Health Conditions

Uterine Factors
Growths and lesions (sores) inside the uterus can cause female infertility. Abnormal structures on the uterine wall, such as polyps, scars, or tumors, may prevent pregnancy by keeping a fertilized egg from attaching to the uterine wall. Other possible uterine factors that could contribute to infertility are congenital abnormalities (structural deviations that develop before birth) or an intrauterine device (IUD) that has been left in the uterus by mistake.

Endometriosis
As many as 5.5 million American women may have endometriosis, a chronic condition that can lead to fertility problems. Endometriosis occurs when cells from the endometrium (the inner lining of the uterus) become displaced and deposit outside of the uterus. Usually accumulating on pelvic or abdominal organs such as the bladder, intestines, and ovaries, the displaced endometrial tissue swells during the menstrual cycle causing symptoms. These symptoms may include abdominal pain, heavy menstrual periods, spotting between periods, and infertility. Even though the exact ways that endometriosis may cause infertility are not fully understood, endometriosis is believed to damage the ovaries or fallopian tubes. The resulting alterations in menstrual cycles can upset the hormonal balance needed for conception to occur. Endometriosis usually decreases after menopause. Surprisingly, it may also lessen after a full-term pregnancy.

Tubal factors
A number of factors can damage the fallopian tubes, the ducts which carry eggs from the ovaries to the uterus. Fertilization takes place in the fallopian tubes. Injuries and scarring can thicken and stiffen the fallopian tubes, making both egg transport and fertilization more difficult. Infertility may result from some types of fallopian tube damage that may be caused by:

• Appendicitis (especially a ruptured appendix)
• Fallopian tube surgery
• Recurring pelvic inflammatory disease (PID)
• Septic abortion (serious infection of the uterus associated with a miscarriage or abortion procedure)
• Use of an intrauterine device (IUD) for birth control

Cervical Factors
Cervical mucus is a slippery secretion that moistens and protects. It is always present around the cervix (the opening of the uterus into the vagina). In general, cervical mucus forms a soft plug that keeps bacteria and other organisms from invading the uterus. However, the composition of cervical mucus changes throughout the menstrual cycle. The preovulatory phase typically occurs one to three days before ovulation (the release of a mature egg by one ovary). During this phase, cervical mucus changes from its normal thick, gooey form to a thinner form. The more watery mucus allows sperm to penetrate through the cervical opening to the fallopian tube. Normally, cervical mucus contains hormonal and chemical components that promote sperm functioning and help sperm survive in the female reproductive tract. When the composition of the mucus is altered in any way (such as by low estrogen levels), sperm are less likely to penetrate the cervix or survive long enough to reach the egg.

Additionally, antisperm antibodies may be present in cervical mucus, as well as in semen produced by the male partner. Antibodies are proteins made by the body's immune system to fight off invaders such as bacteria. Each type of antibody attacks only one specific type of invader. Although the exact effects of antisperm antibodies are unclear, frequently they are associated with infertility. Studies are currently underway to evaluate whether any treatments targeting these antibodies could help restore fertility.

Ovarian Factors

Ovulation Failure
Failure to ovulate (release mature eggs from the ovaries) may result from numerous causes:

A primary cause of ovulation failure is age-related change in the reproductive system. A woman's fertility declines after the age of 30 years - falling dramatically after the age of 40 years. During the time when a woman is approaching menopause, ovulation typically becomes erratic, making fertilization more difficult. Approximately one-third of the women who attempt to conceive in their mid- to late-thirties will experience infertility problems.

Polycystic Ovarian Syndrome (PCOS) is another common cause of ovulation failure. Formerly called Stein-Leventhal Syndrome, PCOS is a condition in which eggs fail to mature, instead remaining in the ovaries as many small cysts. As the cysts accumulate, the ovaries stretch to as much as five times their normal size. Women with PCOS produce more androgen hormones, such as testosterone, which may result in facial and body hair, a deeper voice, decreased breast size, and other masculine features. Typically, PCOS also causes acne, irregular or absent menstrual periods, and weight gain. In the 1980s, untreated PCOS was found to be related to high cholesterol and lessened ability to use insulin properly.

Premature Ovarian Failure (POF) is essentially early menopause. Occurring in women who are younger than 40 years old, POF has no apparent cause in many cases. For other women, POF may have multiple factors that include genetics and previous pelvic infections. It may also be caused by drug or radiation treatments for cancer. Recently, some cases have been linked to certain autoimmune disorders including diabetes, rheumatoid arthritis, and systemic lupus erythematosus.

Diminished Ovarian Reserve refers to a decrease in both the number and the condition of the eggs in a woman's ovaries as she ages. Unlike men, who make new sperm throughout their life, women are born with a large, but limited number of eggs in their ovaries. Gradually, between about age 35 and menopause, when the egg supply runs out, the ovaries lose the ability to produce mature eggs. Finally, hormonal imbalances can lead to ovulation abnormalities. Disorders of the adrenal, hypothalamus, pituitary, or thyroid glands may change blood levels of hormones such as estrogen, prolactin, or progesterone enough to upset ovarian function.

Luteal Phase Abnormalities
Rarely, female infertility may result from a lack or imbalance of progesterone, one of the main female hormones. During the luteal phase (the phase immediately following ovulation) of the menstrual cycle, the inner lining of the uterus usually responds to increased progesterone levels by becoming thick and wrinkled. The softer, folded texture makes a fertilized egg more likely to stay (implant) in the uterus and start a pregnancy. If progesterone levels are not high enough or if progesterone is not present for an appropriate length of time during the luteal phase, the uterus cannot prepare correctly. Even though ovulation and fertilization may occur normally, the uterus cannot trap and nourish a fertilized egg.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.