Female Infertility

The uterus, fallopian tubes and ovaries form part of the female reproductive system. During a process called ovulation,⁵ an ovary releases an egg into one of the fallopian tubes every month, where it could potentially be fertilised by sperm.⁵

If the egg is fertilised, it will implant itself in the uterus and the woman will become pregnant.⁵  This is called conception.⁶ If the egg is not fertilised, the woman will have her monthly period.⁵

The journey of the egg being released by the ovary (ovulation) and becoming fertilised by sperm (conception) is illustrated below. The fertilised egg develops into a blastocyst, which, if it successfully implants in the uterus, is the beginning of a potentially successful pregnancy.⁶

Infertility in women can be caused by:

• Problems with ovulation, like polycystic ovarian syndrome (PCOS).^1,3
• Illnesses affecting the reproductive organs, like endometriosis.³
• Pelvic adhesions (bands of scar-like tissue, often caused by infection or inflammation).^3,7
• Blocked fallopian tubes, which may prevent the egg from being released properly or prevent the sperm from reaching the egg.³
• Abnormalities in the uterus or the cervix (the lower end of the uterus).¹
• High levels of prolactin hormones in the blood.³
• Damage to the reproductive organs caused by untreated sexually transmitted diseases (STDs).⁸

If a woman of reproductive age has been unable to conceive a baby after one year of unprotected sex or after artificial insemination, she is considered to be suffering from infertility.¹ Reproductive age is defined by the World Health Organisation as 15 to 49 years.¹⁵

Infertility and its underlying cause may be diagnosed through a variety of tests, including:¹⁶

• Pelvic examination: The pelvic area is examined for infection, lumps or tenderness which could be a sign of problems like fibroids, ovarian tumours, endometriosis or pelvic inflammatory disease.
• Blood tests: Blood samples can be tested for progesterone hormone levels to find out whether the patient is ovulating.
• Ultrasound: A non-invasive scan is used to check the condition of the ovaries, uterus and fallopian tubes.
• Hysterosalpingo-contrast-ultrasonography: This type of ultrasound is used to check the fallopian tubes for blockages or abnormalities which could cause a problem with ovulation or fertilisation.
• Hysterosalpingogram: An X-ray of the uterus and fallopian tubes is taken, using a special dye to find blockages or abnormalities.
• Laparoscopy: This is usually only used in patients with a history of pelvic inflammatory disease or a likelihood of fallopian tube blockages. It is a keyhole surgery that uses a tiny camera to examine the uterus, fallopian tubes and ovaries. A dye may also be injected into the fallopian tubes to highlight any blockages.

Struggling with infertility can have a major psychological impact on a woman, causing feelings of:¹⁷

• Fear and worry.
• Guilt.
• Loneliness.
• Depression and grief.
• Low self-esteem.
• Failure.
• Helplessness.

The type of treatment used will depend on the underlying cause of infertility and on the patient’s age.¹ The ultimate goal of treatment is to establish a healthy pregnancy that results in a healthy delivery.¹

Lifestyle habits that can improve fertility include:¹

• Maintaining a healthy weight.
• Quitting smoking.
• Managing stress.

Common assisted fertility treatments (AFTs) include intrauterine insemination (IUI) and in vitro fertilisation (IVF).¹⁹

• IUI: Sperm from the partner or donor is placed directly into the uterus, giving it a better likelihood of reaching the eggs.¹⁹

In cases where infertility is caused by problems with ovulation like PCOS, hormone therapy or medications to stimulate ovulation can be used to restore fertility.¹ This can be followed with timed sexual intercourse or IUI.¹

• IVF: The patient takes a high dose of injectable hormones, stimulating the ovaries to produce multiple follicles (sacs containing immature eggs).¹⁹ Once the eggs have matured, they are retrieved and combined with the sperm in a lab, and those that result in embryos (i.e. the sperm successfully joins with the egg) are transferred to the patient’s uterus.¹⁹

IVF is considered the best option for women with abnormal fallopian tubes and those with endometriosis-related infertility.¹ Egg donation via IVF is also an option for women with age-related infertility and/or a low number of eggs available.¹ Ovarian stimulation may also be used, although success often depends on the patient’s age.¹

Unfortunately, the high cost of fertility treatments like IVF is a major barrier to those seeking treatment in developing countries.²⁰ Infertility will continue to be a problem in countries with low resources if fertility treatments do not become more accessible.²⁰