Pregnancy is the result of a process with many steps. In order to become pregnant, or conceive, a woman's body must release an egg from one of her ovaries during ovulation. Along the way, a man's sperm must fertilize the egg.
The fertilized egg will then proceed through the fallopian tube toward the uterus, which is the womb for the embryo. From there, it must attach, or implant, to the inside of the uterus.
Any problem in these steps may result in subsequent infertility in the woman, or infertility could also be based on a factor from the partner. Either way, the first step in the process is to identify what is causing the underlying condition.
Sometimes it is difficult to accurately establish the exact cause of infertility, since the disorder can be caused by a variety of factors that differ from woman to woman. However, there are three criteria to help identify infertility: age, timing, and frequency.
In general, a healthy reproductive system begins with a healthy hormonal balance, seeing as hormones regulate menstruation and fertility.
Hormonal Causes of Infertility
The female reproductive cycle is regulated by the complex rise and fluctuations of various reproductive hormones, mainly estrogen and progesterone, which work together to prepare a woman's body for pregnancy.
Initial conception involves three, important stages: ovulation, fertilization, and implantation.
Estrogen is most abundant and at its highest levels during the first half of the menstrual cycle - known as the follicular phase - as the body prepares the uterus for ovulation. Estrogen levels then surge to initiate the ovulatory phase until the egg is fertilized. During these phases, low estrogen levels would be the main cause for infertility.
After fertilization and implantation of the egg about a week after ovulation, progesterone levels increase dramatically to proliferate the endometrium to nourish the embryo. During these later phases of conception, lower estrogen levels are normal.
If pregnancy doesn't occur, progesterone and estrogen levels both drastically drop during the luteal phase - which is the phase after ovulation - to ultimately shed the uterus lining during menstruation, thus beginning the cycle over again.
Getting pregnant requires that the delicate balance between all of the associated hormones is intact. Any disturbance or imbalance in healthy estrogen or progesterone levels can result in anovulation and menstrual difficulties, leading to infertility.
There are several stages within a woman's reproductive life in which it will be harder or impossible for her to get pregnant due to partial or complete infertility, including pregnancy, perimenopause, and postmenopause.
Other Causes of Infertility
While hormonal imbalance is the major underlying cause of infertility, experts also point out that possible reproductive and environmental factors may be other underlying conditions causing infertility in a woman. Some reproductive factors include poorly functioning fallopian tubes, the presence of endometriosis, and an abnormal uterus, while environmental factors can include workplace hazards and exposure to pesticides. Keep in mind that infertility also includes the male factor as well.
Risk Factors and Triggers
Risk Factors for Infertility
Risk factors for infertility are characteristics that increase the likelihood of a woman having problems with getting pregnant. Although a woman may have several risk factors, this does not mean that she will automatically be infertile. Once there is an infertility diagnosis, doctors will decipher the ultimate cause to determine if a risk factor was to blame.
Some women are more likely than others to be infertile because of health and behavioral risk factors. Health risk factors include age, weight, and sexual history. Behavioral risk factors include partaking in habits such as smoking and drinking alcohol.
Signs and Symptoms
Because each woman's normal reproductive cycle is different, each one will experience symptoms of infertility differently. However, keep in mind that often times, there are no signs of infertility or symptoms associated with infertility problems.
Common Symptoms of Infertility
- Irregular periods (absent or bleeding in between)
- Painful periods (including pelvic pain)
- Painful intercourse
- Unusual discharge
- Changes in libido
Direct Signs of Infertility
Irregularities with the female reproductive cycle could be some of the biggest red flags to an infertility doctor when determining causes of infertility in women. However, it is important to note that infertility is not always the result of the aforementioned abnormalities in the menstrual cycle. As opposed to more noticeable symptoms, medical signs are measurable criteria that are usually assessed by a physician.
- Low or excessive hormone levels (blood and urine tests)
- Presence of cysts and other reproductive system irregularities (imaging tests)
- Abnormal cervix, uterus, or vagina (gynecology exam)
- More than one miscarriage
Signs detected by a physician may be related to an underlying ovulation disorder, such as PCOS or hypothalamic dysfunction, or infections affecting the female reproductive system. These indirect signs include abnormal hair growth, acne, and pain during intercourse among others.
Diagnosing and identifying the causes of infertility is generally done by a gynecologist without a referral to an infertility specialist. Most often than not, the problem may come down to timing intercourse with ovulation. Nonetheless, the doctor may do additional testing as needed depending on age and prior medical history. These additional tests range from ovarian reserve testing to imaging tests and urine or blood tests.
Prevention and Management
While there is no single way to completely prevent infertility, especially if caused by genetics, there are a few steps that a woman can take to lessen chances of being infertile.
Lifestyle changes to support fertility are extremely important, especially with regard to diet, exercise, and healthy habits. Women looking to prevent or manage infertility should consume a diet rich in vitamin C, zinc, and iron as well as avoid smoking and excessive alcohol consumption. Low- to moderate-intensity workouts about three times weekly will help maintain an ideal body weight for conception. Moreover, women may seek ways to complement these lifestyle approaches with the use of supplements that help nourish the body of essential nutrients and, therefore, help correct hormonal imbalances leading to infertility. These supplements include folic acid, selenium, and vitamin A among others.
In whichever life stage a woman is in when diagnosed as infertile, there are effective methods for infertility management, especially in regard to the stress involved. Making minor daily changes and enlisting the help of others can make a huge difference for women who are trying to overcome infertility.
Moreover, there are certain tips to follow that can help improve the experience of finding out one is infertile, giving women the stepping stones they need to cope with the life stage. The following are general tips that women of all ages can use to relieve stress, such as partaking in meditation and relaxation techniques as well as pursing new hobbies.
Furthermore, there are also specific infertility management tips that can be followed by women who are below the age of 35 and above the age of 35.
Specific tips for managing infertility below age 35 include practicing good habits, taking proper precautions, and recognizing when to seek help.
Specific tips for managing infertility above age 35 include joining a support group, strengthening relationships, and recognizing that infertility at this age is not the end.
Alternative Management Tips for Infertility
Alternative treatments can also be a useful way to manage stress brought on by occupational and lifestyle factors that are negatively affecting a woman's fertility. These treatments will not tackle the hormonal cause behind most women's infertility, but they are effective in reducing stress in the short- and medium-term. Alternative treatments include massage, acupuncture, and biofeedback.
While these measures often help to improve the chances of becoming pregnant, they are unable to treat the root of the problem, which, in most cases, is hormonal imbalance. However, there are several natural infertility treatments that can treat the hormonal causes.
When trying to get pregnant, infertility can present a heavy burden to long-term plans; however, hormonal causes of infertility are generally treatable.
Four Approaches to Treat Infertility
Four levels of approaches can be considered for treating infertility. These are categorized as: (1) Lifestyle Changes, (2) Alternative Medicine, (3) Pharmaceutical Medicines, and (4) Advanced Fertility Options.
If possible, women are encouraged to begin with the least risky approach to treat infertility, lifestyle adjustments, and then proceed to the next level of care. Depending on the condition, medical intervention may be necessary for infertility treatment.
This primary level of infertility treatment involves the least amount of risk; although, it conversely requires the highest amount of self-discipline. Often, simple changes in lifestyle can reap huge benefits in overcoming infertility, and achieving a higher overall level of health. Fundamentally, an improved diet, regular exercise, and healthy habits can do a woman great service.
As previously mentioned under prevention, when considering nutrition, it is important to choose fresh and whole grain foods to supplement the body with proper vitamins and nutrients while reducing caffeine and alcohol intake. Also, regular exercise should involve low- to moderate-intensity workouts two to three times a week to maintain a healthy weight and avoid overly strenuous activities that risk infertility.
Although these changes will help promote fertility, they do not directly address hormonal imbalance, the most common cause of infertility. Further treatment may be necessary. Alternative medicine has proven to be an excellent way of treating infertility related to hormonal imbalance in a safe and natural way.
Alternative Medicine for Infertility
Alternative medicines and supplements generally involve little to no risk and can be an extremely effective for treating infertility. In the case of herbal supplements, there are two main types to take into consideration: phytoestrogenic and hormone-regulating herbal supplements.
Phytoestrogenic herbal supplements
These supplements, such as black cohosh, contain estrogenic components produced by plants that regulate hormones. By carefully introducing certain plant-based estrogens into the body before fertilization, these herbs help treat an underlying estrogen imbalance to normalize menstrual cycles and promote healthy maturation of the egg before ovulation.
However, after conception, purposeful consumption of excess estrogen is unnecessary as progesterone takes over as the dominant hormone to build up the uterine lining, allowing the fertilized embryo to implant itself.
Hormone-regulating herbal supplements
These supplements, including Macafem stimulate the body's natural hormone production by nourishing the pituitary, thyroid, and endocrine glands, helping the whole reproductive system produce hormones more efficiently. This ultimately results in balancing estrogen as well as other important hormones, such as progesterone.
These supplements can be considered the safest and most natural way to treat the underlying hormonal imbalance behind infertility, and they can be taken throughout a woman's life as they support the body's natural hormone production.
Additionally, there are other types of supplements that can promote fertility, including prenatal vitamins that include thiamine, niacin, and vitamin E and other herbal supplements, such as dandelion and ginger.
A combination of approaches is usually the most effective route to take. Lifestyle changes combined with alternative medicine can ultimately promote fertility. However, for some women, the symptoms will be so severe that a more drastic treatment is necessary.
Pharmaceutical Medicines for Infertility
The cost of infertility treatment will dramatically increase as a woman progresses into use of pharmaceutical medications and procedures. Nevertheless, there are many pharmaceutical infertility medicines to choose from, a couple of which include hormone medication as well as ovulation induction medication.
Advanced Fertility Options
Aside from pharmaceutical medicines for infertility, an infertile woman can follow through with more advanced fertility options to ultimately achieve conception, such as intrauterine insemination and in vitro fertilization.
These four approaches are not mutually exclusive. A woman may use different approaches at different times or any combination of them, depending on the duration and severity of infertility symptoms and signs. Today, more and more women find that dealing with infertility can successfully be accomplished via a combination of healthy lifestyle and alternative treatments.
- Academy of Nutrition and Dietetics. (2017). Foods That Can Affect Fertility. Retrieved April 25, 2017, from http://www.eatright.org/resource/health/pregnancy/fertility-and-reproduction/fertility-foods
- American Pregnancy Association. (n.d.). Infertility and Acupuncture. Retrieved April 28, 2017, from http://americanpregnancy.org/infertility/acupuncture/
- American Psychological Association. (2006). Does stress hinder conception? Retrieved April 26, 2017, from http://www.apa.org/monitor/sep06/stress.aspx
- Centers for Disease Control and Prevention. (n.d.). Infertility FAQs. Retrieved April 21, 2017, from https://www.cdc.gov/reproductivehealth/infertility/
- Hormone Health Network. (2013). Women's Reproductive Health. Retrieved April 24, 2017, from http://www.hormone.org/diseases-and-conditions/womens-health/womens-reproductive-health
- Institute for Integrative Healthcare. (2014). Massage Therapy Aids Fertility Treatment. Retrieved April 28, 2017, from http://www.integrativehealthcare.org/mt/archives/2014/10/massage-therapy-aids-fertility-treatment.html
- Journal of Human Reproductive Sciences. (2012). Alcohol and fertility. Retrieved April 25, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493844/
- Mayo Clinic. (n.d.). Amenorrhea. Retrieved April 25, 2017, from http://www.mayoclinic.org/diseases-conditions/amenorrhea/basics/causes/con-20031561
- Mayo Clinic. (n.d.). Getting pregnant. Retrieved April 26, 2017, from http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611
- Mayo Clinic. (n.d.). Female infertility. Retrieved April 24, 2017, from http://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/dxc-20214762
- National Cancer Institute. (n.d.). Diethylstilbestrol (DES) and Cancer. Retrieved April 25, 2017, from https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/des-fact-sheet#q3
- National University of Natural Medicine. (n.d.). About Hormone Imbalance: How Does My Hormonal Cycle Work? Retrieved April 27, 2017, from http://womeninbalance.org/about-hormone-imbalance/
- Stanford University. (n.d.) What Causes Female Infertility? Retrieved April 21, 2017, from https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/Causefem.htm
- The American Congress of Obstetricians and Gynecologists. (2011). Hysterosalpingography. Retrieved April 25, 2017, from http://www.acog.org/Patients/FAQs/Hysterosalpingography
- The American Congress of Obstetricians and Gynecologists. (2015). Ovarian Reserve Testing. Retrieved April 25, 2017, from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Ovarian-Reserve-Testing
- The National Infertility Association. (n.d.). Caffeine: Does it Affect Your Fertility and Pregnancy? Retrieved April 25, 2017, from http://www.resolve.org/about-infertility/optimizing-fertility/caffeine-does-it-affect-your-fertility-and-pregnancy.html
- The National Infertility Association. (n.d.) Understanding Fertility Medications. Retrieved April 28, 2017, from http://www.resolve.org/family-building-options/fertility-medicines/understanding-fertility-medications.html
- The National Infertility Association. (n.d.). What Is Infertility? Retrieved April 21, 2017, from http://www.resolve.org/about-infertility/what-is-infertility/frequently-asked-questions-about-infertility.html
- University of Maryland Medical Center. (n.d.). Infertility in Women. Retrieved April 26, 2017, from http://www.umm.edu/health/medical/reports/articles/infertility-in-women
- U.S. Department of Health and Human Services: Office on Women's Health. (2012). Infertility fact sheet. Retrieved April 24, 2017, from https://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.html#b
- US National Library of Medicine. (2010). The pros and cons of phytoestrogens. Retrieved April 28, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074428/