Are you interested in learning about female infertility? Female infertility is the inability to become pregnant despite having frequent, unprotected sexual intercourse for at least a year. Its causes are wide-ranging and can be difficult to diagnose, but the most common cause is lack of ovulation. In most cases, infertility is due to infrequent or no ovulation (Mayo Clinic, 2021).

Main Causes of Female Infertility Development

According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, 2020), the causes of infertility are associated with multiple factors. These include age, lifestyle, menstrual cycle, and reproductive system problems. In addition, exposure to toxic environmental factors and even non-specific causes can be observed. In the natural process of ovulation, the mature egg is released from the follicle that has developed in the ovary. It is taken up by the fallopian tubes and fertilised by sperm. The fertilised egg then travels down the fallopian tubes to the uterus and implants in the endometrium to grow. When this process does not occur, female infertility is experienced (Mayo Clinic, 2021). The main causes of infertility in women are highlighted below (Mayo Clinic, 2021; NICHD, 2020; NHS, 2020):

Lack of ovulation

Lack of ovulation or infrequent ovulation is the most common cause of female infertility. This situation is due to problems in the ovaries that prevent the egg from being released in its natural cycle. Ovulation problems can also occur during the transition to menopause and at the menopausal stage itself, between 45 and 55. They can be the result of:

• Polycystic ovary syndrome (PCOS). That causes a hormonal imbalance and affects ovulation. It is the most common cause of lack of ovulation and can appear at menopause. It presents symptoms and signs such as insulin resistance, obesity, acne, and abnormal hair growth on the face and body.
• Dysfunction of an area of the brain called the hypothalamus. It occurs when follicle-stimulating hormone and luteinizing hormone are no longer produced. These are responsible for stimulating ovulation each month and are affected with the onset of menopause.
• Excess production of prolactin by the pituitary gland, located in the brain. This reduces estrogen production, especially during menopause, and can lead to female infertility.
• Primary ovarian insufficiency during the transition to menopause; when the ovaries stop functioning before the age of 40. It can appear due to immune diseases, certain genetic conditions, or infections. These cause the development of early menopause and, therefore, female infertility.

Fallopian Tube Damage

Did you know that the fallopian tubes must be healthy to prevent any type of female infertility? If they are damaged or blocked, you could have tubal infertility. It can block the passage of the fertilised egg to the uterus or prevent sperm from reaching the egg. It is caused by:

• Pelvic inflammatory disease (PID) is an infection of the genital tract that causes female infertility. It includes the uterus, fallopian tubes, and ovaries. It is caused by infections of sexual transmission such as chlamydia, gonorrhea, among others.
• Surgery to the abdomen or pelvis can lead to female infertility. These include surgery for ectopic pregnancy, in which the fertilised egg implants and grows in a fallopian tube instead of the uterus.

Endometriosis

Here is a disorder you need to know about to avoid possible female infertility. Endometriosis occurs when the endometrium (tissue or lining that normally grows in the uterus) implants and grows in other places, such as the ovaries. This problem can damage the ovaries or fallopian tubes and cause female infertility. It can also affect the implantation of the fertilised egg and fertilisation in less direct ways, such as damage to the sperm and egg.

Some uterine or cervical disorders

Some uterine or cervical disorders can interfere with the implantation of the egg. This increases the risk of miscarriage and, therefore, female infertility. These include:

• Polyps or benign growths (fibroids or fibroids) can block the fallopian tubes or interfere with implantation. Although not in all cases, many women who have fibroids or polyps can get pregnant.}
• Problems in the uterus from birth, although they are rare. These can cause problems getting pregnant or maintaining the pregnancy.
• Cervical stenosis; a narrowing of the cervix due to hereditary damage or malformation causes female infertility.
• Cervical mucus problems. This situation occurs when the cervix cannot produce the best mucus. The aim is to allow the sperm to travel more easily.

Now you know the causes of female infertility and its relation to menopause. It occurs when a woman has been unable to get pregnant after trying for a year. In most cases, it is mainly caused by a lack of ovulation due to problems associated with ovarian function. It also develops due to damage to the fallopian tubes, endometriosis, and some uterine disorders.

Ovulation during the perimenopausal period

You may not be familiar with this term, but it is essential for the health of your body. Perimenopause is the time when the body makes the natural transition to menopause. It usually occurs sometime in the 40s, about two to three years before menopause. At this stage a woman is still ovulating, so she is still fertile (Mayo Clinic, 2021; Perez and Salvador; 2020). In this condition, estrogen levels rise and fall irregularly and menstrual cycles may lengthen or shorten. She begins to experience changes due to a drop in female hormones and menstrual cycles in which the ovaries do not release an egg (Mayo Clinic, 2021). According to the University of Rochester Medical Center (n.d.), in perimenopause, the ovaries gradually stop functioning. Ovulation may become erratic and then stop, contributing to female infertility. The menstrual cycle is prolonged and menstrual flow may be irregular before the last period. During this time, your body releases eggs less regularly, produces less estrogen, and becomes less fertile.

Ovulation in menopause: is pregnancy possible at this stage?

Naturally, a woman is born with all the eggs she will produce in her lifetime - 1 to 2 million. However, that number decreases throughout life, and over time, ovarian function declines. A lower quantity and quality of eggs leads to changes in hormone levels, which increases female infertility. After a woman goes through menopause, there is no way for her to become pregnant naturally (NICHD, 2020). Fertile Period of a Woman A woman's fertile period lasts approximately from 16 to 35 years of age. From this age onwards and especially from the age of 40, a woman's fertility progressively declines until the complete depletion of the egg reserve at menopause. Aging decreases your chances of getting pregnant because your ability to produce eggs is reduced (OASH, 2019; Barrenetxea et al., 2020). However, some women can get pregnant even up to 50. This is because during perimenopause, women still ovulate and, therefore, there is a minimal possibility of pregnancy. For this reason, it is recommended to use contraceptive methods until menstruation has stopped for 12 consecutive months (Pérez and Salvador; 2020). When a woman reaches menopause it marks the end of her reproductive years. Therefore, it is no longer possible for her to become pregnant naturally because her ovaries stop functioning (OASH, 2019; Barrenetxea et al., 2020). In summary, female infertility is characterised by not falling pregnancy after a year of unprotected sex. It is due to several causes, mainly ovulation problems that generate a hormonal imbalance and affect your normal cycle. In addition, it is affected with age, as during perimenopause the ovaries gradually stop working. And finally when women reaches menopause, they are no longer fertile. References Barrenetxea G., Rodríguez, L., Barranquero, M., Baltá, R. y Salvador, Z. (2020, 29 de diciembre). ¿Qué causa la esterilidad femenina? – Síntomas y tratamientos. Revista Médica Reproducción Asistida ORG. https://www.reproduccionasistida.org/esterilidad-femenina/ Centro Médico de la Universidad de Rochester. (s.f.). Perimenopausia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P04651 Instituto Nacional de Salud Infantil y Desarrollo Humano Eunice Kennedy Shriver (NICHD). (2020, 27 de marzo). ¿Cuáles son algunas de las causas de la infertilidad? https://espanol.nichd.nih.gov/salud/temas/infertility/informacion/causas Instituto Nacional de Salud Infantil y Desarrollo Humano Eunice Kennedy Shriver (NICHD). (2020, 27 de marzo). ¿Qué factores relacionados con la edad pueden estar involucrados en la infertilidad de hombres y mujeres? https://espanol.nichd.nih.gov/salud/temas/infertility/informacion/edad Mayo Clinic. (2021, 26 de octubre). Perimenopausia. https://www.mayoclinic.org/es-es/diseases-conditions/perimenopause/symptoms-causes/syc-20354666 Mayo Clinic. (2021, 27 de agosto). Esterilidad femenina. https://www.mayoclinic.org/es-es/diseases-conditions/female-infertility/symptoms-causes/syc-20354308 Oficina para la Salud de la Mujer (OASH). (2019, 1 de abril). Infertilidad. https://espanol.womenshealth.gov/a-z-topics/infertility Pérez, E. y Salvador, Z. (2020, 14 de abril). Menopausia en la mujer: cuándo se produce y qué síntomas tiene. Revista Médica Reproducción Asistida ORG. https://www.reproduccionasistida.org/menopausia/ Servicio Nacional de Salud en el Reino Unido (NHS). (2020, 18 de febrero). Esterilidad. Causas. https://www.nhs.uk/conditions/infertility/causes/