Potential Causes of Female Infertility

1
What Causes Female Infertility?

Young woman sitting on edge of bed, holding head, wondering what causes infertility
There are many possible causes of female infertility. The best treatment for you will depend on what's wrong. Seb Oliver / Getty Images

Between 10 and 15% of couples will experience infertility. This means they will not conceive after at least one year of trying. Of these infertile couples, approximately one-third will discover fertility problems on the woman’s side, another third will find the problem on the man’s side, and the rest will find problems on both sides or receive a diagnosis of unexplained infertility.

What causes female infertility?

In the simplest of terms, female infertility happens when one or more of the following occurs...

  • Something goes wrong with ovulation
  • Something prevents the egg and sperm from meeting
  • Something prevents a healthy embryo from being created (This can be caused by problems on either side.) 
  • Something prevents healthy implantation of the embryo

What can cause these possible fertility problems? Many different diseases, conditions, and situations.

Here are 8 potential causes of female infertility, along with their most common symptoms, how they impact fertility, and fertility treatment options. 

2
Polycystic Ovarian Syndrome (PCOS)

Woman looking in the mirror worried about acne and abnormal hair growth
Women with PCOS may experience acne or unwanted hair growth. Yuri_Arcurs / Getty Images

You’ve probably heard of polycystic ovarian syndrome (PCOS.) PCOS is a common cause of female infertility and affects an estimated 8% of women. 

Women with PCOS may have higher than normal levels of androgens, or “male” hormones. This may lead to problems with acne and unwanted hair growth.

Many but not all women with PCOS struggle with their weight. They may be diagnosed with insulin resistance. 

Upon ultrasound examination, the ovaries of women with PCOS may show tiny pearl-like strings of cysts.

Most common symptoms: irregular or absent menstrual cycles, acne, oily skin, abnormal hair growth, and obesity.

How PCOS causes fertility problems: PCOS causes irregular ovulation. Some women with PCOS won’t ovulate at all. Hormonal imbalance also increases the risk of miscarriage.

Common treatment: Most women with PCOS will be treated with first-line fertility drugs like Clomid or Femera (letrozole.) If this isn’t successful, stronger fertility drugs like gonadotropins may be tried next.

If none of these works, IVF may be tried next.

If insulin resistance is present, treatment with the diabetes drug metformin may be recommended before treatment with fertility drugs start.

Lifestyle recommendations may include weight loss, regular exercise, and diet change.

3
Endometriosis

Woman in bed with menstrual cramps
Women with endometriosis may experience painful periods. vitapix / Getty Images

It’s estimated that 1 in 10 women suffer from endometriosis. Because diagnosis is complicated – it can’t be detected with a simple blood test or ultrasound – many women suffer silently.

To understand endometriosis, you need to know what endometrium is. The endometrium is the tissue that lines the uterus. It thickens and grows every menstrual cycle, preparing the uterus for an embryo.

If pregnancy doesn’t happen, the endometrium breaks down, leaving your body via menstruation.

Endometriosis is when endometrium grows outside the uterus. (This should never happen.) They may form near the ovaries and fallopian tubes, around the urinary and gastrointestinal tract, and even, in rare cases, in the lungs.

The endometrial deposits can cause pain and infertility.

Most common symptoms: extremely painful menstrual, pelvic pain not during menstruation, and pain during defecation and/or urination, especially during your period.

However, some women never have any clear symptoms of endometriosis. The only sign something is wrong may be infertility.

How endometriosis causes fertility problems: endometrial deposits may prevent an egg from getting to the fallopian tubes. Endometriosis can also cause problems with ovulation, especially if endometrial cysts form on the ovaries.

Even if the fallopian tubes are clear and ovulation is taking place, the inflammation caused by endometriosis may interfere with healthy implantation of an embryo. Not everything about endometriosis and fertility is understood.

Common treatment: treatment partially depends on how severe the endometriosis is. (By the way, pain isn’t an accurate predictor of severity. You can have mild endometriosis with terrible pain, or severe endometriosis with no pelvic pain at all.)

Surgical removal of endometrial deposits may be recommended before fertility treatment takes place.

If there are problems with ovulation, fertility drugs may be tried. If the fallopian tubes are blocked, IVF treatment may be required.

Lifestyle changes like diet and exercise may be recommended to help cope with pain, but there is little evidence this will help with conception. 

4
Age-Related Infertility

Hispanic woman lighting birthday candles
With age comes wisdom and fertility problems. JGI/Jamie Grill / Getty Images

Not every cause of infertility is a disease or unnatural condition. Healthy aging is a common cause of female infertility.

While both men and women have decreased fertility as they age, this decline is more pronounced in women.

Most common symptoms: age-related infertility usually has no obvious symptoms.

The odds of experiencing infertility start to increase significantly every year starting at age 35 and get even more pronounced after 40.

Some women will have symptoms, which include changes in menstruation (bleeding becomes lighter), irregular cycles, and vaginal dryness (decreased cervical mucus).

How age causes fertility problems: even if you’re ovulating, egg quality goes down as you age. This is why women over age 35 are at greater risk of having a miscarriage or having a child with a genetic disorder.

Some women will also experience irregular ovulation, in addition to decreased egg quality.

Common treatment: this varies greatly. Some women will be able to conceive with the help of low-tech treatments like Clomid. Others will require stronger fertility drugs and possibly even IVF.

The biggest obstacle with age-related infertility is that fertility drugs aren’t as effective.

For example, while the IVF success rates for the average 31-year-old is 38%, the success rate for the average 43-year-old is just 10%.

This is due to decreased ovarian reserves. Some women will need an egg or embryo donor to conceive.

5
Thyroid Dysfunction

Close up of shoulder, neck, and collarbone, where the thyroid gland is located
Thyroid hormones can impact your fertility. Alyssa B. Young / Getty Images

The thyroid is an essential gland of the endocrine system. Located at the front of the neck and just above your collarbone, the thyroid gland uses iodine to produce specific thyroid hormones. These hormones regulate energy and metabolism throughout the body.

Hypothyroidism is when the thyroid gland doesn’t produce enough of these hormones. Hyperthyroidism (most commonly caused by something known as Graves' Disease) is when the gland overproduces thyroid hormones.

Even though the thyroid gland is not a part of the reproductive system, the hormones it regulates can have an impact on your fertility.

Most common symptoms: for hypothyroidism, fatigue, weight gain, frequently feeling cold, and depression are common symptoms.

In hyperthyroidism, anxiety, getting easily overheated, fatigue, insomnia, and unusual weight loss may occur.

Women with either thyroid disorder may have irregular periods.

How thyroid dysfunction causes fertility problems: whether you have an under or overactive thyroid, either situation can lead to irregular ovulation. This can cause trouble with getting pregnant.

Those with untreated thyroid problems are also at a higher risk of miscarriage and birth defects (if they do get pregnant.)

Women with thyroid dysfunction may also be at increased risk of having other fertility diseases, specifically endometriosis.

Common treatment: as long as there are no additional fertility problems, diagnosis, and treatment of the thyroid problem will regulate the menstrual cycles in most women.

After their hormones are regulated, they may be able to conceive on their own.

6
Obesity

Obese hispanic woman, friend exercising with resistance bands
Weight loss can help obese women conceive without fertility treatment. Susan Chiang / Getty Images

Obesity is a common cause of preventable infertility in both men and women.

According to the American Society of Reproductive Medicine, 6% of women with primary infertility can’t conceive due to obesity.

In some cases, obesity is the result of a hormonal imbalance. For example, both PCOS (especially with insulin resistance) and hypothyroidism can lead to weight problems.

Most common symptoms: irregular cycles, unusually long periods, and heavy bleeding during menstruation may occur. Some women may have their menstrual cycles completely stop. Some women will also experience abnormal hair growth.

How obesity causes fertility problems: fat cells play a role in hormonal regulation. When there are too many fat cells, the body produces excess estrogen.

This impacts the reproductive system. Too much estrogen can signal the reproductive system to shut down, leading to ovulation problems.

Irregular ovulation or anovulation makes conception difficult in obese women.

Common treatment: weight loss via diet and exercise is an effective treatment for obesity-related infertility.

More than 70% of obese women who bring their weight down to a healthier level will conceive on their own without fertility treatment.

If there is a hormonal imbalance causing abnormal weight gain or making normal weight less difficult, this should be treated first. Otherwise, the weight loss plan may be unsuccessful or significantly more difficult to achieve.

If there are other fertility problems, weight loss may not be enough. In this case, fertility treatments may also be needed. 

7
Premature Ovarian Insufficiency (Premature Ovarian Failure)

Her head is filled with worries over premature ovarian failure
Premature ovarian insufficiency (POI) is a difficult condition to treat. Peopleimages / Getty Images

Premature ovarian insufficiency (POI) is when the quantity and quality of eggs in the ovaries are abnormally low before the age of 40. It occurs in less than 1% of women.

POI is sometimes called premature ovarian failure (POF).

With POI, the ovaries may not respond to fertility drugs that stimulate ovulation. This makes it a difficult condition to treat.

Some possible causes of POI include:

  • Congenital or genetic conditions (like Fragile X)
  • Surgical injury to the ovaries
  • Toxin exposure (like from chemotherapy)
  • Unknown – this is true for the majority of cases

POI seems to run in families. If your mother or grandmother had it, you are at risk.

POI also seems to be associated with some autoimmune disorders, including thyroid dysfunction.

Most common symptoms: irregular or absent periods, vaginal dryness, hot flashes, mood swings, and insomnia.

Some women with POI experience no symptoms besides infertility.

How POI causes fertility problems: the quality and quantity of eggs are low. They may not be ovulating at all, or ovulation may be sporadic. If ovulation is occurring, the egg quality may be poor. This lessens the odds of conception.

Women with POI are not only less likely to conceive on their own, they are also more likely to experience failed fertility treatment.

Common treatment: treatment depends on the severity of the condition. In mild situations, fertility drugs, and IVF treatment may help a woman conceive.

It is not impossible for women with POI to get pregnant with their own eggs. An estimated 10% of women will conceive with or without the help of fertility drugs.

With that said, many women with POI require an egg or embryo donor.

8
Premature/Early Menopause

Woman Drinking Coffee Looking Out Window worrying about early menopause
Early menopause often runs in families. Lilli Day / Getty Images

Premature menopause is when menopause occurs before the age of 40.

It is similar to but not the same as premature ovarian insufficiency (POI). With POI, you may still ovulate, and pregnancy with your own eggs may still be possible.

With premature menopause, ovulation has completed ceased. You cannot conceive on your own or with your own eggs.

Early menopause tends to run in families. It can also occur after medical treatment (like chemotherapy) or surgery (like in the surgical removal of the ovaries.)

Some genetic conditions and autoimmune disease may lead to early menopause.

Most common symptoms: absent menstrual cycles for at least 12 months, hot flashes, vaginal dryness, mood swings, and sleep difficulties.

How early menopause causes fertility problems: women in early menopause cannot ovulate at all. Therefore, they can’t get pregnant with their own eggs.

Common treatment: IVF with an egg or embryo donor is the only treatment available.

Fertility drugs can’t be used to stimulate the ovaries after early menopause.

9
Hyperprolactinemia

Close up of woman's chest and neck, women with hyperprolactinemia may have sore breasts
Hyperprolactinemia may cause sore breasts, milky discharge, and infertility. D.Jiang / Getty Images

Hyperprolactinemia is a relatively common but less well-known cause of irregular ovulation in women.

According to the American Society of Reproductive Medicine, 1 in 3 women with irregular periods but otherwise healthy ovaries have hyperprolactinemia.

Prolactin is a hormone that develops the breasts and helps produce breast milk. Prolactin levels are naturally higher during pregnancy and breastfeeding.

Hyperprolactinemia is when prolactin levels are high, but the woman is not pregnant or breastfeeding.

(Note: Men can also get hyperprolactinemia, and it can cause male infertility.)

Most common symptoms: milky discharge from the nipples, irregular or absent periods, painful sex due to vaginal dryness, unwanted hair growth, and acne.

Some women will also have headaches or vision problems. Other women have no obvious symptoms.

How hyperprolactinemia causes fertility problems: usually, prolactin is released when you’re pregnant or breastfeeding.

Besides helping produce breast milk, high levels of prolactin shut down the reproductive system. This way, when you have a breastfeeding infant, you are less likely to get pregnant with another baby.

(The natural suppression of menstruation during breastfeeding is known as lactational amenorrhea.)

With hyperprolactinemia, the reproductive system is suppressed without good reason. Ovulation becomes irregular or completely stops, and this causes infertility. 

Common treatment: treatment depends on the cause of the hyperprolactinemia.

The medications bromocriptine and cabergoline are most commonly used to lower prolactin levels and restore regular ovulation.

Some medications can cause hyperprolactinemia. If this is your situation, your doctor may take you off the problem medication.

Some women experience hyperprolactinemia due to a thyroid problem. Treating the thyroid issue should lower prolactin levels. 

Sources:

G. William Bates, M.D. Abnormal Body Weight: A Preventable Cause Of Infertility. https://www.asrm.org/Abnormal_Body_Weight/

Hyperthyroidism. MedlinePlus.  https://www.nlm.nih.gov/medlineplus/hyperthyroidism.html

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Hyperprolactinemia (high prolactin levels). Fact Sheet. ReproductiveFacts.org. https://www.asrm.org/FACTSHEET_Hyperprolactinemia_Prolactin_Excess/

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