When the desired pregnancy fails to occur month after month, it can be extremely distressing for many women. In fact, it is estimated that approximately 10 to 15 percent of all couples struggle with fertility issues. The causes of female infertility are diverse, ranging from hormonal disorders to anatomical changes. Below, you will learn about the ten most common triggers and how to recognise warning signs early.
1. Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome is a common cause of menstrual irregularities and absent ovulation. Small cysts form in the ovaries, which can disrupt the normal maturation process of the eggs. PCOS is often associated with elevated levels of male hormones (androgens), which can manifest as acne and increased hair growth.
Signs: Irregular or absent menstruation, weight gain, acne, increased body hair.
What to do: A gynaecologist can diagnose PCOS with the help of blood tests and ultrasound. Often, lifestyle changes (e.g., weight loss, exercise) and adjusted hormone therapy can help stabilise the cycle and increase fertility.
2. Ovulation Disorders Outside of PCOS
Even without PCOS, menstrual irregularities can occur where ovulation is irregular or does not occur at all. Examples include thyroid dysfunctions, being overweight or underweight, and stress. Additionally, increased prolactin secretion (hyperprolactinaemia) can disrupt the hormonal balance.
Signs: Missed periods (amenorrhoea), extremely irregular cycles, mood swings, signs of thyroid dysfunction (e.g., hair loss, weight fluctuations).
What to do: Comprehensive hormone tests and, if necessary, thyroid function tests can provide insights. Depending on the diagnosis, medications (e.g., ovulation inducers) or treatment of the underlying condition (e.g., thyroid medication) may help.
3. Endometriosis
In endometriosis, cells similar to the uterine lining grow outside the uterus – for example, on the ovaries, fallopian tubes, or within the abdominal cavity. These can cause inflammation and adhesions that impair egg maturation, fertilisation, and embryo implantation.
Signs: Severe menstrual pain, pain during intercourse, chronic pelvic pain.
What to do: A precise diagnosis is usually made via ultrasound and/or laparoscopy. Surgical interventions and hormone therapies can alleviate symptoms and improve the chances of a successful pregnancy.
4. Blocked or Damaged Fallopian Tubes (Tubal Factor)
The fallopian tubes are essential for transporting the egg to the uterus after ovulation. If they are blocked or damaged, sperm cannot reach the egg, or the embryo cannot be transported further. Common causes include infections (e.g., chlamydia) or adhesions following surgeries.
Signs: Often asymptomatic, usually discovered during fertility investigations (e.g., hysterosalpingography).
What to do: Depending on the situation, surgical procedures can restore tubal patency. In severe cases, assisted reproductive technologies (e.g., IVF) are an alternative.
5. Fibroids and Congenital Uterine Anomalies
Fibroids are benign tumours in or on the uterus that can deform the uterus and make the implantation of the fertilised egg difficult. Congenital malformations (e.g., a septate uterus) also reduce the space available for embryo development.
Signs: Heavy or prolonged menstrual bleeding, lower abdominal pain, a feeling of pressure in the pelvis.
What to do: An ultrasound clarifies the position and size of fibroids or malformations. Surgical correction can often significantly improve fertility.
6. Infections and Inflammations
Chronic infections – for example, sexually transmitted diseases like chlamydia or gonorrhoea – can lead to pelvic inflammatory disease (PID) and cause lasting damage to the fallopian tubes or uterus. An untreated endometritis (inflammation of the uterine lining) can also reduce fertility.
Signs: Lower abdominal pain, unusual discharge, fever (in acute inflammations). However, it can often be asymptomatic.
What to do: If an infection is suspected, prompt medical consultation is important. Antibiotic treatments or targeted therapies can prevent complications.
7. Age and Egg Quality
As age increases, both the number and quality of eggs decline. From around 35 years, women’s fertility noticeably decreases, and the risk of miscarriages or chromosomal anomalies rises.
Signs: No direct symptoms, more statistical and hormonal changes (e.g., low AMH levels).
What to do: Early family planning can help. Women who wish to delay parenthood have the option of social freezing (egg preservation). Additionally, fertility clinics offer treatments that can partially compensate for age.
8. Genetic and Immunological Causes
Some women carry genetic variations that hinder normal egg or embryo development. Immunological factors, such as autoimmune diseases (e.g., lupus, antiphospholipid syndrome), can also make it difficult for the body to support the implantation or maintenance of a pregnancy.
Signs: Often no specific, noticeable symptoms in daily life. However, autoimmune diseases often present with signs like fatigue, joint pain, or skin changes.
What to do: Special blood tests and genetic examinations assist in diagnosis. Close monitoring by specialists and tailored therapies (e.g., anticoagulants for antiphospholipid syndrome) often increase the chances of pregnancy.
9. Lifestyle and Weight
Being overweight or underweight, as well as an overall unhealthy lifestyle (e.g., smoking, high alcohol consumption, chronic stress), can sustainably disrupt the cycle and hormone production. Particularly, an extreme calorie deficit or persistent stress can lead to the complete absence of ovulation in some women.
Signs: Irregular bleeding, lack of ovulation, lack of energy, concentration problems.
What to do: A balanced diet, stress reduction, adequate sleep, and avoiding nicotine and excessive alcohol are fundamental for healthy fertility.
10. Unexplained (Idiopathic) Infertility
Despite thorough investigations, normal hormone levels, and intact fallopian tubes, some women find no clear reasons for the absence of pregnancy. This form of infertility is particularly distressing because there appears to be no concrete cause.
Signs: Regular cycle, no abnormal lab or ultrasound findings, yet no pregnancy.
What to do: Fertility treatments such as in vitro fertilisation (IVF) or intrauterine inseminations (IUI) can often still be successful. Seeking a second opinion or transferring to a specialised fertility centre is worthwhile in many cases.
Conclusion
Female infertility can have numerous causes – from hormonal disorders to structural and genetic factors. However, modern medicine offers a variety of diagnostic and therapeutic options, making a successful pregnancy possible in many cases. It is important to seek advice early and adjust your lifestyle if necessary. Open communication with your partner, a trusting relationship with your doctor, and, if needed, psychological support can also help navigate the often challenging journey to your desired child.