Understanding the Causes of Infertility in Women

If you’re a woman trying to conceive a child and you’ve been having unprotected sex for a period of one year – or 6 months if you are 35 or older – without success, it’s time to talk to your doctor about a fertility evaluation for you and your partner. When a couple fails to conceive, the problem can be with the man, the woman or with both partners, so it’s important to have the necessary testing done to determine where the problem lies.

Generally, a woman produces several potential egg follicles in her ovaries each month. One of those eggs will mature, burst forth from the ovary and travel into the fallopian tube. If the egg doesn’t meet up with a man’s sperm, it – along with the endometrial lining of the vagina – will be shed during monthly menstruation. If, however, a woman's hormones aren’t functioning properly, the egg won’t mature correctly or may not be produced in the first place. This can occur due to a number of different causes, the most common of which is polycystic ovarian syndrome (PCOS). If there is scarring or cysts on the ovary, it can be difficult or impossible for a mature egg to burst forth.

In normal situations, the egg travels through the fallopian tube, where it is typically fertilized, to arrive at the uterus. If the fallopian tube is absent, blocked or scarred, the egg can’t continue on its journey successfully, and the man's sperm can’t join with the egg for fertilization.

If the egg is properly fertilized in the fallopian tubes and arrives at the uterus, it must implant itself into the uterine wall in order to grow. While the egg is growing, it’s supported by hormones produced by the corpus luteum – the structure on the ovary from which the egg emerged. If the corpus luteum doesn’t produce sufficient hormones, the pregnancy will end early. This infertility issue is known as luteal phase defect.

It’s also possible that the uterine lining won’t support the fertilized egg, or that uterine fibroids can interfere with implantation. The interior of the uterus can be malformed, which can make successful implantation and growth difficult.

The cervix itself can cause fertility issues as well. If the cervix is scarred, it can prevent semen from entering the uterus and reaching the egg. If the cervical mucus or vaginal environment is inhospitable to sperm, they can be killed before they get a chance to reach the egg. The cervix can also fail to remain closed during a pregnancy leading to miscarriage or premature birth. This condition is known as having an incompetent cervix and is often a problem for women whose mothers took DES during the 1970s.

As you can see, there are a number of different physical and hormonal factors that must work together successfully for a woman to become pregnant and carry that pregnancy to term. If you’re having trouble conceiving, there are a number of physical and chemical tests that can be performed to determine exactly what the cause of the problem is. Once you have a diagnosis, take the time to understand exactly what it means and how it can be treated. Even if the problem is serious, you’ll find that most infertile couples have a number of options from which to choose.