Female infertility: causes and treatment

Frequency of infertility in women

If you are unable to conceive, about forty percent of the time it is you and forty percent of the time it is your partner. In the remaining twenty percent of cases, the cause lies with both of you or cannot be clarified despite advanced medicine. Infertility on the part of the woman can have different causes. It can be hormonal, caused by organic damage to the genital tract or caused by hereditary or venereal diseases. Below we go into detail about the most common possible reasons for female infertility.

Hormonal causes of female infertility

There are numerous hormonal disorders in the female menstrual cycle that lead to insufficient maturation of the egg cell or problems with implantation. The causes can often not be clearly differentiated, but are often related. In the following we give an overview of the most frequently detected hormonal disorders:

PCO syndrome: Polycystic ovarian syndrome (PCO) describes “cysts” on the ovaries. However, these are not real cysts, but rather many small egg sacs that cannot mature and atrophy prematurely. These atrophied follicles can then be seen on the ultrasound as small “cysts”. PCO is primarily attributed to two causes: an increased level of male hormones and what is known as insulin resistance. A higher number of male hormones ensures that the follicles can no longer mature and ovulation no longer occurs. This is often reflected in prolonged menstrual cycles or even no menstrual periods at all. The ovaries are then often enlarged. An excess of insulin can also lead to disruption of the ovaries and ovulation. PCO syndrome is more commonly found in overweight women. In our post “What is PCOS Syndrome? ” you learn more.

Insulin resistance : Obesity not only increases the likelihood of PCO syndrome, but also the likelihood of insulin resistance (commonly associated with PCO syndrome). Insulin resistance causes increased insulin production. The reason for this lies in a disturbance in the transfer of insulin into the cell. Too little sugar is absorbed into the cell for energy supply. In turn, the production of insulin in the pancreas is increased in order to maintain sugar utilization. The increased insulin level in the blood and the increased release of LH from the pituitary gland then increases the blood level of the male hormones.

Elevated Male Hormones : About a third of women with irregular periods have elevated levels of male hormones. These lead to disturbances in egg cell maturation and even the absence of ovulation. They can lead to the observation of the PCO syndrome mentioned above.

Elevated prolactin : Hyperprolactinemia is the most common dysfunction of the pituitary (pituitary) gland. In many women, it is the cause of disturbed ovulation or a missed menstrual period. The increased prolactin level has a negative effect on the hypothalamus and prevents it from producing the hormones that are important for ovulation. The maturation of the egg cells is permanently disturbed. An increased prolactin value is often reflected in menstrual disorders, milk production in the breasts (prolactin is also produced to a greater extent during breastfeeding) and increased male hormones. A common cause of the increased prolactin value is the thyroid dysfunction described below. But stress and some medications can also increase the level of prolactin in the blood.

Thyroid dysfunction : A thyroid dysfunction can be a cause for the increase in prolactin levels described above and thus trigger the effects on ovulation already described. An underactive thyroid gland is much more common than an overactive one.

A pituitary or pituitary gland disorder is present in more than ten percent of women who have never had a menstrual period without hormones. But even women who are anorexic, do competitive sports or have a lot of stress can temporarily suffer from such a disorder. Tumors or an acute reduction in blood flow are rarely the reason. The pituitary gland is only able to produce its hormones if it receives the right commands from the hypothalamus. If this is not the case, the ovaries do not receive an adequate signal for the maturation of egg cells and thus no estrogen production and no ovulation takes place.

Premature menopause : Ovarian dysfunction occurs in one percent of women before the age of forty. Then one speaks of premature menopause. The reasons for this are very diverse and have not yet been fully clarified. It is possible that genetic diseases are present or an autoimmune disease. Antibodies against the FSH receptors responsible for estrogen production may also be a concern. Statistically, there is a connection to certain factors that can promote premature menopause, such as smoking, a family history, short menstrual cycles, diabetes or a vegetarian diet.

Yellow body weaknessis one of the most common causes of female infertility. When ovulation occurs, the corpus luteum develops afterwards. After ovulation, the corpus luteum hormone is responsible for preparing the lining of the uterus for implantation of the embryo. If a woman suffers from luteal insufficiency, the lining of the uterus is not ideally prepared and the egg cell cannot implant itself. The pregnancy is terminated early. A sign of luteal insufficiency can be a shorter second half of the menstrual cycle associated with spotting, low luteal hormone levels and early miscarriages. Since luteal insufficiency is often associated with insufficient maturation of the follicles and the egg cell, it is often not a stand-alone diagnosis,

Organic causes of infertility

But not only disturbances in the woman’s hormone balance can prevent ovulation or the successful fertilization of an egg cell. Organic reasons such as adhesions, cysts and tumors can also be the cause:

• Damage to the fallopian tubes is the reason for their infertility in two thirds of the women affected. If the fallopian tubes are interrupted, stuck together or narrowed, the sperm cannot reach the egg cell or the fertilized egg cell cannot reach the uterus.
• Scarring of the cervix due to inflammation or surgery makes it difficult or impossible for sperm to get into the fallopian tube to fertilize the egg.
• Fibroids : Depending on their size and location, fibroids (benign muscle tumors) can also cause infertility or lead to miscarriages and problems during pregnancy.
• Endometriosis is a chronic, benign growth of the lining of the uterus that extends beyond the uterus. Endometriosis is very painful and can lead to adhesions and adhesions in the fallopian tubes .

Age and lifestyle as “helpers” of infertility

The hormone balance is strongly influenced by the living conditions. If a woman is older or has a lot of stress or an unhealthy lifestyle, this can have a major impact on her hormonal balance.

• Age : As the woman gets older, the egg cells formed at the time of her own birth also age. Fewer egg cells mature and the chance of pregnancy decreases. Aging of the oocytes can also lead to chromosomal changes that can cause a failure to mature and also increase the chances of miscarriage and a chromosomal abnormality in the child.
• Obesity can have a negative effect on the desire to have children. Because obesity is often observed in connection with hormonal disorders such as insulin resistance, increased male hormones and prolactin levels, PCO syndrome and thyroid dysfunction.
• Underweight : Being underweight can also have a negative impact on the desire to have children. If the woman’s weight is too low, the body classifies it as a “famine” in which pregnancy would not be beneficial to the mother’s health. It signals to the brain that the corresponding reproductive processes should be throttled.
• Stress : Mental stress has a clear effect on the hormone balance in women. If a woman suffers from a lot of stress, increased prolactin levels are often measured. You can read about the effect under the hormonal causes.
• Taking medication : Taking medication can also have an impact on the hormone balance. It is therefore advisable to always discuss drug treatment with the doctor in more detail against the background of the desire to have children.

Immune system fights back

In rare cases, there is also the possibility that the woman’s immune system sees the eggs as “foreign bodies” and tries to fight them. This phenomenon also occurs in men. In very rare cases, there can also be mutual incompatibility of the immune systems in men and women. You can read more about the “fight of your own immune system” in our article “ When the immune system prevents pregnancy ”.

STDs

Some infectious diseases transmitted through sexual contact can reduce fertility. These include chlamydia and gonorrhea (clap). Both women and men who have had such a sexually transmitted disease can become infertile as a result.

• Chlamydia : Chlamydia infections, especially if left untreated, are a common cause of a woman’s sterility and frequent miscarriages. The sexually transmitted disease can lead to adhesions in the uterus and to blocked fallopian tubes. The woman cannot have children naturally. Unfortunately, this infection often lies dormant in the body undetected and can then break out again and again. A pregnant woman can also pass them on to the child.
• Gonorrhea (clap) : Gonorrhea is also often not noticed because it hardly shows any symptoms. It is the most common sexually transmitted disease. An untreated gonorrhea infection has far-reaching consequences for many organs, including the genitals. It can therefore also lead to organic damage, which results in sterility in women. Pregnant women can also pass this disease on to their babies during childbirth. If not treated in time, it can lead to blindness in the baby.

hereditary diseases

Hereditary diseases can alter chromosomes, causing the body’s reproductive processes to be disrupted or making it more likely to cause miscarriage. Hereditary diseases can influence numerous chromosomal characteristics. Detailed genetic diagnoses provide information about the causal relationships.

Repeat miscarriages

The inability to successfully complete a pregnancy is a form of infertility in its own right. If there are three miscarriages in a row, the doctor speaks of “habitual abortions”, which are repeated miscarriages. The most common cause of miscarriages are genetic defects in the child. Other causes can be infections in the mother, but also fibroids and thyroid disorders. Congenital malformations of the uterus are rather rare and often the exact cause of a miscarriage cannot be determined at all.

You can find more information about sterility in men and women in our “Infertility” section. You can find more information on fertility treatment under “ Artificial insemination ” or general tips in the “ Getting pregnant ” section.