15 Causes of Infertility in Women
What causes infertility?
An estimated 10% of women have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC). Infertility can be one of the toughest medical issues for woman to deal with—not just because of the emotional upheaval, but because there are so many causes behind it.
About 30% of infertility cases are caused by a spectrum of ovulation disorders ranging from exercise-induced amenorrhea (when you don’t get your period) to premature ovarian failure, Corey Burke, an andrologist and embryologist with Cryos International, a sperm and egg bank in Orlando, FL, tells Health.
Other causes of infertility include age and lifestyle choices, both of which can also affect a woman's odds of having a healthy baby.
"Women who want to increase their chances of getting pregnant often don't know the best things to do or what to watch out for," Francisco Arredondo, MD, a reproductive endocrinologist and fertility specialist in San Antonio, Texas, tells Health. Yet the more you know and the earlier you know it, the more proactive you can be in your own family planning. If you want to have kids one day or have been trying without success, read up on the most common causes of infertility.
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Carrying around extra pounds is not a direct cause of infertility itself. But obesity can affect hormone production and make it more difficult for a woman to get pregnant, William Schlaff, MD, chairman of the department of obstetrics and gynecology at Jefferson Medical College, Thomas Jefferson University, Philadelphia, tells Health. "The more weight a woman gains over her healthy weight, the more she tends to experience decreased ovarian function," he says.
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Being too thin
Just as excess body fat can result in infertility or fertility difficulties, so can not having enough of it. "Maintaining a healthy body weight—one that falls in the normal BMI range and that is reached through a healthy diet and moderate exercise—is one of the most important things a woman can do to increase her chances of getting pregnant," says Dr. Arredondo.
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There’s a reason people say their biological clock is ticking in terms of having kids. “Birthdays are really the biggest factor,” when it comes to causes of infertility, Nicole Noyes, MD, Northwell Health Chief of Reproductive Endocrinology and Infertility, tells Health. “There is an endpoint to fertility. If someone were to ask me what the ideal age to have a child is, I’d say it’s somewhere between 25 and 35. The fact is that the older a woman is, the harder it is to get pregnant, even with medical intervention.”
Why is age so important? Egg quality declines with time. Women over 40 "have a decreased ovarian reserve and egg quality, which often leads to difficulty conceiving,” says Burke. “While they can absolutely carry a baby in advanced age, their ovaries have surpassed the point at which they produce high-quality, healthy eggs.”
This isn’t to say you’d should be rushing to get pregnant in your 20s, or you won't be able to get pregnant on your own in your late 30s or 40s. But if you are planning to wait to have kids until you’re older, the process may be a little more complicated.
Your family history
Ask your mom how old she was when she went through menopause. If she started on the early side, then you probably will, too. "Women are born with a certain amount of eggs," says Dr. Arredondo, "and there are certain genetic factors that might make you born with more or less eggs than usual, or that may make you use those eggs faster than other average women." But keep in mind that you certainly aren't doomed to relive the same exact scenario your mom did.
Certain chemicals have been linked to fertility issues. Exposure to pollutants, pesticides, and industrial compounds can decrease a couple's ability to have children by up to 29%, according to a 2013 study published in Environmental Health Perspectives.
Additionally, a 2015 Washington University study found that 15 common chemicals were associated with early menopause. These chemicals include nine PCBs (which have been banned since 1979 but still exist in older products), three pesticides, two forms of plastics called phthalates (often found in personal care items and beauty products like perfumes and nail polishes), and the toxin furan, a byproduct of industrial combustion.
While the jury is still out as to how much exposure can affect fertility and if the link between some chemicals and infertility is cause and effect, it might be a good idea to try to steer clear of these if you can.
Smoking can hurt a developing fetus, but lighting up can also drastically affect a woman's chances of getting pregnant in the first place. Smoking causes up to 13% of all infertility cases, according to the American Society for Reproductive Medicine. (One 2014 study even found that a woman's smoking may affect the fertility of her sons.)
Cigarette smoke disrupts hormones and damages DNA in both men and women, says Dr. Arredondo. "And it doesn't have to be heavy smoking, either," he says. "Even women who smoke moderately or who are exposed to secondhand smoke have disrupted endocrine function and can experience significant fertility issues."
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There's no evidence that a few drinks a week will affect your fertility, but doctors do caution against heavy drinking—more than one drink a day for women—which has been linked to an increased risk for ovulation disorders. One Swedish study that tracked more than 7,000 women for 18 years found that the heaviest drinkers were more likely to have sought out fertility treatment.
You probably already know you should stop drinking if you think you could be pregnant. Drinking during the early stages of pregnancy (and possibly even before conception) has been linked to premature births. As for whether it's safe to drink later in pregnancy, the jury's still out. Many doctors say a small amount of alcohol is OK, but the CDC and Surgeon General say it's best not to indulge since there is no proof that it's not harmful to the baby.
It's a myth that you can't get pregnant while breastfeeding, but at the same time, it's true that women who are still nursing one child may have trouble conceiving another one. "It impacts ovulation," says Dr. Schlaff. "It's not impossible—so it shouldn't be used as your only birth control method—but it is a decision that can have a negative impact on your fertility."
Older moms who want to have another baby before they have to worry about age-related fertility decline should discuss how long to breastfeed with their doctor. Otherwise, it may be better to wait at least a year and a half before having another child, anyway: a 2014 University of Cincinnati College of Medicine study found that women who wait less than 18 months after having a child to conceive again are more likely to have a shorter pregnancy and preterm birth.
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Working out helps keep you strong and full of energy—both important when you're trying to get pregnant. Thing is, you can overdo it. "If you're exercising too much, it can have a negative impact on ovulation," says Dr. Schlaff. It's not just an issue that affects very thin athletes, either. A study published in Fertility and Sterility found that normal-weight women who exercised vigorously for more than five hours a week had a harder time getting pregnant.
The most obvious sign of a potential problem is a change in menstrual cycle, says Dr. Schlaff. "It doesn't have to go away completely, either," he says. "If you notice that it becomes lighter or shorter, you should talk to your doctor about the implications for your fertility and your health."
Injectable birth control
Once you stop taking most forms of hormonal birth control, you can get pregnant within a month, says Dr. Schlaff. The one exception: Depo-Provera, the injectable birth control. Each Depo-Provera injection prevents pregnancy for 12 to 14 weeks—and while some women do get pregnant in as little as one month after that protection wears off, it can take other women up to a year to conceive. Doctors recommend women stop using injectable birth control several months before they hope to get pregnant.
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A 2015 study published in The Obstetrician & Gynecologist supports the long-suspected theory that thyroid disorders can contribute to ovulation and pregnancy problems, and suggests that women having trouble conceiving be tested for over- or underactive thyroid. "People with significant thyroid disease are typically going to have some pretty obvious symptoms," says Dr. Schlaff, "but subclinical, undiagnosed hypothyroidism is certainly a recognized problem as well, and we know it can have subtle effects on fertility without a woman knowing it."
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If you're addicted to venti lattes, some studies suggest you may have trouble getting pregnant. A 2011 study from the Nevada School of Medicine found that caffeine interferes with the muscle contractions that help eggs travel from the ovaries and through the fallopian tubes to the womb, while a 2012 Danish study revealed that drinking five or more cups of coffee a day may cut a woman's chances of successful in vitro fertilization by half. That said, other studies suggest caffeine plays no role in fertility. Either way, if you're struggling to conceive, it's worth taking a look at your caffeine intake and cutting back if you're drinking more than 200 milligrams a day—that's1 to 2 8-ounce cups of coffee.
Polycystic ovary syndrome is one health issue that can affect a woman's chances of getting pregnant or successfully carrying a pregnancy to term.
“In this case, the ovaries may not develop a healthy egg or release one at all,” Burke explains. “This is due to small follicles in the ovaries that never mature to result in a normal release of the egg.” PCOS is also associated with insulin resistance, elevated insulin levels, and increased production of androgen (male hormones). “These abnormalities can result in issues with ovulation or failure to ovulate at all, making it more difficult to conceive,” says Dr. Noyes.
Endometriosis, which occurs when endometrial tissue grows outside of the uterus, is another cause of female infertility. “This distortion of a woman’s reproductive system may cause the fallopian tubes and ovaries to become blocked, preventing the sperm and egg from coming into contact,” explains Dr. Noyes.
Endometriosis can also interfere with normal ovulation and egg quality. “Endometriosis may inhibit ovulation, causing eggs to become trapped in the ovaries, and could produce chemicals that prevent the movement of the egg down the fallopian tube,” she adds.
Women with autoimmune disorders (such as lupus or rheumatoid arthritis) may also have trouble conceiving, since their bodies may reject a fertilized egg or attack her partner's sperm. In many cases, though, women with these health conditions can still get pregnant and have healthy babies, says Dr. Arredondo. Working with a medical team to manage and improve symptoms, and seeking fertility help if needed, can increase the chances for success.
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Sexual health history
Pelvic inflammatory disease (PID) is an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea, or trauma, says Alan Copperman, MD, medical director at fertility health benefits company Progyny in New York City. Remember: If the fallopian tubes are blocked, the sperm and the eggs cannot meet.
“PID may cause scar tissue or abscesses in the fallopian tubes, resulting in damage to the reproductive organs and infertility,” says Burke. “And, unfortunately, this disease is very common, affecting approximately one million women every year”—and one in eight of those women will experience difficulties getting pregnant.
Chlamydia itself can also cause damage to the fallopian tubes without any other symptoms, and many women may not know they had the disease until they experience trouble getting pregnant.
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Women with higher levels of an enzyme linked to stress had a harder time getting pregnant, according to a 2014 study published in Human Reproduction. Researchers say this study doesn't indicate that stress alone is responsible for fertility problems, but they do suggest that women who have been trying to get pregnant for several months try adopting a stress management program.
"Perceived stress can certainly alter hormone levels and ovulation," says Dr. Arredondo. "Stress itself is not bad, but when it is in excess—and when we react to it in a negative way—it can have all kinds of impact on our health and our bodies."
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