Female Infertility, Causes, Investigation And Treatment

Infertility is best referred to as subfertility until proper investigations have been done to rule out any chance of possible conception by natural means

There’s no governing definition for for female infertility, but can commonly be accepted to be defined as an inability to conceive after 12months or 1year of regular unprotected sexual intercourse.

Causes Of Female Infertility

The following factors can lead to fertility problems in a female

  1. Disorders of ovulation
  2. Disorders of the uterus
  3. Disorders of the fallopian tube

Disorders Of Ovulation

The commonest cause of a problem with ovulation is polycystic ovarian syndrome (PCOS). PCOS leads to inability to ovulate(anovulation) which results in oligomenorrhea (Below optimal menstruation).

Disorders Of The Uterus

Uterine disorders such as fibroids can impair fertility in women. However, their impact on fertility depends on their size and location. Submucosal and intramural fibroids >5cm affect implantation of the the embryo. Endometrial polyps can also interfere with fertility.

Disorders Of The Ovarian Tube(Fallopian Tube)

Tubal blockage is usually associated with inflammatory processes in the pelvis such as pelvic inflammatory disease (PID) or endometriosis. Chlamydial infections in particular can produce significant degrees of tubal damage, often resulting in a hydrosalpinx — a blocked Fallopian tube, often with a thickened wall, flattened epithelial mucosa and peritubal adhesions.

Previous pelvic or abdominal surgery can result in postoperative scar tissue or adhesions that can also compromise tubal patency and function.

The following disease conditions can as well impair fertility in a woman

  • Endometriosis
  • Diabetes
  • Epilepsy
  • Thyroid disorders
    Other contributory factors include
  • Cigarette smoking
  • Age
  • Low ovarian reserve: This is the ability of the ovaries to produce egg cells that are not capable of fertilization

Investigations For Infertility

The approach to investigations and treatment of infertility should always be couple-centred.

Female investigations

  • The patency of the fallopian tubes and uterine cavity are basically investigated with an X-ray in a procedure known as Hysterosalpingography (HSG). Can as well be done with an ultrasound study in a procedure called hysterocontrast synography (HyCoSy).
  • Blood hormone profiling is also a necessary investigation that assesses the level of the Follicle stimulating hormone (FSH), oestradiol and Leutenizing hormone (LH).


Treatment of the couple with Subfertility should be evidence based, which relies on an accurate diagnostic evaluation of the clinical history and examination, and the investigation findings. Treatment should also be personal and directed towards findings in other to increase the chance of a good result.

Ovulation Induction (OI)

Carried in women who have anovulation as a result of PCOS. The common drug used is Clomiphene citrate tablets. This treatment option is used after tubal patency and normal semen fluid analysis has been established.

In-vitro Fertilization (IVF)

This involves fertilization of the female egg in a conducive environment outside the uterus and growing a culture of embryo which is then transferred through ultrasound guidance back into the female uterus for implantation and finally pregnancy.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is performed by introducing a small sample of prepared sperm into the uterine cavity with a fine uterine catheter. IUI may be helpful in cases of mild endometriosis, mild male factor subfertility, in couples who do not have intercourse or in single women or same sex couples using donor sperm.

Other treatment modalities include;

Hydrotubation: Involving infusing the uterine cavity and fallopian tubes with fluid usually normal saline to improve patency of the cavity and tubes.

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