Causes of Infertility
in Women

1. Hormonal disorders
2. PCO syndrome
3. Blocked fallopian tubes
4. Endometriosis
5. Genetic diseases
6. Ovarian insufficiency / Premature Ovarian Failure
7. Malignant diseases

1. Hormonal disorders

A woman's cycle (menstrual cycle) is controlled by a number of hormones. A hormonal imbalance may lead to a variety of disturbances. The causes are diverse and may result in the failure of oocyte maturation (oogenesis) / follicle maturation or in anovulation, i.e. the absence of ovulation. If progesterone levels are too low, pregnancy does not occur (corpus luteum insufficiency). There are other factors that may play a role here, such as hypothyroidism or hyperthyroidism, elevated prolactin levels, polycystic ovaries (PCO syndrome), extreme physical strain, other stress factors as well as severe underweight (anorexia, bulimia) or heavy overweight but also tumors (though this is an extremely rare occurrence).

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Example: corpus luteum deficiency

Some women suffer from corpus luteum insufficiency (also referred to as a luteal phase defect). In this disorder, the yellow body (corpus luteum) that develops from the follicle remnants left behind after ovulation is not capable of actively producing enough progesterone to allow the embryo to attach to the endometrium and successfully implant in the womb. This either prevents embryo implantation from occurring or the pregnancy does not last and the embryo is shed with the onset of menstrual bleeding. It is possible to identify this disturbance by performing a specific hormone analysis in the second half of the cycle (menstrual cycle). If blood testing reveals a low level of progesterone in the days following ovulation, this indicates such a luteal phase defect (corpus luteum defect). The situation can be improved by using progesterone for luteal phase support. It can be administered orally, vaginally or by intramuscular injection. Moreover, the corpus luteum might not be able to properly pick up embryonic signals. This kind of disturbance cannot be identified by a hormone analysis. In such a case, repeated intramuscular application of hCG (human chorionic gonadotropin) is the sole means to prevent the disintegration of the corpus luteum. By aspirating the follicles during egg collection, many of the granulosa cells (which would normally develop into the corpus luteum) are removed. Therefore, IVF/ICSI/IMSI treatment naturally results in corpus luteum insufficiency. Here, too, the remedy is progesterone supplementation. We would like to stress that progesterone supplementation solely in the form of vaginal suppositories/tablets is often not enough to supply the uterine mucosa with sufficiently high doses of the hormone. Where appropriate, it is possible to choose the above route of administration after the 6th week of pregnancy, since at this time the developing placenta, too, secretes progesterone, adding to the already existing level provided by vaginal suppositories or tablets.

2. PCO syndrome

It is estimated that globally 5 to 10 % (some studies even assume rates of up to 15 %) of all women of childbearing age suffer from PCOS, i.e. polycystic ovary syndrome. PCO syndrome is very complex and is considered to be one of the most common endocrinopathy in women. The root causes of the hormonal imbalances involved in this pathology are still largely unknown. Such disorders may have a negative impact on the fertility of the affected women. It is thus important to see experienced specialists in order to undergo diagnostic work-up. Subsequently, the specialist(s) may propose suitable therapy options to them, which may also include ART medical treatment.

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2. Blocked fallopian tubes

Fertilization takes place in the fallopian tubes, also called uterine tubes. Subsequently, the fallopian tubes carry the fertilized egg (zygote), i.e. the resulting embryo to the uterus. Tubal function can be impaired due to various circumstances. In the worst case, the uterine tubes become completely blocked. The possible reasons may include, by way of example, adhesions and scarring after previous surgery, ascending infections from the genital tract (e.g. chlamydia), condition following tubal pregnancy, sterilization and endometriosis.

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4. Endometriosis

Endometriosis occurs in about 15% of the general female population. It is a medical condition in which endometrial tissue grows in parts of the body outside the uterus. Endometrial lesions are found in locations such as the urinary bladder, bowel, fallopian tubes, ovaries or the pelvic wall. Women of reproductive age diagnosed with endometriosis often suffer from painful menstrual periods. Moreover, functional disorders of the fallopian tubes are often caused by adhesion formation in endometriosis. Moreover, ectopic endometrial lesions are responsible for the release of certain messenger substances, which in turn are associated with lower pregnancy rates. To date, the causes of endometriosis as well as its negative impact on natural conception are not yet fully understood.

5. Genetic diseases

Genetic disorders in humans might result in serious diseases and may also have an adverse effect on fertility, leading for instance to reproductive impairment, miscarriages etc. Particularly for those couples who had to face a number of setbacks in the past, and who are now willing to use assisted reproductive technology (ART) to address their infertility issues, the linking of reproductive medicine and genetics might be a real blessing (Learn more).

6. Ovarian insufficiency/Premature Ovarian Failure

Ovarian insufficiency is generally understood as a severe impairment or even the loss of ovarian function in the affected woman. There are either no follicles present in the ovaries or the already small ovarian pool of follicles is gradually depleted, leading to inadequate hormone production, i.e. preventing successful oocyte maturation.

7. Malignant diseases

Patients suffering from malignant diseases need therapies that are tailored to their individual situation. This may include, for instance, radical surgery and/or chemotherapy and/or radiation. Any such treatment may cause infertility in men and women of reproductive age. There are fertility preservation options for both males and females, including the freezing of a semen sample or testicular tissue intended for transplantation at a later point in time. Oocyte cryopreservation (egg freezing) is available to women as a means of preserving female fertility. Our biologists are internationally recognized experts in the field of freezing techniques for human cells and tissues (see "Cryopreservation").