Fertility in females

Learn about fertility and infertility in females.

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Female fertility

Female fertility refers to a woman’s ability to conceive a biological child. Understanding when you’re ovulating — and having sex regularly five days before and on the day of ovulation — can improve the odds of conceiving. In an average 28-day cycle, day 1 is the first day of menstruation, and ovulation occurs on day 14. Ovulation is the release of a mature egg from an ovary. It generally takes 12-24 hours to travel along the fallopian tube into the uterus. Your chance of getting pregnant is highest when sperm are present in the fallopian tube during ovulation.

Not everyone has a regular 28-day cycle, however, and rather than count days, other signs should be looked for, including:

Change in vaginal secretions – just after ovulation, the clear and wet vaginal secretions become thicker and cloudy in appearance.

Change in basal body temperature – the body’s ‘base temperature at rest’ increases slightly during ovulation. In tracking your basal temperature every morning before getting out of bed, a pattern may be seen. The most fertile period is 2 to 3 days prior to the temperature rise.

As reproductive hormone levels change throughout the month, stimulating follicle growth and ovulating, so they help the uterus (‘womb’) prepare for a potential implantation of an embryo. A rise in oestrogen leading up to ovulation followed by the surge in progesterone after ovulation helps the endometrium (‘lining’ of the womb) reach a thickness and structure that supports implantation.

Timeline: Ovulation to Implantation
Timeline: Ovulation to Implantation

What is infertility?

Infertility is defined as the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce, either as an individual or with his/her partner. Approximately 15% of couples experience fertility difficulties and these can be due to:

  • female fertility problems (about 40%)
  • male fertility problems (about 40%)
  • both male and female fertility problems (about 10%)
  • unknown cause (about 10%)

Causes of infertility in females

Anatomical issues

  • Fibroids
    Fibroids are benign growths of uterine tissue that are seen in 30-40% of women over 30 years of age, but they can occur at any age. Although they do not always cause infertility, they are seen in 5-10% of infertile women. The fibroid size and position can impede the movement of sperm and egg and, can inhibit implantation.
  • Uterine shape
    A normal shaped uterus is described as ‘pear shape’. Some women are born with an abnormally shaped uterus which, depending on the severity, can increase the risk of miscarriage (pregnancy loss).

PCOS (Polycystic Ovarian Syndrome)

PCOS is a relatively common condition that effects ~1 in 10 women of childbearing age. A hormone imbalance interferes with normal ovarian function and, instead of a follicle maturing and releasing an egg each month, the follicles remain small and can build up in number so that there are many (‘poly’) follicles (small cysts/fluid filled sacs). Women with polycystic ovarian syndrome have a large number of small follicles on their ovaries as well as abnormal androgen hormone levels. The hormone imbalance can cause symptoms such as:

  • Irregular periods, sometimes weeks apart, sometimes months apart
  • Weight gain or difficulty losing weight
  • Acne on the face, chest and upper back
  • Increased hair growth, particularly on the face and lower abdomen

Endometriosis

Endometriosis is a disorder where the tissue that lines the uterus also grows outside of the uterus. The endometrial tissue can grow on the ovaries, fallopian tubes, lining the pelvis, and the bowel. Just as the lining of the uterus thickens and then breaks down with hormonal changes of the menstrual cycle, so too do the abnormal growths of endometrial tissue outside of the uterus. Over time, the broken-down tissue can build up in the uterus and cause inflammation, irritation, and adhesions (scar tissue binding the pelvic organs together). Endometriosis can cause severe pain with menstruation (‘painful periods’), as well as difficulty conceiving a pregnancy.

Cancer treatment

One in three women who still have their reproductive organs but have undergone cancer treatment will have fertility issues. This can be due to acute ovarian failure where the ovaries temporarily shut down, or, due to early or ‘premature’ menopause where egg numbers become very low and ovulation eventually stops. Premature menopause can also result from the ovaries being surgically removed.

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