Polycystic Ovarian Syndrome, Endometriosis, and Other Causes of Female Infertility

Female infertility is a contributing factor in about two thirds of fertility cases. However, because the female reproductive system is somewhat less accessible than that of the male, diagnosis and treatment in women can sometimes be a little more difficult. The key is to understand the common causes of infertility in women and know how to identify them. In women over 35, age-related infertility is prevalent. In younger women, reproductive conditions, such as polycystic ovarian syndrome and endometriosis, are among the most common causes of female infertility at our Florida practice.

Reproductive Conditions
Ovulation Disorders
Physical Barriers
Hormonal Imbalances
Age-Related Infertility

Reproductive Conditions

Some of the most common causes of female infertility are reproductive conditions. Diseases that affect the ovaries, uterus, fallopian tubes, and other associated organs can interfere with ovulation, fertilization, or implantation in a number of ways. While some women are diagnosed with a reproductive condition in their teens or early twenties, others are unaware of the problem until they try to become pregnant. During a female infertility assessment, certain symptoms or a family history will indicate testing for a reproductive condition. Treatment depends on the specific condition and its severity. Two of the most common reproductive conditions are endometriosis and polycystic ovarian syndrome.

Endometriosis

Endometriosis is a condition that occurs when segments of the uterine lining, or endometrium, grow on structures outside of the uterus. Endometriosis can result in female infertility and often causes severe menstrual cramps and other pelvic pain, fatigue, and abnormal menstrual bleeding.

Because the endometrial tissue outside of the uterus responds to hormonal changes the same way the lining inside the uterus does, by building up and breaking down with each menstrual cycle, tissue from the endometrial lesions is shed into the pelvic cavity and has no way to exit the body. This causes inflammation, scarring, and cysts that may result in pain and female infertility.
Diagnosis involves a laparoscopic physical examination, during which a camera, attached to a thin tube, is inserted through a small incision in the abdomen. This allows the physician to view the internal structures of the abdomen and pelvic region and determine the extent of the endometrial growth.

Depending on the severity of the problem, endometriosis may be treated with surgery, medication, or both.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS), another leading cause of female infertility, is an endocrine condition that interferes with ovulation. Due to the excess production of androgens (male hormones), women with PCOS often do not ovulate normally. Rather than a single ovarian follicle developing and releasing a mature egg each cycle, multiple ovarian cysts form but do not release any eggs. Common symptoms of polycystic ovarian syndrome include irregular menstruation and signs of hyperandrogenism, such as excess body hair, acne, and thinning hair on the head. Obesity and insulin resistance are also closely associated with PCOS.

While polycystic ovarian syndrome cannot be cured, its effects can be minimized with long-term treatment. To overcome female infertility due to PCOS, clomiphene citrate is usually prescribed to restore normal ovulation. When obesity is a factor, dietary changes and weight loss will frequently cause normal menstruation and ovulation to resume spontaneously.

If dietary changes and clomiphene citrate are ineffective, the patient and physician will discuss alternative treatment options. Due to the high risk of ovarian hyperstimulation syndrome (OHSS) in women with polycystic ovarian syndrome, in vitro fertilization (IVF) may not be recommended.

Ovulation Disorders

Irregular or absent ovulation may be the result of premature ovarian failure, a condition such as polycystic ovarian syndrome, or a different type of hormonal imbalance. Depending on the severity and source of the problem, ovulation disorders can be among the easiest or most difficult types of female infertility to treat. Hormonal imbalances, once identified, can usually be corrected through medication. Fertility drugs can also be administered to stimulate the ovaries and cause one or more eggs to be released. If the ovarian reserve (egg supply) is low, however, ovarian stimulation is unlikely to be helpful. In vitro fertilization with donor eggs is an alternative option that may be indicated in such cases.

Physical Barriers

Another common cause of female infertility is a blockage or barrier in the fallopian tubes or uterus that prevents the egg from coming into contact with sperm or implanting into the uterine lining. Such a blockage may be due to a congenital abnormality, post-surgical adhesions, or any condition that produces scar tissue. Minimally invasive surgery to remove the barrier is one potential treatment option for this type of female infertility. In vitro fertilization (IVF), which was developed for the purpose of helping women with tubal blockages to become pregnant, is also highly effective. Even if a physical malformation of the uterus makes it impossible for the patient to carry a pregnancy, IVF with a gestational carrier will allow the patient to have a biological child of her own.

Hormonal Imbalances

Hormones can be thought of as a chemical communication system used by the body to regulate growth, reproduction, and other processes. When too much or too little of any given hormone is produced, whether as a result of a condition like polycystic ovarian syndrome or a glandular malfunction, these processes are not carried out correctly and problems arise. A hormonal imbalance can cause female infertility by disrupting ovulation, preventing the thickening of the uterine lining, or otherwise preventing a pregnancy from becoming established. Fortunately, once identified, a hormonal imbalance can usually be corrected through medication, lifestyle or dietary changes, or a combination of both.

Age-Related Infertility

Women over the age of 35 often suffer from age-related infertility as their egg reserve declines and hormonal changes make conception and pregnancy more difficult. Unlike some types of female infertility, age-related problems are progressive. The longer the patient waits before seeking treatment, the less likely it becomes that assisted reproductive technology will be helpful.

In some cases, in vitro fertilization (IVF) can be effective for the treatment of age-related female infertility. However, if the ovarian reserve is too low to allow for the collection of a sufficient number of eggs, IVF with egg donation may be indicated instead.

Contact Our Florida Practice

Contact our practice to learn more about how polycystic ovarian syndrome, endometriosis, and other female infertility problems are treated by our Florida specialists.