Which Female Factors Affect Pregnancy?
When working normally, your body runs the cycle of ovulation automatically and precisely, so irregular periods are the most common indicators of a female fertility problem. However, many other possible problems that may not seem obvious can interfere when trying to conceive.
The most common cause of female infertility, ovulatory problems are about 30% of cases. Even if your body is healthy and organs are normal, pregnancy can’t occur unless you produce a healthy egg capable of being fertilized. In order for your ovaries to produce eggs that mature and release, the major hormones that drive your menstrual cycle must function normally. If you have abnormal or irregular menstrual cycles you may not be ovulating — or more often, not ovulating regularly and normally. There are many reasons for a woman to have ovulatory problems; a significant part of your evaluation will be devoted to pinpointing — and treating — such ovulatory problems.
Abnormalities of the fallopian tubes are the second most frequent problem, and account for about 20% of female infertility. Tubal factor can include a wide range of problems and different causes. Tubal blockage is fairly common and easy to understand, though not infrequently even tubes that are open may have significant damage, or even dysfunction. Anytime a woman has tubal abnormalities she may be at risk for, besides infertility, having an ectopic (usually tubal) pregnancy.
Uterine problems, which account for about 5% of all female infertility, include abnormal growths and other anomalies that make it difficult for an embryo to implant and develop. Most common are abnormal growths such as fibroids (leiomyoma) and endometrial polyps. These conditions arebenign (non-cancerous) and usually slow growing, but can still sometimes cause significant female fertility problems. Some women (2-3%) have abnormalities of the uterus they have been born with (congenital), which cause problems. Like testing of the Fallopian tubes, you will be evaluated early and thoroughly for uterine factors.
The peritoneum is a very thin blanket of tissue that lines the abdomen and pelvis. It allows organs to glide and slide smoothly against each other and work efficiently; disorders of peritoneum can cause female infertility. Pelvic adhesions (often referred to just as “scar tissue”) pull organs outof their proper place or can bind them together; either one will interrupt normal function. Endometriosis, another disorder of peritoneum, occurs when the tissue that lines the uterus grows in other areas of the body — including ovaries, tubes, pelvis, bladder, and even bowel. Endometriosis can affect fertility in up to 30-40% of females, and does so in complicated ways. Some women have both endometriosis and pelvic adhesion together.
Cervical problems are very much less common or important in female infertility than was once believed, but still contribute to a small number of cases.
The most elusive diagnosis, good estimates are that roughly 15% of infertile couples will have completely normal testing. Unexplained infertility does not apply to couples who have been incompletely or partially tested, but to those who have been exhaustively tested with no abnormal findings. These couples may have problems with factors such as egg quality, tubal function, or sperm viability, but physicians aren’t able to explain why. Even in cases where your infertility is called unexplained, that does not mean pregnancy isn’t possible.