Types of Infertility in Women

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction - Infertility

What is it?

As per data 3.9% to 16.8% of women of age 15 to 49 respectively are infertile in India. But what is it, are there any different types of infertility, there are many questions and we are going to answer them all.

Infertility in women is referred to as a condition where one can’t get pregnant after trying to conceive for 1 year. This is a serious condition, which can be traumatic for a woman. However, if you understand the cause maybe you can cope with the same.

In This Article

What are the types of infertility in women?

1. Primary Infertility

Primary infertility in women refers to the inability to conceive or carry a pregnancy after at least one year of regular, unprotected sexual intercourse without the use of contraception. It is a condition where a woman has never been able to achieve a successful pregnancy.

There can be various factors that contribute to primary infertility in women, including:

Ovulation disorders: Irregular or absent ovulation can make it difficult for a woman to conceive. Conditions such as polycystic ovary syndrome (PCOS) or hormonal imbalances can interfere with the release of mature eggs from the ovaries.
Fallopian tube abnormalities: Blockages or damage to the fallopian tubes can prevent the sperm from reaching the egg or the fertilized egg from traveling to the uterus for implantation. This can be caused by infections, previous surgeries, endometriosis, or pelvic inflammatory disease.
Uterine abnormalities: Structural issues in the uterus, such as uterine fibroids, polyps, or congenital malformations, can affect fertility by interfering with implantation or the development of a healthy pregnancy.
Cervical factors: Certain conditions affecting the cervix, such as cervical stenosis (narrowing of the cervical opening) or cervical mucus abnormalities, can hinder the sperm's ability to enter the uterus.
Endometriosis: This condition occurs when the tissue lining the uterus (endometrium) grows outside the uterus, typically in the pelvic cavity. Endometriosis can cause inflammation, scarring, and adhesions, which can affect fertility.
Age-related factors: As women age, their ovarian reserve (number and quality of eggs) decreases, making it harder to conceive.
Genetic factors: Some genetic conditions can impact fertility in women. For example, certain chromosomal abnormalities or conditions like Turner syndrome can affect the development and function of the reproductive organs.

It is important for women experiencing primary infertility to consult with a healthcare professional, such as a gynecologist or reproductive endocrinologist, who can perform a thorough evaluation to determine the underlying cause and recommend appropriate treatment options. Fertility treatments like ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF) may be recommended depending on the specific diagnosis.

2. Secondary Infertility

Secondary infertility in women refers to a situation in which a woman who has previously given birth to a child is unable to conceive or carry a pregnancy to term despite trying for an extended period (usually one year) without the use of contraception. It is important to note that secondary infertility can affect both women and men, but in this case, we will focus on secondary infertility in women.

There can be various causes of secondary infertility in women, including:

Age: As a woman gets older, her fertility declines, and this can affect her ability to conceive again. The quality and quantity of eggs decrease with age, making it harder to get pregnant.
Ovulation disorders: Conditions like polycystic ovary syndrome (PCOS) or hormonal imbalances can disrupt regular ovulation, leading to difficulties in conceiving.
Fallopian tube problems: Previous pelvic infections, surgeries, or conditions like endometriosis can cause scarring or blockages in the fallopian tubes, which can prevent the sperm from reaching the egg.
Uterine issues: Conditions like fibroids (non-cancerous growths in the uterus) or uterine polyps can affect fertility by interfering with implantation or increasing the risk of miscarriage.
Previous pregnancy complications: Certain complications during a previous pregnancy, such as uterine infections, placenta previa, or preterm labor, may contribute to secondary infertility.
Lifestyle factors: Factors like obesity, smoking, excessive alcohol consumption, and high levels of stress can impact fertility and decrease the chances of conception.

If you are experiencing difficulties getting pregnant again and suspect secondary infertility, it is recommended that you consult with a healthcare provider who specializes in fertility. They can conduct a thorough evaluation, including a medical history and physical examination, and potentially recommend further tests such as hormone assessments, ultrasound scans, or a hysterosalpingogram (HSG) to evaluate the fallopian tubes.

3. Unexplained Infertility

Unexplained infertility in women refers to the inability to conceive despite undergoing a thorough evaluation that does not reveal any specific cause for the fertility issues. It is a frustrating and challenging diagnosis because there is no clear reason identified for infertility. When a woman is diagnosed with unexplained infertility, it means that all the standard tests and assessments conducted on her and her partner have come back to normal.

Several factors could contribute to unexplained infertility, although they may not be readily identifiable through routine testing.

Some possible underlying causes include:

Ovulation issues: Although ovulation appears to be normal, there may be subtle abnormalities that are challenging to detect.
Fallopian tube function: The fallopian tubes may have minor defects or dysfunctions that are not detectable through standard tests.
Uterine abnormalities: There might be structural abnormalities in the uterus that are difficult to identify, such as small polyps or adhesions.
Endometriosis: In some cases, endometriosis may not be evident during diagnostic procedures but could still affect fertility.
Immunological factors: Certain immune system abnormalities might interfere with conception, such as immune reactions against sperm or embryos.
Sperm function or quality: Although sperm parameters may appear normal, there could be subtle issues that impact fertility.
Egg quality: Sometimes, the quality of eggs might be compromised even though they appear normal during evaluation.
Unknown factors: It is also possible that there are currently unidentified factors involved in fertility that medical science has not yet fully understood or detected.

When facing unexplained infertility, couples often undergo various fertility treatments, including assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF). These treatments aim to overcome potential barriers to conception and increase the chances of achieving pregnancy.

It’s important for couples experiencing unexplained infertility to consult with a fertility specialist or reproductive endocrinologist who can provide personalized guidance, conduct further tests if necessary, and recommend appropriate treatment options based on their specific situation.

4. Anovulatory infertility

Anovulatory infertility in women refers to a condition in which a woman is unable to ovulate regularly or at all, which can make it difficult for her to conceive. Ovulation is the process by which a mature egg is released from the ovaries and becomes available for fertilization by sperm. Without ovulation, there is no egg available for fertilization, leading to infertility.

There can be various causes of anovulatory infertility, including:

Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder characterized by enlarged ovaries containing small cysts. It can disrupt the normal hormonal balance and interfere with ovulation.
Hormonal imbalances: Certain hormonal imbalances, such as an excess of prolactin (hyperprolactinemia) or thyroid hormone abnormalities, can disrupt ovulation.
Premature ovarian insufficiency (POI): Also known as premature menopause, POI occurs when the ovaries stop functioning before the age of 40.
Obesity: Excessive body weight can disrupt hormone production and lead to irregular or absent ovulation.
Excessive exercise: Intense physical activity or extreme exercise can disrupt the delicate hormonal balance necessary for regular ovulation.
Chronic conditions: Certain chronic conditions, such as polycystic kidney disease or autoimmune disorders, can interfere with normal ovulation.
Medications: Some medications, such as certain antidepressants or chemotherapy drugs, can affect ovulation.

If you suspect you may be experiencing anovulatory infertility, it is important to consult with a healthcare professional, such as a reproductive endocrinologist or fertility specialist. They can evaluate your specific situation, conduct necessary tests, and provide appropriate guidance and treatment options.

5. Tubal factor infertility

Tubal factor infertility refers to a type of infertility caused by abnormalities or damage to the fallopian tubes. The fallopian tubes play a crucial role in the reproductive process by transporting eggs from the ovaries to the uterus and providing a site for fertilization to occur.

Several factors can contribute to tubal factor infertility, including:

Pelvic inflammatory disease (PID) is an infection that can cause swelling and scarring of the fallopian tubes. It is often caused by sexually transmitted diseases.
Previous surgeries: Surgeries in the pelvic area, such as those to treat ectopic pregnancies or remove ovarian cysts, can sometimes result in scarring or damage to the fallopian tubes.
Endometriosis is a condition where the tissue that lines the uterus grows outside of it. If the endometrial tissue grows in or near the fallopian tubes, it can cause damage or blockage.
Tubal ligation: Tubal ligation, also known as having one's "tubes tied," is a form of permanent contraception where the fallopian tubes are surgically sealed or blocked to prevent pregnancy. While it is an effective birth control method, it can lead to tubal factor infertility if a person later desires to conceive.

The diagnosis of tubal factor infertility typically involves a combination of medical history evaluation, physical examination, imaging tests (such as laparoscopy), and sometimes blood tests to assess hormone levels.

In more severe cases where the fallopian tubes are extensively damaged or cannot be repaired, in vitro fertilization (IVF) may be recommended. IVF involves retrieving eggs from the ovaries, fertilizing them with sperm in a lab, and transferring the resulting embryos into the uterus.

It’s important to consult with a fertility specialist or reproductive endocrinologist who can evaluate your specific situation, provide a diagnosis, and recommend appropriate treatment options for tubal factor infertility.

6. Uterine factor infertility

The uterus plays a crucial role in supporting a pregnancy by providing a suitable environment for the implantation, nourishment, and development of the fetus. Uterine factor infertility refers to the condition in which a woman is unable to conceive or maintain a pregnancy due to abnormalities or dysfunction of the uterus.

There are several potential causes of uterine factor infertility, including:

Uterine structural abnormalities: Congenital malformations or structural abnormalities of the uterus, such as a septate uterus (a uterine cavity divided by a wall), bicornuate uterus (a uterus with two horn-like structures), or uterine fibroids (non-cancerous growths in the uterus), can interfere with the implantation and development of an embryo.
Asherman's syndrome: This condition occurs when scar tissue forms inside the uterus, typically as a result of previous uterine surgeries, such as dilation and curettage (D&C) procedures or cesarean sections. The adhesions can reduce the size of the uterine cavity or even obliterate it, leading to infertility.
Endometrial abnormalities: The endometrium, the inner lining of the uterus, needs to be receptive and adequately prepared for embryo implantation. Conditions such as endometrial polyps, thin endometrium, or endometrial hyperplasia (excessive growth of the endometrial lining) can affect implantation and pregnancy success.
Uterine infections: Infections of the uterus, such as chronic endometritis or pelvic inflammatory disease (PID), can cause inflammation and damage to the uterine lining, impairing implantation and pregnancy.
Immunological factors: In some cases, the woman's immune system may produce antibodies that target and attack the embryo or the endometrial lining, preventing successful implantation.

The diagnosis of uterine factor infertility typically involves a comprehensive evaluation of the woman’s medical history, a physical examination, and specialized tests. These tests may include ultrasound imaging, hysterosalpingography (an X-ray procedure to examine the uterine cavity and fallopian tubes), hysteroscopy (a procedure to visualize the uterus using a thin tube with a camera), or an endometrial biopsy.

7. Cervical factor infertility

Cervical factor infertility refers to a condition in which a woman has difficulty getting pregnant due to abnormalities or issues related to her cervix. The cervix is the lower part of the uterus that connects to the vagina, and it plays a crucial role in fertility and the process of conception.

What are the common causes and factors associated with cervical factor infertility?

Cervical mucus abnormalities: The cervix produces mucus that changes in consistency and composition throughout a woman's menstrual cycle. This mucus helps sperm travel through the cervix and into the uterus. If the cervical mucus is too thick or too thin, it can hinder sperm movement and reduce their chances of reaching the egg.
Cervical stenosis: This refers to the narrowing of the cervical opening, making it difficult for sperm to pass through. It can be caused by scarring from previous surgeries, infections, or congenital abnormalities.
Cervical polyps or fibroids: Polyps are small, non-cancerous growths, and fibroids are benign tumors that can develop in the cervix. These growths can affect the shape or size of the cervical canal, potentially obstructing the passage of sperm.
Cervical infections: Infections such as cervicitis (inflammation of the cervix) or sexually transmitted infections (STIs) can cause inflammation and damage to the cervical tissue, affecting fertility.

Cervical factors related to cervical cancer treatment: Treatments like surgery or radiation therapy for cervical cancer can sometimes result in scarring or damage to the cervix, affecting its ability to function properly. The diagnosis of cervical factor infertility typically involves a comprehensive fertility evaluation, which may include a physical examination, hormone testing, imaging studies, and specialized tests such as a hysterosalpingogram (HSG) to assess the cervix and fallopian tubes.

8. Endometriosis-related infertility

Endometriosis is a medical condition in which tissue similar to the lining of the uterus, called endometrium, grows outside the uterus. This condition can cause various symptoms, such as pelvic pain, painful periods, and infertility. When endometriosis affects the reproductive organs, it can lead to fertility problems. Endometriosis-related infertility occurs when the presence of endometriosis affects the normal functioning of the reproductive system. The exact mechanisms by which endometriosis causes infertility are not fully understood

What are the factors contributing to endometriosis-related infertility?

Adhesions and scar tissue: Endometriosis can cause the formation of adhesions, which are bands of fibrous tissue that can bind organs together. Adhesions can interfere with the normal movement of the fallopian tubes, preventing the egg from reaching the uterus or the sperm from reaching the egg.
Distorted anatomy: Endometriosis can cause structural changes in the reproductive organs. For example, endometriosis implants may grow on the ovaries and form cysts called endometriomas. These cysts can damage the ovaries and affect the release of eggs.
Inflammation and immune system dysfunction: Endometriosis is associated with chronic inflammation in the pelvic region. This inflammation can create an unfavorable environment for conception and implantation of a fertilized egg. Additionally, immune system dysfunction in women with endometriosis may interfere with fertility.
Hormonal imbalances: Endometriosis is influenced by hormonal fluctuations throughout the menstrual cycle. Hormonal imbalances associated with endometriosis, such as elevated levels of estrogen, can disrupt the normal ovulation process, making it more difficult for pregnancy to occur.

It’s important to consult with a healthcare professional or a fertility specialist to discuss individual circumstances and develop a personalized treatment plan. They can provide guidance, explore appropriate treatment options, and help increase the chances of conception for individuals with endometriosis-related infertility.

9. Age-related infertility

Age-related infertility in women refers to the decline in fertility that occurs as women get older. It is primarily influenced by the aging of the ovaries and the depletion of a woman’s egg supply, known as ovarian reserve.

What causes age-related infertility?

Ovarian reserve: Women are born with a finite number of eggs, and as they age, the quantity and quality of the eggs decrease. This reduction in ovarian reserve can make it more difficult to conceive and increase the risk of miscarriage.
Irregular menstrual cycles: As women approach their late 30s and early 40s, they may experience irregular menstrual cycles, including changes in cycle length and ovulation patterns. These irregularities can make it harder to predict ovulation and conception.
Decreased egg quality: With age, the quality of eggs declines. Older eggs are more prone to chromosomal abnormalities, which can lead to a higher risk of miscarriage and genetic disorders such as Down syndrome.
Diminished ovarian response: As women age, their ovaries may not respond as effectively to hormonal signals from the brain. This can result in a lower number of eggs being released during each menstrual cycle.
Increased risk of medical conditions: Advanced maternal age is associated with an increased risk of certain medical conditions, such as uterine fibroids, endometriosis, and polycystic ovary syndrome (PCOS), which can further impact fertility.
Lower success rates with assisted reproductive technologies (ART): While technologies like in vitro fertilization (IVF) can help overcome some fertility challenges, the success rates decline with age. This is primarily due to the decrease in egg quality and quantity.
Menopause: Menopause is the natural cessation of menstruation and marks the end of a woman's reproductive years. The average age of menopause is around 45–55, but it can occur before or after. Once menopause occurs, a woman can no longer conceive naturally.

It’s important to note that fertility varies among individuals, and while age is a significant factor, it does not guarantee infertility. However, the chances of conception decrease as women get older. If a woman is concerned about age-related infertility or is experiencing difficulty conceiving, it is advisable to consult with a fertility specialist who can evaluate individual circumstances, offer guidance, and explore potential treatment options based on the specific situation.