A pregnancy is the successful result of an amazingly complex set of processes:
- the woman’s body must release an egg cell from one of her ovaries (ovulation)
- the egg must move through her fallopian tube towards the uterus (transport)
- a sperm cell must get to the egg and penetrate it (fertilization)
- and the fertilized egg must attach itself to the uterine lining (implantation).
Infertility can be the result of a problem with one or more of these processes.
In this article, we look at some of the most common reasons for infertility in women, their typical symptoms, and what you can do to overcome them.
What is it? Endometriosis is a very common, but often undiagnosed, condition. It occurs when the tissue which normally lines your uterus – the endometrium – starts growing outside the uterus too, typically on your ovaries or your bowel.
This wild-growing tissue behaves just like it would in the uterus: it thickens throughout your cycle, then breaks down and bleeds when menstruation sets in.
However, unlike the uterine lining, the bleeding tissue can’t exit your body through the vagina. It stays trapped, gets irritated and often painful. It can also form scar tissue or abnormal adhesions that bind organs together, often affecting the functions of the ovaries, the uterus and the fallopian tubes.
Symptoms: The symptoms of endometriosis vary a lot, and some women suffering from the condition have no symptoms at all.
Pelvic pain is a common symptom, and it can occur before, during or after your period. Many women with endometriosis have severe, sometimes debilitating, menstrual pains. Some also experience pain during exercise, sex, or bowel movements.
Another common symptom is abnormal bleeding, such as very heavy periods, bleeding between periods, or bleeding after sex. Fatigue, depression and mood swings are also typical.
What you can do: You will not be able to cure endometriosis on your own, but you can alleviate some of the symptoms. Endometriosis is an estrogen-responsive disease, and the symptoms often improve when estrogen production is reduced. Evening Primrose Oil, Dong Quai and Vitex are all herbs that ease symptoms for some women. As always, ask your doctor’s advice before using herbal medicine.
Treatments: Endometriosis is usually treated with medication or surgery. Hormonal therapy can slow the growth of endometrial tissue, but will not cure the condition.
Learn more: endometriosis.org
Ovulatory disorders are one of the most frequent causes of female infertility. They include problems with the development of eggs, the release of eggs, or the timing of egg development and release, and are usually caused by hormonal imbalance.
POLYCYSTIC OVARIAN SYNDROME (PCOS)
What is it? Polycystic ovarian syndrome (PCOS) is a very common cause of female infertility. This endocrine disorder is characterized by numerous cysts on the ovaries, elevated levels of androgens (male hormones), and reduced insulin sensitivity.
Symptoms: Irregular periods, prolonged bleeding, or no periods at all, are typical PCOS symptoms. The male hormones may cause excess facial and body hair growth, oily skin and acne. Because of the reduced insulin sensitivity, obesity is also common in women with PCOS.
Not all PCOS patients have all of the symptoms, and each symptom can be mild or severe.
What you can do: If you are overweight, losing weight – even just a little – can greatly improve the symptoms. Eating a low glycemic index (GI) diet may be very beneficial, as it helps reduce insulin levels. Learn more
Treatments: There is no cure for PCOS, but it is possible to treat the symptoms.
When a woman with PCOS wants to get pregnant, the first treatment is usually clomifene, an ovulation-stimulating drug. If the clomifene treatment is unsuccessful, the doctor may prescribe metformin, a drug that can lower insulin and blood sugar levels.
Finally, a minor surgical procedure called laparoscopic ovarian drilling can be performed to destroy the tissue that’s producing androgens, which may restore the normal functioning of the ovaries.
Learn more: PCOS Awareness Association
What is it? Less common than PCOS, hypothalamic amenorrhea occurs when the hypothalamus – a gland in the brain – fails to produce enough gonadotropin-releasing hormone (GnRH), the hormone that “kicks off” the menstrual cycle. Underlying causes include very low body weight or body fat percentage, rapid weight loss, extreme exercising, and emotional or physical stress.
Symptoms. The main sign of the condition is the absence of menstrual periods. Some women with hypothalamic amenorrhea also experience low libido (sex drive), sleep disturbances, depression or anxiety.
What you can do: The best treatment for hypothalamic amenorrhea is often self-treatment. Reducing stress, increasing your weight to a healthy level, and decreasing the intensity of exercise can be enough to get your cycles back on track. Psychological support can be of great help in the process.
Treatments. If the above lifestyle changes don’t improve the condition, your doctor may prescribe ovulation-inducing medication or more advanced reproductive technologies.
Learn more: noperiodbaby.blogspot.com
PREMATURE OVARIAN FAILURE
What is it? While the ovarian function naturally declines as women age, until ovulation and menstruation stops completely at menopause, in some women this ovarian failure occurs too early, sometimes as early as the teenage years.
The underlying cause can be a genetic disorder, an autoimmune disease, or chemotherapy or radiation therapy. A family history of premature ovarian failure increases your risk of developing the disorder.
Symptoms: The symptoms of premature ovarian failure are similar to those of women going through menopause: irregular periods, hot flashes and night sweats, mood swings, and reduced libido (sex drive).
What you can do: If you are under 40 years old and have irregular periods in combination with other menopause-like symptoms, see your doctor. Premature ovarian failure is not only a fertility problem, it’s an endocrine disorder with important health implications.
Treatments: Premature ovarian failure is typically treated with hormone replacement therapy, which helps prevent complications such as osteoporosis.
Unfortunately, infertility is harder to treat and advanced reproductive technologies such as egg donation may be required.
Learn more: The Infertility Voice
What is it? Prolactin is a hormone produced in the pituitary gland, primarily associated with the secretion of breast milk. Excess levels of this hormone in non-pregnant or breastfeeding women can disrupt the normal production of other hormones, inhibiting ovulation.
Hyperprolactinemia is sometimes caused by a small, usually benign tumor in the pituitary called a prolactinoma. Certain prescription medicines can also increase prolactin levels.
Symptoms: Hyperprolactinemia symptoms include irregular or missed periods, decreased menstrual flow, reduced libido (sex drive), vaginal dryness and pain during intercourse, and abnormal production of breast milk. Large prolactinomas can sometimes cause headaches and vision problems.
What you can do: Clinical studies have shown that Vitex (chasteberry) can have a beneficial effect on mild hyperprolactinemia. Do consult your doctor before taking any herbal medicines for fertility-related problems.
Treatments: Prescription medication can block prolactin production in the pituitary. In rare cases, surgery can be used to remove a prolactinoma.
Learn more: hormone.org
What is it? The thyroid is as small gland situated at the base of your neck, just below the Adam’s apple. The hormones produced by the thyroid regulate a multitude of processes in your body, and an overactive or underactive thyroid may disturb or inhibit ovulation.
Symptoms: Hypothyroidism, or underproduction of thyroid hormones, slows down the metabolic processes in your body. This leads to symptoms such as irregular periods or heavy and long-lasting bleeding, increased sensitivity to cold, frequent tiredness and weakness, slow and sluggish movements, constipation and muscle cramps.
Hyperthyroidism, or overproduction of thyroid hormones, is less common. Typical symptoms include longer menstrual cycles and lighter bleeding, increased sensitivity to heat, sudden weight loss, appetite changes, frequent bowel movement, irritability and insomnia.
What you can do: If you suspect that you have a thyroid disorder, see a doctor. Thyroid dysfunction is not only a potential fertility problem, it’s also associated with an increased risk of miscarriages and pregnancy complications.
In order to prevent thyroid dysfunction, make sure you get enough iodine. Good sources of iodine include iodized table salt, seaweeds, dairy and saltwater fish. If your diet is poor in iodine, you may want to consider taking a supplement. Be aware that too much iodine can also cause problems, so don’t take supplements if you’re not sure you need it. Ask your doctor for advice before taking any supplements.
Treatments: The underproduction of thyroid hormones is treated with hormone replacement therapy, usually for life. Excess thyroid hormone production can be treated with anti-thyroid medication, radioactive iodine, or surgery.
Learn more: Thyroid.org
TUBAL INFERTILITY (DAMAGED FALLOPIAN TUBES)
What is it? The fallopian tubes are a pair of narrow tubes which connect each of your ovaries to the uterus. After ovulation, the egg moves into one of the fallopian tubes where it can meet the sperm cells and get fertilized. The fertilized embryo then continues the journey through the fallopian tube and to the uterus where it implants.
When the fallopian tubes are blocked or damaged, they can prevent sperm from getting to the egg or hinder the passage of the fertilized egg into the uterus.
The most common cause of blocked fallopian tubes is pelvic inflammatory disease (PID), which is often the result of a sexually transmitted disease such as chlamydia. Tubal damage can also be caused by scar tissue from surgery or endometriosis (see below), or by uterine fibroids.
Symptoms: The only symptom of blocked or damaged fallopian tubes is the inability to conceive.
What you can do: If you have ever had pelvic inflammatory disease and you have been trying to conceive for a little while, ask for tubal infertility investigation sooner rather than later.
Treatments: If you have one open tube, you can still get pregnant, although it may take a bit more time. Your doctor may prescribe ovulation-stimulating drugs such as clomifene, to increase your chances of ovulating on the side with an open tube.
If both tubes are blocked, surgery can open tubes or remove scar tissue. If the tubal damage is important, your doctor may suggest in vitro fertilization, which bypasses the fallopian tubes.
Learn more: Wikipedia
UTERINE OR CERVICAL INFERTILITY CAUSES
Uterine or cervical abnormalities include problems with the opening of the cervix or the cervical mucus, or abnormalities in the shape or cavity of the uterus.
What is it? Pelvic adhesions are bands of scar tissue that cause different organs in the abdomen or pelvis to grow together. For example, an ovary can become attached to the top of the vagina or the pelvic sidewall, and this can disturb its normal functions.
Typical causes of such adhesions are surgery (such as removal of an ovarian cyst), appendicitis, endometriosis, and infections – including infections that go unnoticed.
Symptoms: The symptoms depend on the location and severity of the adhesions. Many women don’t have any symptoms other than infertility. Some suffer pelvic pain with a “pulling” sensation, nausea, or constipation.
What you can do: If you have had previous surgery in the pelvic area and are struggling to get pregnant, ask your doctor to consider looking for pelvic adhesions. You may need hysterosalpingography and/or endoscopy, as many adhesions can’t be seen with X-rays.
Treatments: The only effective treatment for pelvic adhesions is surgery.
Learn more: pelvicpain.org.uk
What is it? Uterine fibroids, or myomas, are benign (non-cancerous) tumors that grow from the muscle tissue of the uterus. They are quite common, and usually don’t cause fertility problems. But depending on the size and location of the fibroids, they can prevent the sperm from reaching the eggs, prevent the eggs from reaching the uterus, or disturb implantation.
Symptoms: Uterine fibroids are often symptom-free, but in some women they can cause painful periods and heavy bleeding, frequent urination, pelvic pain and constipation. An ultrasound scan is usually sufficient to diagnose uterine fibroids.
What you can do: There is no known self-treatment for uterine fibroids, but herbal medicines that reduce estrogen levels, such as Vitex, can alleviate the symptoms. Consult your doctor before taking any herbal remedies for fertility-related problems.
Treatments: If you have uterine fibroids that are causing fertility problems, the most likely treatment is surgical removal.
Learn more: uterine-fibroids.org
PELVIC INFLAMMATORY DISEASE (PID)
What is it? Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. In most cases, it is caused by a bacterial infection that spreads from the vagina or cervix and up to the uterus, ovaries and fallopian tubes. It is often a complication of an untreated sexually transmitted disease, such as gonorrhea and chlamydia.
PID can cause irreversible damage to the reproductive organs, especially scarring of the fallopian tubes, and is a common cause of infertility.
Symptoms: PID doesn’t always cause any obvious symptoms. Some women experience pelvic pain, pain during intercourse and/or urination, bleeding between periods, or a discolored (yellowish or greenish) and smelly vaginal discharge.
What you can do: If you suspect that you may have PID or a sexually transmitted disease, see your doctor immediately.
Treatments: Mild cases of PID can often be successfully treated with antibiotics. If the infection has caused an abscess, surgery may be required.
Learn more: MedlinePlus
OTHER CAUSES AND UNEXPLAINED INFERTILITY
What is it? Certain medical conditions and/or their treatment can indirectly lead to infertility. Women with untreated celiac disease and asthma, for example, have higher infertility rates than other women.
Many cancers, especially female reproductive cancers, also affect fertility. The same is true for both radiotherapy and chemotherapy. Other medications can also cause temporary infertility.
Finally, in some cases, a cause is never found. Unexplained infertility can be the most frustrating diagnosis of all.
What you can do: Talk to your doctor about your plans to get pregnant if you receive medical treatment for any health problem, even if it seems completely unrelated to fertility.
Make sure that the infertility investigation has thoroughly covered the male partner. About a third of infertility cases are due to a male factor only.
Do your best to optimize your health and fertility by maintaining a healthy weight, eating well, and getting enough exercise. Mind-body exercises such as meditation can help reduce the inevitable stress caused by the situation.
Treatments: If no infertility cause is found, most couples will be advised to keep trying to get pregnant naturally (so-called “expectant management”). After one or two years of trying unsuccessfully, assisted reproduction can be offered. Treatment options include ovarian stimulation, intrauterine insemination (IUI), and in vitro fertilization (IVF).