Causes of Female Infertility

According to WHO, it is the inability of a couple to conceive after two years of unprotected intercourse. Factors that may become a cause of infertility in a female include:

A. Ovarian or Hormonal Factors:

1. Hypogonadotrophic Hypogonadism:

Hypogonadism is an important cause of infertility in both males and females.Causes of hypogonadotrophic hypogonadism are:
• Hyperprolactinemia usually occurs due to:
a) Drugs
b) prolactin-secreting tumours
• Hypothalamic Insufficiency as occurs in Kallman syndrome which is associated with low levels of sex hormones resulting in late commence or non-completion of puberty.
• Pituitary Insufficiency usually due to:
a) Tumours
b) Necrosis
c) Thrombosis
d) Stress
e) Exercise

2. Hypergonadotrophic Hypogonadism:

It can occur in following conditions:
• Menopause
• Luteal Phase Deficiency(shorter duration of luteal phase & low progesterone level during it)
• Gonadal Dysgenesis(developmental disorder of reproductive system)
• Premature Ovarian Failure (autoimmune,cytotoxic chemotherapy,tumour)
• Resistant Ovary Syndrome(insensitivity to hormones)

3. Metabolic Diseases:

• Thyroid Disorders like hypo or hyperthyroidism.
• Liver Diseases(decreased levels of SHBG)
• Obesity
• Androgen Excess
• Polycystic Ovarian Syndrome(androgen excess and anovulation)

B. Tubal Factors (involving fallopian tubes):

These can be any of the following:
• Occlusion Or Scarring Of The Fallopian Tube
• Salpingitis Isthmica Nodosa (nodular thickening of narrow part of fallopian tube due to inflammation)
• Infectious Salpingitis

C. Uterine Factors:

These are:
• Leiomyomata (Fibroids)
• Congenital Malformations (Bifid Uterus)
• Adhesions (Asherman’s Sydrome)
• Endometritis or Abnormal Endometrium

D. Cervical Factors:

• Stenosis
• Inflammation Or Infection
• Abnormal Mucus Viscosity

E. Immunological Factors (Anti-Sperm Antibodies in serum and Cervical Mucus)

F. Psychosocial Factors (Decreased Libido)

G. Iatrogenic :
• Prolonged use of oral contraceptives
• Cancer chemotherapy
• Radiotherapy

H. Idiopathic(unexplained etiology)