Causes of Female Infertility
There may be one or more factors causing female infertility or having difficulty conceiving.
- Anovulation– women who have irregular menstrual cycles or cycles longer than 35 days, are failing to ovulate (develop a mature follicle with an oocyte (egg) that can be released and is capable of being fertilized), or they may have ovulatory dysfunction where either they have suboptimal follicullar development or a defect in the second phase (luteal phase) of the menstrual cycle which may lead to failure to fertilize, lack of embryo implantation or early miscarriage.Over 90% of anovulatory patients will ovulate with one or a combination of the current medications available for treatment .
- Tubal Factor– after release from the ovary at ovulation , the oocyte (egg) must be picked up and transported by the fallopian tube to its mid- segment. It is here that the oocyte is fertilized by the sperm that has traveled up the uterus and into the tube. Therefore the fallopian tube must be open (patent) and functional. If the tube is obstructed or has scar tissue (adhesions) surrounding the tube it will be difficult or impossible for the oocyte or the sperm to reach the mid-segment and therefore fertilization will not occur as it normally ocurs in nature.The good news is that for patients with tubal obstruction or severe damage the fallopian tubes can be completely by-passed by retrieving the oocyte directly from the ovary and fertilizing it directly in the laboratory in a petri dish in the procedure known as in-vitro fertilization (IVF).
- Uterine Factor– normally the embryo implants in the uterine cavity , so if the cavity has either fibroids , polyps or adhesions inside it, the embryo will fail to implant. In addition some women may be born with anomalies of the uterine cavity like an intrauterine septum or bicornuate uterus . The miscarriage rate among women with a large uterine septum is quite high .Fortunately the majority of the above conditions can be resected or corrected surgically and is usually followed by a subsequently normal implantation rate.
- Cervical Mucus Factor– spontaneous conception occurs because the cervical mucus acts as a reservoir where sperm survives for hours or a few days and from there they move to the uterus and eventually the tubes. Therefore if a woman does not produce good cervical mucus at ovulation this may cause female infertility. This is not a very common cause of infertility but can be present in patients who may have had previous surgery of the cervix, cone biopsy or cryosurgery. Intrauterine insemination bypasses the mucus and places the sperm high in the uterus, and close to the entrance to the tubes.
- Endometriosis / Adhesions– if either of these conditions is present in the pelvis, ovaries, and/or fallopian tubes it may distort the normal anatomy and be responsible for infertility in the female. Implants of endometriosis scattered throughout the pelvis may also diminish fertility even if the ovaries and tubes are free.These conditions are treated by our physicians via minimal incisions at an ambulatory surgery center using an operative laparoscope. This is an outpatient procedure.The Northern California Fertility Center has an experienced team of Reproductive Surgeons with a combined 54 years of experience between them and they have been pioneers in the laparoscopic treatment of these conditions using the CO2 laser since 1988.
- Low Ovarian Reserve– while men keep producing new sperm throughout their reproductive years, women are born with a set number of oocytes (eggs), all of which are already present at birth.Generally, a decrease in ovarian reserve begins around the age of 35. At this age both the number of oocytes as well as the quality of the remaining oocytes begins to diminish , and therefore women will have less of an opportunity to become pregnant on their own in their late thirties and their early forties. Women who are 35 or older are given either a clomiphene citrate challenge test to determine their ovarian reserve, or an antral follicle count via ultrasound in combination with an FSH (Follicle stimulating Hormone) and AMH (Anti-Mullerian Hormone) testing before receiving treatment for infertility problems at our Sacramento-area fertility center.Although less common and more difficult to identify, it is also possible for a woman’s eggs to be of poor quality or difficult to fertilize. Regardless of the issue, when a low ovarian reserve is present or oocytes are of poor quality, patients can achieve a very high success rate through IVF with egg donation.
- Inplantation Failure or Early Losses– a myriad of factors can be responsible for this, from a thin endometrial lining, to hormonal deficiencies, infections, chromosomal abnormalities and other rare causes.