this surgical procedure involves tying,
clamping off or burning the ends of the fallopian tubes so pregnancy
Treatment Options for
– including antibiotics, can be effective in treating sexually
transmitted diseases and PID. Early diagnosis and treatment are
important to avoid further damage. Medications also may be prescribed
for endometriosis, to help shrink the tissue that is blocking or
distorting the organs.
– may be an option for opening up and/or repairing tubal damage or
blockages from infection, endometriosis, surgery or other factors.
Surgery is the only way to reverse a tubal
ligation, and it may be recommended to remove or block off the
fallopian tubes prior to IVF for a patient with hydrosalpinges.
Fertilization (IVF) – required when blockages cannot be
removed and/or tubal damage is so severe that it cannot be repaired, IVF
is the recommended treatment. The tubes are bypassed during this
procedure because the eggs are retrieved from the ovaries and fertilized
outside of the body. The embryos are returned directly to the uterus for
A thin layer of lubricated
tissue, the peritoneum, covers the abdominal organs and allows
them to slide against each other. Surgical procedures, infections and
endometriosis can cause scar tissue - adhesions
- that link two organs together. Adhesions on the ovaries can affect ovulation
or block the fallopian tubes, keeping the egg and/or sperm from following
their natural course. Adhesions inside the uterus can affect implantation.
Although many women have adhesions without symptoms, they can cause severe
menstrual cramps, abdominal tenderness, pelvic pain or pain during
Treatment Options for
– recommended for removing adhesions and/or repairing damage from
infections, endometriosis, surgeries or other factors.
Fertilization (IVF) – required when adhesions are severe and
cannot be removed, or damage is so severe that it cannot be repaired.
Fibroids and Polyps
Saline sonogram showing a polyp
These growths (fibromas,
myomas and leiomyomas) are benign tumors made up of thread-like tissue
that clumps together to form masses. Usually found inside the uterus, they
affect implantation of the fertilized egg. Symptoms associated with fibroids
– especially if they are large - include heavy bleeding, pain and abdominal
Treatment Options for Fibroids and
– although medications can shrink fibroids in some cases, the result
is not permanent. Instead, they can only temporarily reduce symptoms,
delay surgery or shrink the fibroid enough to allow for a less invasive
– required for removal of fibroids and polyps if they are large enough
and are affecting fertilization and/or embryo implantation.
results from congenital defects, hormonal deficiencies and/or the aging
process. Some women don’t have menstrual periods while others menstruate but
don’t ovulate. Women with amenorrhea have never had a period
or had irregular periods that stopped prematurely. With anovulation,
eggs aren’t released from the follicles and oligo-ovulation is
characterized by longer cycles and infrequent ovulation. Other forms of
ovulatory dysfunction, called luteal phase defects, occur when a
woman has a menstrual cycle and is ovulating, but the cycle is too short for
the uterine lining to thicken properly. Common forms of ovulatory dysfunction
Failure – menopause usually occurs after several decades of
menstrual cycles and natural depletion of the ovarian reserve. Premature
ovarian failure, or early menopause can be caused by
exposure to certain chemicals, chemotherapy and radiation for cancer
treatment. It also results from other conditions that affect the
cycle-regulating hormones or damage the ovaries so they no longer
produce eggs. Certain genetic disorders can trigger premature ovarian
failure, as can autoimmune diseases – such as lupus or rheumatoid
arthritis - that cause the body to mistakenly attack the ovaries.
Ovarian Syndrome – genetically linked hormonal imbalances can
ovarian syndrome (PCOS), a condition that prevents ovulation.
Without the necessary level of follicle
stimulating hormone (FSH), the follicles don’t develop properly
and the eggs don’t mature. An imbalance of luteinizing
hormone (LH) causes overproduction of estrogen, abnormal thickening
of the uterine lining and very heavy and/or irregular periods. High
levels of LH can trigger over production of male hormones, including
testosterone, which cause acne and facial hair – common symptoms of
PCOS. Over time, elevated estrogen levels associated with PCOS may
create an increased risk of uterine cancer and diabetes.
– this condition is associated with the pituitary gland located in the
brain, which produces prolactin
to help regulate ovulation and stimulate breast milk production in
pregnant women. Overproduction of prolactin results from tumors on the
pituitary, an underactive thyroid (hypothyroidism)
or an adverse reaction to certain prescription medications, including
antihistamines, oral contraceptives, tranquilizers and antihypertensives.
As a result, women experience irregular or no ovulation, and they may
produce breast milk even though they aren’t pregnant.
Amenorrhea – the hypothalamus gland, also located in the
brain, produces gonadotropin-releasing hormone (GnRH). This chemical
stimulates the pituitary gland to release follicle stimulating hormone (FSH)
and luteinizing hormone (LH). When the hypothalamus stops producing GnRH
as a result of this condition, it affects the FSH and LH levels needed
for egg development and ovulation.
Treatment Options for Ovulatory
– birth control pills can stimulate and regulate the menstrual period
if a woman is not trying to get pregnant. Infertility patients with PCOS
may start with clomiphene citrate, a medication designed
to stimulate the ovaries to produce multiple follicles and eggs. Other
fertility drugs – human chorionic gonadotropin (HCG) and human
menopausal gonadotropin (HMG) – also may be prescribed if clomiphene
citrate alone is not effective. Finally, progesterone
may be necessary to help thicken the uterine lining and sustain
Medication also is available to suppress overproduction of prolactin
caused by hyperprolactinemia.
In cases of hypothalamic amenorrhea, gonadotropins (LH and FSH) are
prescribed to regulate levels of these hormones.
Induction (OI) – used alone or with insemination,
OI relies on fertility drugs to stimulate development of the follicles
and eggs. For this reason, it can be an effective treatment for various
forms of ovulatory dysfunction and luteal phase defects. As part of an
OI cycle, progesterone may be prescribed alone - or combined with other
fertility medications - to stimulate development of the uterine lining
to support pregnancy. Human
chorionic gonadotropin (HCG) also may be prescribed to overcome
luteal phase defects by triggering ovulation.
Fertilization (IVF) – recommended as it may offer the best
chance for pregnancy when infertility is related to ovulatory
dysfunction. Hormones designed to regulate the reproductive cycle and
stimulate the development of multiple eggs will provide more chances for
Donor In Vitro
Fertilization – required in cases of premature ovarian failure
when there are no eggs available. Eggs from a young female donor, whose
body has been stimulated by fertility drugs, are retrieved and
fertilized in the laboratory with the male partner’s sperm. The
embryos are transferred into the recipient’s uterus, which has been
prepared to support pregnancy.