Infertility is a challenging issue that affects many couples worldwide, impacting people of all genders. But female infertility in particular is a common problem, affecting millions of people with female reproductive organs worldwide. (1)
This article is pending medical review.
Contributors
Written by Sophie Oppelt
Reviewed by Marjan Naghdi, Lea Dörner
Edited by Juliëtte Gossens
Infertility in women is defined as the inability to become pregnant or to carry a pregnancy to full term after one year of unprotected sex. This applies when you’re under the age of 35. For those aged 35 and older, you’re said to be infertile after six months of unprotected sex (1). You might think of being completely unable to become pregnant when you hear the term “infertility”. In reality, it’s about the journey to pregnancy being longer or more difficult. Being truly infertile – when there’s zero possibility for you to become pregnant naturally – is very rare. That’s why you might also hear the term “subfertility”. That term reflects most people’s situation a bit more accurately.
It’s important to know that infertility (or subfertility) can be caused by male or female factors, or a combination of both. That’s why both partners should be evaluated and treated for infertility if necessary. Infertility can be a temporary or permanent condition. The likelihood that you’ll become pregnant (or cause a pregnancy) varies depending on the underlying cause and how effective treatment will be.
There are various reasons for why you may experience infertility. This article will discuss some of the common causes and treatment options.
What we're covering
How common is infertility?
Causes of female infertility
Diagnosis
Treatment
How Common Is Infertility?
Female infertility affects about 10-15% of biological females of reproductive age worldwide, according to the World Health Organization (WHO) (1). It’s more common as you become older: biological females over the age of 35 are more likely to face challenges becoming pregnant.
Additionally, certain risk factors can increase the likelihood of experiencing infertility. This includes a history of sexually transmitted infections (STIs), endometriosis or PCOS, or previous surgery in your pelvis or belly (2).
Infertility can affect people of all races, ethnicities, socioeconomic backgrounds, and geographic locations. In some areas, some groups of people experience a higher rate of infertility than others. For example, in the United States, Black women and Hispanic women are more likely to experience infertility (3–5). Lower access to fertility care probably explains part of this difference.
Causes of Female Infertility
There are many possible reasons for female infertility. That’s why you should discuss your particular case with your doctor to find the reason and the right treatment for you. Here, we list some of the most common causes, but they might not apply to your case.
Ovulation disorders: Ovulation disorders occur when a person with ovaries has irregular or no ovulations. This means their ovaries aren’t releasing eggs regularly. Common causes of ovulation disorders include hormonal imbalances such as in polycystic ovary syndrome (PCOS), thyroid disorders, obesity and underweight. (2,6)
Fallopian tube blockage: Your fallopian tubes transport your eggs and embryos toward the womb. When they’re blocked or damaged, fertilization of the egg by sperm might be prevented. Fertilized eggs (zygotes) might also not make it to the womb to nestle and grow. This can, for example, be caused by pelvic inflammatory disease (PID), endometriosis, or previous pelvic surgery. (2,6)
Uterine or cervical abnormalities: Abnormalities in the uterus or cervix can prevent fertilization or the implantation of fertilized eggs. Such abnormalities could include uterine fibroids, polyps, or abnormal cervical mucus (slime). (2)
Age-related infertility: As a person’s age increases, their fertility declines. Ultimately, this might lead to difficulty in becoming pregnant. This is because your egg quality and quantity declines over time. You don’t produce new eggs every month but are born with your total number of eggs – and each month’s menstrual cycle brings this total down over the years. (7)
Other factors: Other factors that can contribute to female infertility include autoimmune disorders, cancer treatments, and certain medications (2, 6). If you are concerned about this, talk to your healthcare provider. They can tell you if this can be a reason for your problems conceiving.
Diagnosis of Female Infertility
In order to diagnose female infertility, your doctor will want to take a thorough medical history, do a physical examination, and maybe perform additional tests.
The following are some of the most common diagnostic tests for female infertility:
Hormone testing: Blood tests for the evaluation of hormone levels. This can help detect ovulation issues and other hormonal imbalances. These can affect your fertility, because the reproductive system largely relies on your hormones. The most common hormone levels your doctor could want to determine include follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone and thyroid-stimulating hormone (TSH). These all work together in your body to create your menstrual cycle with its different phases. (6)
Ovarian reserve testing: By investigating your ovarian reserve, your doctor can get some idea of how many eggs you have left. This can help predict the likelihood of success with fertility treatments. You can read more about the ovarian reserve here. (6)
Imaging tests: Ultrasound, hysterosalpingography (HSG), and hysteroscopy can be used to assess the uterus, ovaries and fallopian tubes for abnormalities. Ultrasound can also be used to follow one of your cycles to see what happens.
Laparoscopy: A laparoscopy is a small surgery, in which your doctor inserts a small camera into your belly. Then, they can examine your ovaries, fallopian tubes, and uterus for possible abnormalities. This could be an obstruction, for example. (6)
Genetic testing: Genetic testing can provide insights into identifying possible genetic mutations that may contribute to infertility. One example is when you or your partner carry chromosome abnormalities. This could not have any effect on yourself, but could lead to a zygote or embryo that isn’t viable, meaning it can’t grow in a healthy way. (6)
Cervical mucus testing: Cervical mucus testing can help determine the quality and quantity of your cervical mucus (part of your discharge), which is important for sperm motility and fertilization.
Once your doctor knows the reason for your infertility, they can create a treatment plan together with you. Luckily, female infertility is often treatable or manageable with the right timing, medication or sometimes surgery.
Treatment Options for Female Infertility
The treatment options for female infertility always depend on why you’re infertile. Every case is different, which makes it so important that you discuss your specific case with your doctor to find the best treatment approach for you. Common treatment options include the following:
Fertility medications: Fertility medications, such as Clomid and Letrozole, can be used to stimulate ovulation in people with ovaries and a uterus who are experiencing ovulation disorders. One of the most common disorders treated this way is PCOS. (2, 6)
Surgery: Some abnormalities in the uterus or fallopian tubes that can cause infertility, can be corrected surgically. Only your doctor can say if that’s possible in your case.
Assisted reproductive technology (ART): ART comes in a range of procedures that can be used to help people get pregnant. These include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and gamete intrafallopian transfer (GIFT). You can read more about ART procedures here. (1, 2 ,6)
Donor eggs or embryos: In case your eggs are of poor quality or quantity, donor eggs or embryos can be used for fertilization. Note that it can be difficult to find donors in many countries, due to strict laws.
Lifestyle changes: Making certain lifestyle changes, such as losing or gaining weight, quitting smoking, and reducing alcohol consumption can also improve fertility if applicable to you. (1, 2, 6)
In conclusion, female infertility is a common problem that affects millions of women worldwide. The causes of female infertility are diverse, and the treatment options always depend on the underlying cause of the condition. If you’re having trouble conceiving, you can seek help from a doctor to see what the cause is and what your options are.
Infertility can also have a significant psychological impact on you and your partner. The inability to conceive or carry a pregnancy to term can lead to feelings of grief, shame, guilt, and depression. The condition can also put strain on relationships, leading to feelings of isolation and social withdrawal. Undergoing fertility treatments can also be physically and emotionally demanding, which could lead to additional stress and anxiety. (8)
In addition, pressure from society or from people around you to have children can make the psychological burden of infertility worse, which leaves many people feeling inadequate or like a failure. It’s really important that you and your partner seek emotional support from friends, family, or a mental health professional to help manage these issues. It can also help to get support from communities that are going through the same issue. More people than you probably think deal with fertility problems. Always keep in mind that you are not alone!
References
World Health Organization (WHO). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO 2018.
Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clinical Biochemistry. 2018;62:2-10. DOI: 10.1016/j.clinbiochem.2018.03.012.
Dongarwar D, Mercado-Evans V, Adu-Gyamfi S, Laracuente M, Salihu HM. Racial/ethnic disparities in infertility treatment utilization in the US, 2011–2019. Systems Biology in Reproductive Medicine. 2022;68(3):180-189. DOI: 10.1080/19396368.2022.2038718.
Jain T. Racial disparities and in vitro fertilization (IVF) treatment outcomes: time to close the gap. Reproductive Biology and Endocrinology. 2020;18. DOI: 10.1186/s12958-020-00672-2.
Peck JD, Janitz A, Craig LB. Ethnic and racial differences in the prevalence of infertility: national survey of family growth (NSFG). Fertility and Sterility. 2016;106(3):E8. DOI: 10.1016/j.fertnstert.2016.07.030.
Carson SA, Kallen AN. Diagnosis and Management of Infertility: A Review. JAMA. 2021;326(1):65-76. DOI: 10.1001/jama.2021.4788.
Crawford NM, Steiner AZ. Age-related infertility. Obstetrics and gynecology clinics of North America. 2015;42(1):15-25. DOI: 10.1016/j.ogc.2014.09.005.
Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues in clinical neuroscience. 2018;20(1):41-47. DOI: 10.31887/DCNS.2018.20.1/klrooney.
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