What is female infertility
Female causes of infertility explain around one-third of all cases investigated. The good news is that today almost all cases of female infertility are amenable to fertility treatment.
Causes of female infertility
Causes of female infertility might be physical (such as damaged Fallopian tubes), hormonal (as in irregular cycles), or simply age-related. Lifestyle factors such as diet, alcohol consumption and stress may also contribute to reduced levels of fertility.
Fertility and age
The most common explanation for female infertility is simply ageing. Studies have shown that fertility begins to stall after the age of 35, and by the age of 40 is in a steep decline. More and more women are delaying the birth of their first children until home and career are well established, but this is often at the expense of their natural fertility.
The main explanation for age-related infertility is simply the approaching end of a woman’s reproductive life. This ‘ovarian reserve’ - a measure of female fertility during the reproductive years can be tested by hormone levels and ultrasound.
These tests will give an idea of remaining fertility, but, once gone, eggs can never be replaced. It is also known that the genetic quality of eggs deteriorates with age, such that embryos become less viable and chromosome disorders more likely.
Damage to the Fallopian tube
IVF was originally developed to by-pass damage to the Fallopian tubes. Damage can be caused by a natural defect such as endometriosis, by infection following pelvic inflammatory disease or from pelvic surgery. Blockage in the Fallopian tube can prevent a sperm from reaching an egg released from the ovary at ovulation or the fertilised egg reaching the uterus. It may also increase the risk of ectopic pregnancy where the fertilised egg implants in the Fallopian tube rather than in the uterus.
Damage to the Fallopian tubes can be detected by an ultrasound scan and/or through a laparoscopy procedure (which will confirm the extent of the damage and whether surgery or IVF is the best treatment option).
The good news is that most women can be helped by IVF treatment as by collecting the eggs directly from the ovaries and fertilising them outside of the body avoids the use of the Fallopian tubes.
Hormonal disorders and Polycystic Ovarian Syndrome (PCOS)
Irregular or absent periods are common and are usually the sign of a hormonal problem. This is can be associated with polycystic ovarian syndrome (PCOS) which usually means cysts can be seen on the ovaries or high levels of (male) hormones in the body. PCOS can often be resolved by weight loss and medication. Depending on the severity, Intrauterine Insemination (IUI) or IVF may be required.
Endometriosis is a condition in which tissue normally formed in the uterus develops elsewhere in the reproductive tract. This common condition can cause pain and disrupt pregnancy in both natural and assisted reproduction. Surgery may sometimes be necessary.
Miscarriage is one of the most common complications of pregnancy, with as many as 25-50% of women experiencing one or more early miscarriages. Today's most usual explanation for miscarriage is a chromosomal abnormality in the egg and resulting embryo, and this is correlated with maternal age. The older the age of the mother, the greater is her risk of a chromosomal abnormality and thus her risk of miscarriage. However, there are other known causes too, including a condition known as antiphospholipid syndrome, infection, and anatomical factors.
Recurrent miscarriage (in the UK) is defined as three or more consecutive pregnancy losses and can affect as many as 1% of all couples trying to have a baby. The risk increases with age. It can be heart-breaking for women and couples when a miscarriage occurs as each new pregnancy brings hope and anxiety.
Fertility test for women
To diagnose any fertility issues, we recommend a Fertility MOT. A fertility test for women includes a pelvic ultrasound scan, blood test and consultation with a fertility specialist. The blood test will measure a hormone known as Anti Mullerian Hormone (AMH), which will give an indication of your ovarian reserve. The scan will check for any polyps, fibroids, cysts or other problems likely to affect fertility. After the tests, results will be discussed during a consultation. This will also give you the opportunity to discuss your medical history and lifestyle and provide advice on maximising your fertility potential.