Are you struggling with growing your family and ever wondered what are the most common causes of female infertility and subfertility? Pinpointing a cause can often be challenging and likely there is more than one reason. It’s also important to remember that fertility is a team sport, so don’t forget to consider your partner’s role.
With that said there are six general buckets that most of the reasons fall into.
- Ovarian: 40%
- Tubal: 30%
- Endometriosis: 15%
- Unexplained: 15%
- Uterine: 1.5-2%
- Cervical: 1.5-2%
Ovarian Factor Infertility & Subfertility
Your ovaries produce estrogen and progesterone and house all of your follicles and eggs. Ovarian related reasons for infertility and subfertility include:
Ovulatory Dysfunction
Anovulation or infrequent ovulation can be due to:
- Hypothalamic Amenorrhea: This can be from over exercise, undereating, high stress.
- Polycystic Ovary Syndrome: Check out my indepth blogs on the this topic HERE.
- Hyperprolactinemia: This can be caused by breast feeding, nipple stimulation, sex, stress, medication, or a pituitary tumor.
- Thyroid Disorders: Hypo and hyperthyroidism.
- Ovarian Cysts
Diminished Ovarian Reserve
A decline in the number of eggs can be due to:
- Age
- Congenital (born with)
- Medications
- Surgical
If you want more information on ovulation or want to know if you’re ovulating, check out my blog on the topic HERE.
Tubal Factor Infertility & Subfertility
Your fallopian tubes act as a conduit for the egg to travel from the ovary to the uterus. This is also the location of fertilization between the sperm and egg. If your tubes are damaged for any reason this can prevent your ability to conceive. Causes include:
- Pelvic Inflammatory Disease (PID)
- Sexually Transmitted Infections (STIs), in particular chlamydia and gonorrhea which can cause scar tissue and adhesions within the fallopian tubes.
- History of tubal ectopic pregnancy
- Pelvic, abdominal, and tubal surgeries which can lead to scar tissue and PID
- Smoking, because it decreases the movement of the hair like projections (cilia) within the tubes that move eggs through
Endometriosis
Endometriosis is the presence of endometrial tissue outside of the uterus. It can be located anywhere in the pelvic cavity, on the ovaries, intestines, rectum, even as distant as the lungs. The tissue is responsive to hormonal shifts, especially estrogen. It has the potential to cause significant pain, especially around menses, but also with intercourse. I have discussed endometriosis in detail in a few different blog posts that you can find HERE.
The causes of infertility and subfertility due to endometriosis include:
- Enhanced local and systemic inflammation
- Physical blockage or adhesions of the fallopian tubes, cervix, and vagina
- Abnormal follicle and egg development due to ovarian endometriomas (endometrial implants on the ovaries)
- Alterations of the uterine lining (endometrium)
- Intercourse can also be extremely painful
Unexplained Infertility & Subfertility
Unexplained subfertility and infertility do not necessarily mean there isn’t a reason, it usually means that the reason has just not been identified yet. You may want to consider additional investigation into the following:
- Underlying blood clotting disorder
- Autoimmunity, especially celiac disease
- Chronic inflammation
- Toxic burden and oxidative stress
- Stress: emotional, mental, physical, chemical
- Consider your partner’s role!
Uterine Factor Infertility & Subfertility
The health of the uterus is important for implantation and then obviously providing a safe place for a baby to grow and develop. There are several uterine changes that can prevent this from happening.
- Uterine septum small or large
- Growths
- polyps
- fibroids
- Adenomyosis: This is endometriosis within the muscular layer of uterine wall, which can create inflammation and thickening of endometrial wall causing issues with implantation.
- Ashermann’s syndrome: Adhesions within the uterus, usually from prior surgery, D & C being the most common.
Cervical Factor Infertility & Subfertility
The cervix is the lowest part of your uterus. It is visible within the vaginal canal and contains a small opening that allows sperm to enter the uterus. The cervix contains glands that normally release mucus which helps or hinders the transport of sperm. Cervical issues influencing fertility include:
- Structural changes such that the opening becomes very small or inflexible, called cervical stenosis. This can be congenital but is most often caused by a history of surgical procedures.
- Cervical polyps can block the opening
- Mucus changes
You Don’t Have To Do This Alone!
If you’re thinking about getting pregnant or struggling with fertility, consider working with a holistically-minded provider who can offer a thorough assessment of your whole health and provide personalized therapeutic options. You don’t have to do this alone! 🙂
I always hope that my posts are supportive of your journey. There are additional resources and references below. Leave me a comment, check back often, and reach out if you need a partner in this process! Thanks so much for reading.
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Additional Resources
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