Female Fertility Issue
1: Age and Female Fertility
Age plays a crucial role in a woman's ability to conceive. A woman is born with around 1 million eggs, but by the time she reaches puberty, this number drops to about 300,000. As she ages, the number of eggs continues to decline until menopause.
Not only does the quantity of eggs decrease with age, but the quality of the eggs also diminishes, which can affect the likelihood of conception and carrying a pregnancy to term.
Likelihood of Conception Each Month
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At age 20, a healthy woman has about a 25% chance of conceiving each month.
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At age 30, this chance drops to around 20% per month.
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By age 35, the likelihood decreases to approximately 15% per month.
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At age 40, a healthy woman has around a 5% chance of getting pregnant each month.
2: Egg Quality and Fertility
2: Egg Quality and Fertility
Understanding Egg Quality
The quality of a woman’s eggs is a crucial factor in her fertility and the likelihood of a successful pregnancy. High-quality eggs have the best chance of developing into an embryo, successfully implanting in the uterus, and resulting in a healthy pregnancy.
Egg quality is determined by whether an egg is chromosomally “normal” (euploid) or “abnormal” (aneuploid). A chromosomally normal egg contains 23 chromosomes. When fertilized by sperm, which also has 23 chromosomes, the resulting embryo will have a total of 46 chromosomes, which is considered normal.
The Impact of Age on Egg Quality
As a woman ages, her ovaries produce more aneuploid eggs, which have an abnormal number of chromosomes. If an aneuploid egg is fertilized, the resulting embryo will inherit too few or too many chromosomes, often leading to implantation failure, miscarriage, or, in some cases, chromosomal disorders like Down syndrome (an extra copy of chromosome 21).
At age 30, approximately 70% of a woman’s eggs are chromosomally normal. This percentage drops to about 60% by age 35, and by age 40, only around 35% of her eggs remain chromosomally normal.
Egg Quantity
A woman is born with all the eggs she will ever have, typically between 1 to 2 million. These eggs, contained within the ovaries as follicles, diminish in number and quality over time. By puberty, a woman has about 300,000 potential eggs, but only a few hundred will be ovulated during her reproductive years.
Based on your age, medical history, and results from ovarian reserve testing (described below), our fertility specialists can determine how well you might respond to ovarian-stimulating drugs and develop a personalized fertility treatment plan. Remember, it only takes one healthy egg and sperm to create an embryo!
Ovarian Reserve Testing
The following tests, including blood work and ultrasound, can help us evaluate your ovulation and overall fertility potential:
Hormone Tests
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Follicle Stimulating Hormone (FSH): On the third day of your menstrual cycle, we can measure FSH levels, which are critical for follicle development. FSH is how the brain signals the ovaries to prepare an egg each month. As egg quality decreases, more FSH is required, so higher FSH levels may indicate lower egg quality.
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Estradiol (E2): E2 works alongside FSH, communicating from the ovaries to the brain. E2 levels increase as the ovarian follicle matures. For accurate evaluation, E2 levels should be under 50 pg/ml early in the cycle; higher levels may suggest early ovarian response and potentially reduced egg quality.
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Anti-Mullerian Hormone (AMH): AMH, produced by the granulosa cells of developing eggs, helps estimate the number of eggs remaining in the ovaries. As the egg count decreases over time, so do AMH levels.
Transvaginal Ultrasound
A transvaginal ultrasound allows us to count the resting/antral follicles (AFC) between days three to twelve of your menstrual cycle. These follicles, measuring between four and nine millimeters, are potential eggs that could mature and ovulate. A lower number of follicles may indicate challenges with egg quality and quantity.
Egg Freezing
For women who aren’t ready to start a family but want to preserve their fertility, egg freezing (also known as oocyte vitrification or cryopreservation) offers a valuable option. After taking ovarian stimulation medication, mature eggs are retrieved, frozen, and stored for future use.
Freezing your eggs when they are at their peak in terms of quantity and quality provides a better chance of a successful pregnancy later in life.
For more information on the egg freezing process, visit our Egg Freezing page.
3: Endometriosis Symptoms – Understanding the Condition & Available Treatments
3: Endometriosis Symptoms – Understanding the Condition & Available Treatments
What is Endometriosis?
Endometriosis is a condition affecting approximately 11% of women of reproductive age and up to one-third of women experiencing infertility. Women with endometriosis often endure painful menstrual periods that are not alleviated by over-the-counter pain relievers. Additionally, they may experience discomfort during intercourse or bowel movements. The condition is caused by the presence of uterine lining cells in various areas of the abdomen and pelvis, most commonly on the ovaries. The standard method for diagnosing endometriosis involves surgically visualizing these implants.
Endometriosis and Infertility
Endometriosis has long been linked to infertility, although the exact cause remains unclear. Possible explanations include tubal damage due to inflammation and impaired implantation caused by inflammatory substances within the uterus. While some women with endometriosis conceive naturally, others face significant difficulties and require fertility treatments. Research indicates that pregnancy rates per treatment cycle may be considerably lower in women with endometriosis compared to those without the condition.
Why IVF May Be an Optimal Choice for Women with Endometriosis?
Endometriosis impacts 30 to 50 percent of women who struggle with infertility. For these women, in vitro fertilization (IVF) presents a promising option by overcoming challenges such as painful intercourse or blocked fallopian tubes due to cysts and adhesions. During IVF, an egg is fertilized in a controlled laboratory setting, promoting a healthier path to pregnancy. The embryo is then transferred to the uterus, increasing the likelihood of conception and the ability to carry a pregnancy to term. Despite some studies showing a reduced pregnancy rate after IVF in women with endometriosis compared to other women of similar age, the overall success rate per cycle in endometriosis patients remains significantly higher than in natural cycles.
Treatment Options for Endometriosis
Women suffering from endometriosis-related pain have several treatment options. Surgical intervention, typically performed via laparoscopy, has been shown to reduce pain temporarily and may improve fertility. Certain hormonal treatments can also alleviate pain but may prevent pregnancy by inhibiting ovulation. These treatments include oral contraceptives, progesterone-only pills, aromatase inhibitors, and injections. Each medication comes with its own set of potential side effects, which patients should be informed about before starting therapy.
4: PCOS and Infertility – Symptoms and Treatment
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age, impacting around 5-10% of young women. It often results in difficulties with conception. Women with PCOS may experience irregular menstrual cycles, abnormal hair growth, acne, and the presence of multiple small cysts on their ovaries.
PCOS and Infertility
PCOS can negatively affect fertility because women with the condition often do not ovulate, or release an egg, each month. This irregular ovulation is due to the ovaries producing excess estrogen. As a result, menstrual cycles become irregular, and elevated levels of hormones like testosterone can impair egg quality, inhibit ovulation, contribute to insulin resistance, and increase the risk of complications such as gestational diabetes.
Is Pregnancy Possible With PCOS?
Although it is possible for some women with PCOS to conceive naturally, many will need the assistance of a fertility specialist to achieve pregnancy.
PCOS and Fertility Treatment
For women with PCOS who are trying to conceive, the initial treatment typically involves lifestyle changes, including a balanced diet and regular exercise. Diets that are lower in carbohydrates and have a reduced glycemic load have been shown to be particularly effective for women with PCOS. It is recommended that women with PCOS engage in at least 30 minutes of moderate exercise three times per week, with daily exercise being the ideal goal.
If lifestyle modifications do not result in regular ovulation, fertility medications may be necessary to help stimulate the release of an egg. The first line of treatment for women with PCOS who do not ovulate and are trying to conceive often includes selective estrogen receptor modulators.
For some women, oral fertility medications alone may not induce ovulation or result in pregnancy, requiring the use of fertility injections. These injections contain hormones that signal the ovaries to produce eggs. Unlike natural cycles, fertility injections often lead to the production of two or more eggs in a cycle. This treatment requires close monitoring through transvaginal ultrasounds and blood tests to measure estradiol levels, a hormone produced by the ovaries. However, fertility injections are associated with an increased risk of multiple pregnancies.
In some cases, women with PCOS may need to undergo in vitro fertilization (IVF) to achieve a healthy pregnancy. This involves daily fertility injections to stimulate the ovaries to produce multiple eggs, which are then retrieved through a minor procedure. The eggs are fertilized in a lab, and the resulting embryo is transferred into the uterus. Additional embryos can be frozen (cryopreserved) for future use.
Health Risks Associated with PCOS
As mentioned earlier, women with PCOS are at risk for insulin resistance, which can be detected through a simple blood test. If insulin resistance is confirmed, treatment with a medication called metformin (Glucophage) may be recommended.
Women with PCOS are also at risk for hyperlipidemia, or elevated levels of cholesterol and triglycerides. This condition can be screened for with a fasting blood test, and early detection is crucial, as hyperlipidemia can lead to cardiovascular disease later in life.
Additionally, women with PCOS may have an increased risk of developing endometrial (uterine) cancer due to persistently high levels of circulating estrogen. Irregular menstrual cycles can cause the uterine lining to thicken excessively, potentially leading to malignancy.
Finally, women with PCOS are also at a higher risk for ovarian torsion, a condition where the ovary becomes twisted.
What Causes Fibroids?
The exact cause of uterine fibroids remains unclear, but it is known that female hormones, particularly estrogen and progesterone, play a significant role in their growth. Fibroids tend to develop during a woman's reproductive years and may shrink during or after menopause when hormone levels decrease. A family history of fibroids suggests a genetic link, and fibroids are also more prevalent in certain ethnic groups, such as African American women.
Who is At Risk for Fibroids?
Women with the following risk factors have a higher likelihood of developing uterine fibroids:
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Being overweight
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Family history of fibroids
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African American ethnicity
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High blood pressure
Uterine Fibroid Symptoms
Many women with fibroids may not experience symptoms and might not even know they have them. For those who do have symptoms, common ones include:
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Heavy menstrual bleeding
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Lower back pain
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Abdominal or pelvic pain
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Abdominal swelling or fullness
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Constipation
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Frequent urination
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Pain during intercourse
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Infertility
Fibroids and Infertility
Most women with fibroids do not experience infertility as a direct result. However, uterine fibroids can affect fertility in several ways:
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They can alter the size or shape of the uterine lining, which may interfere with implantation.
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Fibroids may block the fallopian tubes.
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Certain types of fibroids can increase the risk of pregnancy complications or miscarriage.
Treatment for Fibroids
Smaller fibroids that do not cause symptoms usually do not require treatment. The appropriate treatment depends on the size and location of the fibroids and the patient's desire to preserve fertility.
Common treatment options include hormone therapy and surgery. In some cases, large fibroids may necessitate a hysterectomy, the removal of the uterus.
Your Sakallı IVF fertility specialist can assess whether fibroids are affecting your fertility and recommend the appropriate treatment if needed.
5: Tubal Factor Infertility
Diagnosis of Tubal Factor Infertility
Two main tests are commonly used to diagnose tubal factor infertility:
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Hysterosalpingogram (HSG): This x-ray procedure involves injecting a safe dye into the uterus through the cervix. The dye flows into the fallopian tubes, and if it doesn't, this may indicate a blockage.
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Laparoscopy: A minimally invasive procedure where a laparoscope (a thin tube with a camera and light) is inserted through a small incision below the belly button. The doctor can observe whether the tubes are open by flushing dye through them.
Treatment for Tubal Factor Infertility
If you are diagnosed with tubal factor infertility due to blocked or damaged fallopian tubes, your doctor will discuss various treatment options with you, explaining the benefits and drawbacks of each to help you make an informed decision.
Treatment options include:
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In vitro fertilization (IVF): In this procedure, eggs and sperm are combined in a lab, allowing fertilization to occur outside the body. The resulting embryo is then transferred back into the uterus.
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Surgery: In some cases, surgery may be an option to attempt to open the blocked fallopian tube.
What is Tubal Factor Infertility?
Tubal factor infertility occurs when a woman's fallopian tube(s) are blocked or damaged, preventing sperm from reaching the egg for fertilization or obstructing the fertilized egg from traveling to the uterus. This condition can affect one or both fallopian tubes. In cases where the tubes are partially blocked, there is an increased risk of ectopic pregnancy. Tubal factor infertility accounts for 25-35% of infertility cases in women.
Causes of Tubal Factor Infertility
The primary causes of tubal factor infertility include:
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Endometriosis
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Pelvic infections, such as chlamydia or gonorrhea
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Pelvic Inflammatory Disease (PID)
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Previous surgeries
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Ruptured appendix
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Certain types of trauma
These conditions often lead to the formation of scar tissue, which can block the fallopian tubes.
6: Hypothalamic Amenorrhea
What is Hypothalamic Amenorrhea?
Hypothalamic amenorrhea is a condition where the menstrual cycle and ovulation are disrupted because the hypothalamus is not functioning properly.
Causes of Hypothalamic Amenorrhea
The hypothalamus is a part of the brain that controls various bodily functions, including the production of hormones that initiate the menstrual cycle. It also regulates sleep, hunger, body temperature, and reproductive health. Women with hypothalamic amenorrhea may experience this condition due to severe calorie restriction, excessive exercise (more than two to three hours a day), or significant psychological stress. It is commonly seen in athletes and women with a low body mass index (BMI). When the brain doesn't receive adequate nutrition, it is unable to produce the necessary hormonal signals that regulate ovulation and egg release.
Symptoms of Hypothalamic Amenorrhea
Common symptoms include:
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Missed or very light menstrual periods
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Low sex drive
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Feeling cold frequently
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Depression or anxiety
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Sleep disturbances
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Increased hunger
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Low energy levels
Treatment for Hypothalamic Amenorrhea
Treatment typically involves strategies such as gaining weight, increasing BMI, reducing stress, and cutting back on excessive exercise.
7: Pelvic Adhesive Disease
How Are Pelvic Adhesions Diagnosed?
Pelvic adhesions can be diagnosed through several methods:
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Hysterosalpingogram (HSG): An x-ray procedure where dye is introduced into the uterus via the cervix and passed through the fallopian tubes to check for blockages.
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Hysteroscopy: A thin, lighted tube is inserted through the vagina to examine the cervix and the interior of the uterus.
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Laparoscopy: A fiber-optic instrument is inserted through a small incision in the abdominal wall to view the organs inside the abdomen.
Treatment for Pelvic Adhesive Disease
Treatment options depend on the location and severity of the adhesions. Surgical repair may be possible in some cases. For those facing infertility due to pelvic adhesive disease, in vitro fertilization (IVF) is often an effective treatment option.
What is Pelvic Adhesive Disease?
Pelvic adhesive disease occurs when scar tissue, known as adhesions, causes internal tissues and organs to stick together. This condition is common following abdominal or pelvic surgery and can also result from infections, abdominal trauma, or endometriosis. Many people with pelvic adhesions may not experience any symptoms.
Symptoms of Pelvic Adhesive Disease
Common symptoms of pelvic adhesive disease include:
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Infertility
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Abdominal cramping or pelvic pain
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Nausea
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Bloating
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Bowel obstruction
Pelvic Adhesive Disease and Infertility
Adhesions that develop around the fallopian tubes or ovaries are a frequent cause of infertility. These adhesions can prevent sperm from fertilizing the egg or block the embryo's passage through the fallopian tube into the uterus, increasing the risk of an ectopic pregnancy
8: Sexually Transmitted Diseases (STDs) and Infertility: Understanding the Risks
Fertility Treatment Options
For women whose fallopian tubes have been damaged by STDs, in vitro fertilization (IVF) is a viable fertility treatment option. IVF involves combining sperm and eggs in a laboratory setting, allowing fertilization to occur outside the body. The resulting embryo is then transferred back into the uterus for potential implantation and pregnancy.
STD Screening Recommendations
The CDC advises that all sexually active women aged 25 and younger undergo annual screening for chlamydia and gonorrhea. Women older than 25 with multiple sexual partners or a new partner should also be screened yearly. If an STD is diagnosed, it is crucial to ensure that your partner is also tested and treated to prevent reinfection.
STDs
Chlamydia and gonorrhea are two significant sexually transmitted diseases (STDs) that can lead to infertility. They are among the most common causes of preventable infertility in the United States and globally.
In 2017, the Centers for Disease Control and Prevention (CDC) reported over two million cases of chlamydia and gonorrhea, making them the first and second most frequently diagnosed infectious diseases in the country.
While these infections can be effectively treated with antibiotics, many people may not be aware they are infected due to the absence of noticeable symptoms. Unfortunately, untreated infections can lead to severe reproductive damage. About 25% of women with chlamydia or gonorrhea may experience symptoms such as pelvic or abdominal pain, unusual discharge, and spotting.
How STDs Can Lead to Infertility
If left untreated, chlamydia and gonorrhea can spread to the uterus or fallopian tubes, resulting in pelvic inflammatory disease (PID). PID can cause inflammation, scarring, and blockages in reproductive organs, particularly the fallopian tubes. This scarring can obstruct the passage of eggs to the uterus, potentially leading to infertility. Women with damaged fallopian tubes are also at a higher risk of ectopic pregnancy.
9: Weight and Fertility: Understanding the Connection
Unexplained Infertility and Diet
Research suggests that women with unexplained infertility often have significant dietary differences compared to fertile women. These differences can range from slight micronutrient imbalances, which are usually correctable with supplements, to more severe nutrient deficiencies associated with obesity, which may require long-term dietary changes and lifestyle adjustments. The Academy of Nutrition & Dietetics recommends that all women of reproductive age be informed about the risks of obesity, excessive weight gain during pregnancy, and postpartum weight retention—since 50% of women do not lose their “baby weight.”
Meeting with a dietitian can be highly beneficial for assessing where improvements can be made. Additionally, while extreme athletes often experience missed periods, even regular exercise can cause subtle menstrual changes that may go unnoticed but could decrease fertility. It’s important to discuss with your doctor whether your exercise routine is too intense, too relaxed, or might be impacting your fertility.
The encouraging news is that weight management interventions often lead to high rates of spontaneous pregnancy, and fertility treatments can assist those still facing challenges. Improving your lifestyle not only boosts fertility but also enhances your long-term health and that of your future baby. This is a valuable investment in your well-being. Creating a healthy lifestyle as you grow your family can be an empowering and bonding experience for couples. It’s important to note that an unhealthy lifestyle can also affect male fertility.
Weight and Fertility
During their fertility journey, many women consider how various health and lifestyle factors might affect their chances of conceiving. Among these, weight—closely linked to diet and exercise choices—is a common concern. A simple way to explain this is that our bodies and brains still operate as if we were living in ancient times, where maintaining a healthy weight signals that conditions are favorable for reproduction.
The Science Behind Weight and Fertility
The female reproductive system is closely connected to the adrenal system, which regulates metabolism, nutrition, and energy. In extreme situations, such as severe stress or malnutrition seen during war or famine, the brain may decide that without consistent nutrition, energy should not be used for reproduction. As a result, women may stop menstruating and ovulating, conserving blood and iron and preventing conception. Even less drastic changes in body weight—just a 5-10% shift—can influence menstruation and fertility.
Finding the Ideal Weight for Conception
Achieving the right weight—not too low, not too high—can significantly increase the chances of having a regular ovulatory menstrual cycle. Body Mass Index (BMI) is often used as a rough guide to assess this, with a normal range typically considered between 18.5 and 24.9 kg/m². However, BMI isn’t a perfect tool, as weight distribution (body shape) also plays a role in health. For instance, carrying more weight around the abdomen (apple shape) is linked to conditions like pre-diabetes and type 2 diabetes. Being either underweight or overweight can disrupt ovulation and increase the risk of miscarriage. Excess body fat can also negatively impact egg quality and the uterine lining, where implantation occurs.
10: Unexplained Infertility
For about one in five couples, even after a comprehensive fertility evaluation, the exact cause of infertility remains unclear. Unexplained infertility doesn't mean there’s no explanation; rather, it indicates that the tests conducted so far have returned normal results. There is always an underlying cause! Often, IVF can uncover issues with egg quality, sperm function, or embryo development that standard tests might not detect. Fortunately, even when the specific cause of infertility isn't identified, various fertility treatments can still lead to the successful birth of a healthy baby.
Blood-clotting disorders
Blood-clotting disorders, also known as thrombophilias, can impact fertility and pregnancy outcomes. These conditions cause abnormal clotting, which can interfere with the normal blood flow necessary to support a healthy pregnancy. Women with blood-clotting disorders are at a higher risk for recurrent miscarriage, slow fetal growth, and pregnancy complications such as high blood pressure (preeclampsia).
Cancer and its treatments, such as chemotherapy and radiation, can significantly impact fertility by damaging sperm and eggs. For men and women facing cancer, fertility preservation options are available at Nicosia Fertility. Patients can freeze their eggs, sperm, or embryos before undergoing cancer treatment, allowing them to have biological children in the future. This process is particularly important for young cancer patients who wish to have children after completing treatment.