Female infertility underlies around one-third of situations where couples are having difficulty conceiving. However, a significant proportion of infertility cases include problems with male fertility too, so both partners should always be assessed. Although infertility can be extremely difficult for both partners, research has shown that women are more affected by stress, depression, and anxiety due to infertility compared to men. It is important that when trying for a baby, you make time for yourself and continue to do activities you find enjoyable to help manage this stress.
Female infertility can be due to various disorders and conditions of the reproductive system. It can also be due to natural age-related decline in fertility.
Older age is the single most important determinant of a woman’s fertility. At birth, all the eggs you will ever produce are already present. As you age, your eggs age with you. This means they slowly decline in both quality and quantity.
Rates of infertility of women:
Problems with ovulation account for about a quarter of cases of female infertility. Ovulation refers to the release of an egg from the ovary where it then becomes available for fertilisation. Ovulatory disorders are typically experienced as a menstrual disturbance, such as irregular or infrequent periods and subsequently, irregular ovulation. Some gynaecological conditions may cause a complete lack of ovulation, such as polycystic ovarian syndrome or premature ovarian failure.
Endometriosis affects up to 15% of women of reproductive age, and causes infertility in about half of these women. Cells that typically line the uterus may grow outside of this structure, such as in the pelvis or abdomen. This causes inflammation and damage to ovaries or fallopian tubes, interfering with conception.
Infection and inflammation can cause damage to the reproductive system by creating scar tissue that binds parts of the body together that aren’t normally connected. Adhesions in the pelvis, such as from pelvic inflammatory disease, can result in the uterus, fallopian tubes, or ovaries to become stuck with each other. This distorts their structure and impairs their ability to function properly.
Problems in the uterus causing infertility include fibroids, polyps, or uterine septums. These can impair the ability of a fertilised egg to successfully implant in the lining of the uterus to continue developing into an embryo.
Your first consultation with Dr Kate will involve a thorough review of your overall health and any medical conditions or family history of fertility issues that may be contributing. Based on this, we will then organise additional investigations.
Analysing your blood sample for the levels of certain hormones can tell us if you’re ovulating and also give an indication of ovarian reserve. These hormones include progesterone, anti-Mullerian hormone, and follicle stimulating hormone. Other changes in your hormone levels, such as thyroid hormone, prolactin, and cortisol can also have an impact on your fertility. Depending on your history, additional testing may be indicated.
An ultrasound may be used to assess ovarian reserve, but is also useful for investigating other conditions that relate to infertility, such as uterine fibroids, polyps, ovarian cysts, and polycystic ovarian syndrome. Additional specialised scans such as a hysterosalpingogram or hystero contrast sonography may be necessary to check the inside of the uterus or to see how well your fallopian tubes are working.
Treatment for female infertility will depend on the results of infertility testing. In some cases, Dr Kate can prescribe medications to regulate your hormones and menstrual cycles, or may recommend surgery, such as in the case of fibroids or polyps. For infertility situations which cannot be improved with these interventions, Dr Kate will discuss your options for IVF or other assisted reproductive technologies.
Certain lifestyle changes will be beneficial not only for helping you fall pregnant but also for supporting a healthy pregnancy once you do conceive. Though you can’t stop the effects of age on your ovarian reserves, there are other steps you can take to boost your natural fertility.
