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)