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Female Infertility

Factors Affecting Fertility

  • Age

    Age is a very important component in the human reproductive process. Most importantly, a woman's fertility declines steadily after peaking between the ages of 20-25.



  • Weight

    • If women are over 15% of their ideal body weight, ovulation may be impacted.
    • Estrogen is stored in fat cells and can suppress ovulatory function.
    • Fertility medications may not work in patients that are overweight, or they may require much higher doses of gonadotropins to ovulate.
    • Pregnancies may be complicated by gestational diabetes, hypertension and preeclampsia.
    • Evaluation for insulin resistance is important to evaluate as an underlying cause of obesity.
    • Insulin resistance may be increased in patients with polycystic ovarian syndrome.
    • Weight reduction is the best plan before conceiving and may allow for a spontaneous pregnancy in some cases.
    • Low body fat, less than 10-15% of normal, can cause anovulation.
    • Anorexia, bulimia or restrictive diets can put women at risk.
    • Excessive exercise in marathon runners, dancers, or other athletes may cause suppression of ovulation by elevated endorphin levels along with reduced body fat.
  • Lifestyle Choices

    • Smoking: Women who smoke one to two packs of cigarettes per day who started before the age of eighteen are at a greater risk for infertility. Women smokers have a decreased ovarian reserve and have a lessened response to ovulation induction medications. Components in cigarette smoke have been shown to interfere with the ability of cells in the ovary to make estrogen and to cause a woman's eggs to be more prone to genetic abnormalities (ASRM, 11/03).
    • Caffeine: Excessive caffeine intake has been found to affect ovulation. Some studies have found a link between high levels of caffeine consumption by women and delayed conception. Those who consumed more than 300mg of caffeine per day were twice as likely to have conception delayed for a year or more (Hatch EE, Bracken MB (1993). Association of delayed conception with caffeine consumption. American Journal of Epidemiology, 138(12), 1082-092). Coffee drinking before and during pregnancy has been associated with over twice the risk of miscarriage when the mother consumed 2-3 cups of coffee per day. Caffeine is found in coffee, tea, chocolate, soft drinks, and some over-the-counter medications.
    • Alcohol: Even moderate alcohol intake (as little as five drinks per week) can impair fertility, and during pregnancy can impair fetal development.
    • History of Pelvic Inflammatory Disease (PID): A history of PID (gonorrhea, chlamydia) can increase tubal disease and adhesions in the pelvis. There is an increased risk of ectopic pregnancy (pregnancy in the fallopian tube), which could be life-threatening.
    • Medications: Aspirin and like products taken at midcycle may hamper ovulation. Antidepressants may have a negative effect on normal ovulation. Herbal medications have been associated with ovulatory and sperm dysfunction- it is important to tell your physician if you are taking these products. Chemotherapy/Radiation: Depending on the type of treatment used (male or female), may render an individual sterile. .
  • Occupational and Environmental Risks

    • Handling or exposure to chemotherapeutic agents
    • Handling or exposure to pesticides, textile dyes, drycleaning solution, lead, mercury, cadmium, anti-rust agents and plastic manufacturing
    • Dentists/Dental Assistants
    • Anesthetists

Important Considerations

  • Women are born with all the eggs they will have for a lifetime.
  • The number of eggs is individualized to each woman.
  • Over time, the eggs mature and ovulate each month.
  • When the eggs are declining in number, women may begin having signs of menopause, or declining ovarian reserve (irregular cycles, hot flashes, insomnia).
  • Evaluation of ovarian reserve can be done by obtaining blood levels of FSH, LH, and estradiol on day 3 of the menstrual cycle.
  • Levels of FSH > 13 may represent significant ovarian decline or failure that needs immediate further evaluation.
  • Although patients may have elevated FSH levels, at Reproductive Biology Associates our physicians always repeat FSH levels and assess ovarian function on an individualized basis before ever considering egg donation as the only alternative.

Causes of Female Infertility

Causes of female infertility can be diagnosed in approximately 90% of cases. Between 10% and 30% of cases have multiple causes. The most common reasons for infertility include:

  • Tubal Factor
    • Pelvic Inflammatory Disease (PID)
    • Previous Tubal Ligation
    • History of Ectopic Pregnancy
  • Endometriosis
  • Ovulation and Hormonal Disorders
    • Anovulation
    • Thyroid Disease
    • Hyperprolactinemia
    • Hyperandrogenism
    • Hypogonadotropic hypogonadism
  • Polycystic Ovarian Disease (PCOD)
    • Insulin resistance
  • Ovarian Failure
    • Premature Menopause
    • Ovariectomy
    • Congenital Absence of Ovaries
  • Uterine Abnormalities
    • Uterine Fibroids (liemyomas)
    • DES exposure
    • Septate Uterus/Bicornuate Uterus/Unicornuate Uterus


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