When the desired pregnancy doesn't occur month after month, it can be extremely stressful for many women. In fact, it is estimated that about 10 to 15 percent of all couples struggle with fertility issues. The causes of female infertility are diverse, ranging from hormonal imbalances to anatomical changes. Below, you'll learn about the ten most common triggers and how to recognize 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 gynecologist can diagnose PCOS using blood tests and ultrasound. Lifestyle changes (e.g., weight loss, exercise) and adjusted hormone therapy often help stabilize the cycle and enhance fertility.
2. Ovulation Disorders Outside of PCOS
Even without PCOS, menstrual irregularities can occur, where ovulation is irregular or doesn't happen at all. Examples include thyroid dysfunctions, being overweight or underweight, and stress. Additionally, elevated prolactin levels (hyperprolactinemia) can disrupt the hormonal balance.
Signs: Missed periods (amenorrhea), extremely irregular cycles, mood swings, signs of thyroid dysfunction (e.g., hair loss, weight fluctuations).
What to Do: Comprehensive hormone tests and possibly thyroid function tests provide clarity. Depending on the diagnosis, medications (e.g., ovulation inducers) or treatment of the underlying condition (e.g., thyroid medication) can help.
3. Endometriosis
In endometriosis, cells similar to the uterine lining grow outside the uterus—for example, on the ovaries, fallopian tubes, or in the abdominal cavity. These can cause inflammation and adhesions that interfere with egg maturation, fertilization, 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 from the ovary 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, typically discovered during fertility evaluations (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 tumors in or on the uterus that can deform the uterine cavity and make it difficult for a fertilized egg to implant. 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 location and size of fibroids or malformations. Surgical correction can often significantly improve fertility.
6. Infections and Inflammations
Chronic infections—such as sexually transmitted diseases like chlamydia or gonorrhea—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 is often asymptomatic.
What to Do: If an infection is suspected, promptly see a doctor. Antibiotic treatments or targeted therapies can prevent complications.
7. Age and Egg Quality
As women age, the number and quality of their eggs decline. Starting around age 35, female fertility noticeably decreases, and the risk of miscarriages or chromosomal abnormalities increases.
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 having children can consider social freezing (egg preservation). Additionally, fertility clinics offer treatments that can partially compensate for age.
8. Genetic and Immunological Causes
Some women carry genetic mutations 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 implantation or maintain a pregnancy.
Signs: Often no specific, noticeable symptoms in daily life. However, autoimmune diseases typically present signs like fatigue, joint pain, or skin changes.
What to Do: Specialized blood tests and genetic screenings aid in diagnosis. Close monitoring by specialists and tailored therapies (e.g., blood thinners 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 disrupt the menstrual cycle and hormone production. Extreme calorie deficits or persistent stress can even stop ovulation entirely in some women.
Signs: Irregular bleeding, absent ovulation, low 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 examinations, normal hormone levels, and intact fallopian tubes, some women find no clear reasons for their inability to conceive. This form of infertility is particularly distressing because there seems to be no specific cause.
Signs: Regular cycles, no abnormal lab or ultrasound findings, yet no pregnancy.
What to Do: Fertility treatments such as in vitro fertilization (IVF) or intrauterine insemination (IUI) can often still be successful. Seeking a second opinion or switching to a specialized fertility center is worthwhile in many cases.
Conclusion
Female infertility can have numerous causes—from hormonal imbalances to structural and genetic factors. However, modern medicine offers a variety of diagnostic and treatment options, making a successful pregnancy possible in many cases. It's important to seek advice early and adjust your lifestyle if needed. Open communication with your partner, a trusting relationship with your healthcare provider, and, if necessary, psychological support can also help navigate the often challenging path to your desired child.