Female Fertility

The female reproductive system is a complex network of organs that work together to produce and transport eggs, provide a suitable environment for fertilization, and support the development of a fetus during pregnancy. Infertility is defined as the inability to conceive after a year of unprotected intercourse. According to the Centers for Disease Control and Prevention (CDC), infertility affects approximately 20-25% of women.

Understanding female reproductive anatomy and the various factors that can contribute to infertility is essential for anyone who wishes to become pregnant or who may be struggling to conceive.

A female’s reproductive organs consist of the vagina, cervix, uterus, fallopian tubes, and ovaries. The vagina is the tube that connects the external opening to the cervix, which is the tissue that serves as the entry into the uterus. Both the vagina and the uterus have muscular walls, but the uterus has a thick lining. This lining will allow an embryo to implant and a baby to grow. Each month, blood and tissue build inside the uterus. If a woman’s egg is not fertilized, she will not become pregnant and will shed the lining during her monthly period.

On either side of the uterus, two fallopian tubes extend from the uterus toward each ovary. The ovaries store, mature, and release eggs into the fallopian tubes during ovulation. The fallopian tubes are the location where sperm and egg meet and fertilize. The tubes are narrow at the top near their connection to the uterus and wider toward the ends near the ovaries. The end of the tube is called the fimbriae, delicate structures that are responsible for picking up the egg from the ovary. Infertility can occur if the fimbriae are damaged from:

• An infection, such as gonorrhea or chlamydia
• Scar tissue within or around the tubes due to prior surgery
• Endometriosis
• Tubal pregnancy

One major part of female fertility is the egg, also known as an oocyte, ovum, or gamete. A female is born with a pre-determined number of eggs – usually around one to two million in total. Every month during menstruation, several eggs are triggered for release, but only one reaches maturity. The mature egg is released into the fallopian tubes, while the other eggs are simply reabsorbed into the body. By the time a woman is in her early to mid-50s, a few hundred eggs or fewer remain in her ovaries.

Ovaries also produce the female hormones estrogen and progesterone. Not only do these hormones control the menstrual cycle, but they also play a large role in getting pregnant and sustaining a pregnancy. If hormone levels are too high or low, it can result in miscarriage.

Female infertility causes include:

• Inadequate egg quality or quantity (low ovarian reserve)
• Problems with hormones levels affecting ovulation
• Pelvic scarring or inflammation
• Endometriosis
• Fallopian tube damage or blockage
• Uterine polyps and fibroids

Another fertility issue that women can face is recurrent pregnancy loss, which is when a woman has had two or more miscarriages.

Some diagnoses related to female infertility factor include:

• Ovulation disorders
• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Premature ovarian failure (POF)
• Uterine fibroids and polyps
• Recurrent pregnancy loss
• Advanced maternal age
• Tubal abnormalities or prior tubal ligation

Any disruption in the monthly process of ovulation can result in female infertility. Often, women with ovulation problems will experience irregularities in their menstrual cycles. Testing can be done to determine if a woman is ovulating. Testing for PCOS, thyroid, and/or prolactin disorders can be done. Reproductive endocrinologists specialize in diagnosing and treating PCOS as well as other hormone disorders that affect fertility.

PCOS is a common cause of not ovulating regularly, irregular periods, and female factor infertility. Women who have PCOS experiencing infertility do not mature and release an egg each month. Their ovaries also have many small cysts, which can be as big as a marble or as small as a coarse grain of salt. Treatment for PCOS with infertility may include medications to stimulate the ovaries.

Learn more about PCOS.

Endometriosis is a condition in which cells that are similar to the lining of the uterus (i.e., the endometrial lining) grow outside of the uterus. Endometriosis can cause pain, scar tissue growth, pelvic adhesions, and infertility issues. If the fallopian tubes are blocked or full of scar tissue, this can prevent the egg from traveling through the fallopian tubes down into the uterus. In some cases, this can lead to an ectopic or “tubal pregnancy,” where the embryo implants outside the uterus and in the fallopian tube.

Treatments for endometriosis may include:

• Laparoscopy (surgical removal of endometriosis)
• Hormonal treatments that inhibit the growth of endometriosis
• In-vitro fertilization (IVF)

Learn more about endometriosis.

Sometimes, women under the age of 40 will experience a sudden drop in ovarian function. This is referred to as premature ovarian failure or premature ovarian insufficiency. Sometimes, the cause is unknown, but other times it may relate to autoimmune, genetic, or environmental factors such as exposure to chemotherapy. Treatments for POF may include using an egg from a donor who is young and has a large number of healthy eggs.

Uterine fibroids are benign muscle tumors within the uterus. Fibroids begin within the muscle wall of the uterus but can grow into the uterine cavity as well. A uterine polyp is an overgrowth of tissue, like a skin tag within the uterus. Both may potentially interfere with the implantation of an embryo into the uterus lining. Treatment for fibroids or polyps often includes surgical removal.

What are the common causes of female infertility?

Female infertility can be caused by a variety of factors, including advanced maternal age, ovulation disorders, hormonal imbalances, polycystic ovary syndrome (PCOS), endometriosis, premature ovarian failure, uterine fibroids, and more.

What are the available treatments for female infertility?

There are a wide variety of treatment options available for female infertility, the most common being intrauterine insemination (IUI), in vitro fertilization (IVF), egg freezing, and egg donation.

Can stress affect a woman’s fertility?

While stress can make it more difficult to conceive, stress alone is not a causing factor in infertility.

How long should someone try to conceive before seeking fertility treatment?

For people who are under the age of 35, it’s generally recommended that you see a fertility specialist after a year of unprotected intercourse. However, if you’re over the age of 35, it’s recommended to see a doctor after six months.

Can a woman with a history of sexually transmitted infections (STIs) become infertile?

Women with a history of untreated sexually transmitted infections (STIs) such as chlamydia and gonorrhea can sometimes develop pelvic inflammatory disease (PID), which can cause damage to the fallopian tubes and prevent eggs from being fertilized.

The Reproductive Medicine Group has many years of experience diagnosing and treating the full spectrum of female infertility issues in Florida. With locations in North Tampa, South Tampa, Brandon, Clearwater, and Wesley Chapel, our expert team of fertility specialists is ready to answer all your questions and provide personalized fertility care. Schedule a consultation with The Reproductive Medicine Group.