Discover your path to parenthood with Main Line Fertility, the leading fertility clinic for comprehensive female infertility care in the Greater Philadelphia region. Our team of highly skilled fertility experts combines the most cutting-edge techniques and treatments with a warm and supportive approach to female fertility for individuals of all genders and circumstances with uteruses.
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Understanding Female Infertility
Female infertility is defined as the inability to conceive a child or carry a pregnancy to full term, despite having regular, unprotected sexual intercourse. In general, if you are a woman under the age of 35 who has been trying to conceive for a year, it’s recommended that you see a fertility specialist; however, if you’re over the age of 35, it’s recommended that you see a fertility specialist after six months of trying to conceive. Although female infertility is most closely associated with age, it is very common and can happen to anyone regardless of age, race, ethnicity, sexual orientation, or gender identity.
Recurrent Pregnancy Loss and Infertility
Recurrent pregnancy loss (RPL) is defined as two or more consecutive pregnancy losses before 20 weeks gestation. In other words, a woman is able to conceive but is unable to carry the pregnancy to full term. RPL can be caused by various factors, but in many cases, the cause remains unknown.
Causes of Female Infertility
Infertility in women can result from various factors, such as age, hormonal imbalances, structural abnormalities in the reproductive system, ovulation disorders, and other medical conditions.
Age and Female Fertility
One of the most common causes of infertility in women is age. Women are born with a set number of eggs, which drops dramatically around their mid-to-late-30s. Furthermore, the eggs that remain are more likely to have quality issues, making it difficult for fertilization or implantation to successfully occur.
Hormonal Imbalances
Hormones are chemical messengers that control nearly every bodily function, including reproduction and fertility. Hormonal imbalances in women, such as those caused by polycystic ovary syndrome (PCOS), can cause a wide range of fertility issues, including ovulation dysfunction, ovarian cysts, endometrial abnormalities, and more.
According to the World Health Organization (WHO), PCOS affects an estimated 8–13% of reproductive-aged women, and up to 70% of affected women remain undiagnosed worldwide. It’s the most common cause of anovulation (lack of ovulation or regular periods) and a leading cause of infertility.
Structural Abnormalities
Female infertility is sometimes caused by structural abnormalities of one or more of the reproductive organs, including the uterus, fallopian tubes, or cervix:
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Uterine Abnormalities: The uterus, also referred to as the womb, is the organ responsible for the implantation and gestation of the embryo. One type of uterine abnormality that can interfere with implantation is a uterine septum, which is when a wall-like structure forms a divide in the uterus. The uterus also sometimes develops non-cancerous growths, such as fibroids or polyps, both of which can inhibit uterine function.
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Fallopian Tube Abnormalities: The fallopian tubes are two tubes that connect each ovary to the uterus; not only do they provide a path for released eggs to travel, but the fallopian tubes also serve as the place where the sperm meets the egg and attempts fertilization. Common fallopian tube abnormalities include blockages and tubal adhesions, which is when bands of scar tissue form within the fallopian tubes. These abnormalities can impact fertility by restricting the egg’s ability to reach the uterus or become fertilized by sperm.
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Cervical Abnormalities: The cervix is essentially the gateway between the uterus and the vagina. One of its main functions is to allow fluids, such as menstrual blood and semen, to travel freely between the vagina and the uterus. Abnormalities such as cervical stenosis (i.e., narrowing of the cervical opening) and cervical polyps (i.e., benign growths on the cervix) can interfere with the sperm’s ability to enter the uterus.
Ovulation Disorders
Ovulation refers to when the ovary releases a mature egg into the fallopian tubes. For pregnancy to occur naturally, sperm must be present in the fallopian tubes at the exact right time of ovulation. However, conditions such as primary ovarian insufficiency (i.e., also sometimes referred to as premature menopause) and polycystic ovary syndrome (PCOS) can disrupt ovarian function, making it difficult to get pregnant without medical intervention.
Other Factors that Can Impact Female Fertility
Female infertility can sometimes be caused or exacerbated by a wide variety of lifestyle and environmental factors, including:
- Smoking
- Alcohol consumption
- Drug use
- Obesity
- Poor nutrition
- Stress
- Excessive exercise
- Environmental toxins
- Occupational hazards
- Sexually transmitted infections (STIs), especially if untreated
- Previous reproductive surgeries, such as tubal ligation or removal of fibroids
- Certain medications, such as chemotherapy drug
- Genetic factors
- Hormonal contraceptives, although any fertility issues are typically temporary
Diagnosis of Female Infertility
Diagnosing female infertility generally involves taking a detailed medical history and performing a physical examination to investigate possible fertility issues. This can include hormone testing, ovarian reserve testing, ultrasound imaging, genetic testing, and diagnostic procedures (e.g. hysterosalpingography, laparoscopy, etc.). The information gathered from these tests will help the fertility specialist individualize the best course of treatment for each patient.
Female Infertility Treatments
Common treatment options for female infertility include:
- Intrauterine insemination (IUI): A type of artificial insemination that allows physicians to inject sperm directly into a patient’s uterine cavity during an optimal time of ovulation.
- In vitro fertilization (IVF): The process of fertilization by extracting eggs, obtaining a sperm sample, manually combining them in a laboratory dish, and transferring the resulting embryo(s) into the uterus.
- Egg Freezing: The process of cryopreserving eggs for future use.
- Invocell (IVC): An FDA-cleared fertility assist that relies on an intravaginal device rather than a laboratory incubator to sustain an embryo through its earliest days.
- Third-party reproduction: Using donor eggs, donor sperm, or gestational surrogacy to conceive.
