Infertility in woman: types, causes, symptoms, diagnosis and management

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

It would be an understatement to say that infertility, or the inability to get pregnant, is distressing and challenging for any woman. Society judges women based on whether they can give birth or not. Women are often subject to violence and divorce as a result of infertility. Not surprisingly, most women dealing with infertility also have mental health issues and feel less worthy and underconfident. Infertility in women can result from various factors, including ovulatory disorders, structural issues in the reproductive system, and hormonal imbalances, often necessitating medical evaluation and treatment.

Technically, a woman is diagnosed with infertility if she is below 35 years old and has been unsuccessful in getting pregnant even after trying for a year. The period is six months for women over 35 years of age. However, it is prudent to consult a gynecologist early if you are planning a family and have a history of endometriosis, PCOD, pelvic infections, abortions, etc.

In This Article

Causes of Infertility in Women

The female reproductive system consists of:

Ovaries: There are two ovaries, one on each side. The right and left ovaries alternately release a mature egg every menstrual cycle.
Fallopian tubes: These are tubes that pick up the egg and carry it to the uterus.
Uterus, Vagina, and Cervix: If the egg is fertilized, the resulting embryo gets implanted in the uterus. However, if the egg is not fertilized, the lining of the uterus is shed during periods.

Infertility in women can occur if there is an issue with:

1. Ovulation

The ovaries do not produce sufficient eggs or ovum in the following conditions:

2. Poor quality of ovum

3. Blocked or damaged fallopian tubes

It can prevent the sperm from reaching the egg or hinder the egg’s journey to the uterus. It can be a result of pelvic inflammatory disease (PID), ectopic pregnancies, or surgeries in the area.

4. Uterine or cervical problems

Abnormalities in the uterus, including fibroids, polyps, or structural issues, may interfere with implantation or the ability to carry a pregnancy full term.

5. Endometriosis

This condition occurs when the tissue lining the uterus grows outside of it, causing inflammation, scarring, and potential fertility problems.

6. Other Factors

Types of Infertility in Women

Infertility in women is usually classified as:

Primary Infertility Primary infertility refers to a condition where a woman has never been pregnant and cannot conceive and carry a pregnancy to term for the first time.
Secondary Infertility Secondary infertility is a condition where a woman cannot get pregnant after at least one successful pregnancy and delivery.
Unexplained Infertility As the name suggests, no known reason for infertility is found despite thorough medical evaluations.

Symptoms of Female Infertility

Infertility in women may not always present with specific symptoms. Many women may not find any noticeable signs of infertility until they try to conceive without success. However, certain signs and symptoms that are common in a few cases include:

Irregular or Absent Menstrual Periods Menstrual irregularities, such as infrequent periods or an absence of menstruation (amenorrhoea), could indicate ovulation problems or hormonal imbalances that affect fertility.
Painful or Heavy Periods Severe menstrual cramps (dysmenorrhea) or abnormally heavy bleeding during periods (menorrhagia) can sometimes be associated with conditions like endometriosis or uterine fibroids, which can impact fertility.
Abnormal Bleeding between Periods Unusual bleeding or spotting, besides the regular menstrual cycle, might suggest hormonal imbalances or issues with the uterus or cervix.
Pelvic Pain or Discomfort Chronic pelvic pain or pain during intercourse (dyspareunia) can be a symptom of conditions like endometriosis, pelvic inflammatory disease (PID), or uterine fibroids, which can contribute to infertility.
Hormonal Changes Symptoms like excessive facial hair growth, acne, or sudden weight gain or loss might indicate hormonal imbalances, such as polycystic ovary syndrome (PCOS), which can affect ovulation and fertility.
Previous Reproductive Issues A history of certain conditions, such as sexually transmitted infections (STIs), pelvic surgeries, or prior ectopic pregnancies, can increase the risk of fertility problems.

If you are concerned or suspect fertility issues, consult a healthcare professional or a fertility specialist. They will conduct a thorough evaluation to determine the underlying cause and provide appropriate guidance and treatment options.

Diagnosis of Infertility in Women

The diagnosis of infertility in women involves a complete checkup to find out the underlying causes or factors. It may include the following steps:

Medical History Review The healthcare provider will discuss your medical history, including any previous pregnancies, menstrual cycles, past surgeries, and any known conditions that may affect fertility.
Physical Examination They will conduct a thorough physical examination to assess overall health and identify any signs of hormonal imbalances, structural defects, or other possible reasons contributing to infertility.
Ovulation Assessment It is crucial to make sure that the eggs are being released regularly. Tracking menstrual cycles, measuring basal body temperature, or using ovulation predictor kits are some methods to evaluate ovulation. Your doctor will order blood tests to measure hormone levels during different phases of the menstrual cycle.
Hormonal Testing The doctor will order blood tests to measure hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and thyroid function tests. These tests help assess ovarian function and detect hormonal imbalances that may impact fertility.
Imaging Studies Transvaginal ultrasound is the most preferred imaging technique used to visualize the reproductive organs, including the ovaries, uterus, and fallopian tubes. This can help identify structural abnormalities, uterine fibroids, polyps, or other conditions that could affect fertility.
Hysterosalpingogram (HSG) This is an X-ray procedure where a dye is injected into the uterus and fallopian tubes to assess tubal patency and detect any blockages or abnormalities.
Laparoscopy A surgical procedure called laparoscopy may be performed to visualize the pelvic organs directly. This is particularly useful for diagnosing conditions such as endometriosis, pelvic adhesions, or ovarian cysts.
Genetic Testing In cases where genetic factors are suspected, genetic testing is recommended to identify any chromosomal abnormalities or genetic disorders that could impact fertility.
Other Specialized Tests Depending on the suspected causes, the doctor will order additional tests, such as testing for specific infections (e.g., sexually transmitted infections), autoimmune disorders, or immune system evaluations.

It is essential to work closely with a healthcare professional or a fertility specialist to undergo a comprehensive evaluation and receive an accurate diagnosis.

Treatment and Management

The management of infertility in women depends on the underlying cause(s) identified through a comprehensive evaluation. Some common approaches and treatments used in the management of female infertility are:

Ovulation Induction If anovulation or irregular ovulation is the cause of infertility, medications may be prescribed to stimulate the ovaries and promote regular ovulation.
Assisted Reproductive Technologies (ART) ART procedures, such as in vitro fertilization (IVF), are commonly used to address various causes of infertility. During IVF, the eggs are retrieved from the ovaries, fertilized with sperm in a laboratory, and the resulting embryos are transferred into the uterus.
Intrauterine Insemination (IUI) In cases where there are no severe female factor issues, IUI may be recommended. This procedure involves placing specially prepared sperm directly into the uterus around the time of ovulation to increase the chances of fertilization.
Surgery Surgical interventions may be required to address structural abnormalities affecting fertility. For instance, surgical removal of uterine fibroids, treatment of endometriosis, or repair of damaged fallopian tubes may be performed to improve fertility outcomes.
Hormonal Therapy Hormonal imbalances, such as those associated with polycystic ovary syndrome (PCOS) or thyroid disorders, can be managed with medications to restore hormonal balance and regulate ovulation.
Lifestyle Modifications Certain lifestyle changes, such as maintaining a healthy weight, adopting a balanced diet, reducing stress levels, avoiding smoking and excessive alcohol consumption, and managing chronic medical conditions, can improve the prospects of getting pregnant.
Psychological Support Infertility can be emotionally challenging, and counseling or support groups may be beneficial in providing emotional support and coping strategies during the fertility journey.

Conclusion

It’s important to note that the appropriate management strategy will depend on the specific diagnosis and individual circumstances. Each case is unique, and treatment plans should be personalized based on the couple’s needs and preferences. Consulting with a fertility specialist or reproductive endocrinologist is crucial to receiving an accurate diagnosis, guidance, and appropriate fertility treatment options.