Infertility of women

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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The reason for involuntary childlessness is often seen as infertility in women. In fact, this is only responsible for around a third of all cases of non-pregnancy. Female sterility can have a variety of causes, for example genetic or disease-related. Read more about the background to female infertility and how to fix it here.

Causes of Infertility in Women

In addition to factors that promote sterility equally in both sexes (e.g. obesity, nicotine, drugs, alcohol or stress), there are gender-specific causes of infertility in women.

Advanced age

Nowadays, couples are choosing later and later to have a family. However, from the age of 30 onwards, the probability of a woman becoming infertile increases: the chance of women at the age of 30 to become successfully pregnant within one year is 75 percent; at the age of 35, the value drops to 66 percent. At the age of 40 it is only 44 percent. The reason: the number and quality of egg cells decrease with age, and the likelihood of chromosome damage, miscarriages, complications and infertility increases. A woman should therefore not wait too long to have children.

Hormonal disorder

In around 30 to 40 percent of women affected, a hormonal disorder is responsible for childlessness. If the female hormonal balance does not run smoothly, the following problems lead to infertility:

• The woman produces too few or no egg cells.
• Ovulation does not take place (anovulation).
• The structure of the uterine lining for the implantation of a fertilized egg does not occur.
• The consistency of the cervical mucus (in the cervix) makes it difficult for the sperm cell to penetrate.

Hormonally caused menstrual cycle disorders can be of different types: Sometimes the cycle is lengthened (oligomenorrhea) or shortened (polymenorrhea) or the menstrual period stops completely (amenorrhea).

Hormonal disorders as the cause of female infertility often affect sex hormones such as estrogen, prolactin, gonadotropin and the luteal hormone progesterone. For example, women who are very overweight (obese) often have elevated levels of testosterone and estrogen in their blood. In the same way, being underweight can negatively affect fertility as a result of disorders of the sex hormones. Sometimes a woman's infertility is caused by polycystic ovarian syndrome (polycystic ovary syndrome). Sometimes a so-called porlactinoma - a benign tumor of the pituitary gland - triggers an increased release of prolactin in the brain and thus disrupts ovulation.

In addition to sex hormones, thyroid hormones are also very often responsible for infertility in women: an overactive thyroid gland (hyperthyroidism) mainly leads to miscarriages (abortions). Underactive thyroid (hypothyroidism) mixes up the hormones prolactin and luteinizing hormone, which can cause problems with ovulation.

In addition, a disturbed insulin metabolism in diabetes causes female infertility (insulin is a blood sugar lowering hormone).

Organic causes

It happens that a hormonal disorder has an organic cause. Sometimes, however, a congenital malformation, an operation or illness can also trigger infertility. Women with sticky, overgrown or blocked fallopian tubes, for example, have great problems getting pregnant. Organic causes can be triggered by:

• Inflammation (e.g. fallopian tube inflammation)
• Infections (e.g. chlamydia)
• Endometriosis
• Adhesions after surgery
• spiral
• Ovarian cysts
• benign tumor of the uterus (myoma)
• hormone-producing tumors

Immunological sterility

Sometimes the immune system is also to blame for infertility. In this case, women produce antibodies that are directed against their own egg cells or against the sperm cells of their partner: The defense cells bind to the germ cells and block them in this way. Successful fertilization is then not possible.

Psyche, stress or sexual disorder

Often everything is organically in order, but the woman does not become pregnant. In this case, it is important to analyze possible internal conflicts more closely, because the psyche contributes significantly to successful reproduction. Fears, stress, tension as well as intense physical strain can quickly disrupt the female hormone balance. Sexual disorders in the couple relationship also make reproduction difficult.

Genetic defects

Genetic changes are also a possible cause of infertility in women. These can lead to problems with cell division, for example, so that a fertilized egg cell does not develop further and does not implant in the uterus. The so-called Turner syndrome, in which those affected only have one sex chromosome, also results in infertility in women.

Multiple miscarriages

Many women become pregnant, but repeatedly suffer from miscarriages (abortions). This can be due to malformations of the uterus, a chromosomal disorder in the child, infections, fibroids or thyroid disorders. To the chagrin of the women concerned, however, the cause cannot always be identified.

Signs of infertility in women

Am i really sterile? This question torments many women with an unfulfilled desire to have children. If pregnancy does not occur within a year despite unprotected sexual intercourse, the woman (and / or man) may actually be infertile. In addition to the unwanted childlessness, it is not that easy to spot other signs that clearly point to the sterility of the woman. Possible are:

• Painful intercourse
• chronic pelvic pain
• excruciating menstrual pain (dysmenorrhea)
• heavy and long menstrual bleeding (hypermenorrhea)
• Malformations (endometriosis, fibroids)
• light bleeding (hypomenorrhea)
• Intermenstrual bleeding (metrorrhagia)
• Miscarriages
• excessive hair (suggests too many male hormones; hirsutism)
• Leakage of fluid from the chest (galactorrhea)

However, whether this is really evidence of infertility in women can only be determined after a detailed examination.

Diagnosing female infertility

Usually several examinations are necessary before the diagnosis of infertility:

• gynecological check
• Ultrasound (sonography)
• gynecological smear: condition of the cervical secretion (bracken test), bacteria
• Basal temperature curve or cycle monitoring (to check ovulation)
• Hormone test: estrogens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), androgens (testosterone, DHEA-S), prolactin, progesterone, thyroid hormones, anti-Müllerian hormone
• Examination of the fallopian tubes: hysterosalpingo contrast sonography, hysterosalpingography, endoscopy (hysteroscopy) or laparoscopy (laparoscopy)
• possibly genetic examination

Woman infertility: therapy

Depending on the diagnosis, the following treatments are possible:

• hormonal stimulation of the female ovaries
• Hormone therapy: inhibition or administration of certain hormones (estrogen, prolactin, gonadotropin, progesterone)
• Egg cryopreservation
• Operation: patency of the fallopian tubes
• Artificial insemination for fallopian tube obstruction, endometriosis or immunological sterility: in vitro fertilization (IVF), intratubar gamete transfer (GIFT), in vitro maturation (IVM)

As is well known, it takes two to have children. Therefore, treating one partner for infertility is not always enough. Sometimes women have to endure hormone stimulation or artificial insemination even if the problem lies with the man and everything is fine on the woman's side.

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