Understanding female reproduction and infertility

How does the female reproductive system work?
The female reproductive system provides several functions. The ovaries produce the egg cells, called the ova or oocytes. The oocytes are then transported to the fallopian tube where fertilization by a sperm may occur. The fertilized egg ( embryo)then moves to the uterus, where the uterine lining has thickened in response to the normal hormones of the reproductive cycle. Once in the uterus, the fertilized egg can implant into thickened uterine lining and continue to develop. If implantation does not take place, the uterine lining is shed as menstrual flow.


There are many possible causes of infertility. However, it can be difficult to pinpoint the exact cause, and some couples have “unexplained” infertility or “multifactorial” infertility (multiple causes, often both male and female factors). Some possible causes of female factor infertility can include:

  • Problems with the uterus: This includes polyps, fibroids, septum or adhesions inside the cavity of the uterus. Polyps and fibroids can form on their own at any time, whereas other abnormalities (like a septum) are present at birth. Adhesions can form after a surgery like a D&C.
  • Problems with the fallopian tubes: The most common cause of “tubal factor” infertility is pelvic inflammatory disease usually caused by chlamydia and gonorrhoea.
  • Problems with ovulation: There are many reasons why a woman may not ovulate (release an egg) regularly. Hormonal imbalances, , substance abuse, thyroid problems severe stress and pituitary are all examples of things that can affect ovulation.
  • Problems with egg number and quality: Women are born with all the eggs they will ever have, and this supply can “run out” early before menopause. In addition, some eggs will have the wrong number of chromosomes and cannot fertilize or grow into a healthy fetus. Some of these chromosomal issues (such as “balanced translocation”) may affect all of the eggs. Others are random but become more common as a woman gets older.

Who is at risk for female infertility?

Many factors can increase a woman’s risk of female infertility. General health conditions, genetic (inherited) traits, lifestyle choices and age can all contribute to female infertility. Specific factors can include:

  • Age.
  • Hormone issue that prevents ovulation.
  • Being underweight and overweight.
  • Having a low body-fat content from extreme exercise.
  • Abnormal menstrual cycle
  • endometriosis
  • Structural problems -such as fibroids, uterine septum
  • Autoimmune disorders.
  • PCOS
  • h/o Sexually transmitted disease
  • Excessive substance use (heavy drinking).
  • smoking
  • A past history of ectopic pregnancy

DIAGNOSIS AND TESTS FOR INVESTIGATIONS FOR INFERTILITY

How is female infertility diagnosed?
These tests can also help diagnose or rule out a female fertility problem:

  • Blood test: A blood test can check hormone levels, including thyroid hormones.
  • Transvaginal ultrasound
  • Hysteroscopy.
  • Saline sonohysterogram (SIS): Your provider fills the uterus with saline (sterilized salt water) and conducts a transvaginal ultrasound.
  • Hysterosalpingogram (HSG): X-rays capture an injectable dye as it travels through the fallopian tubes. This test looks for blockages.
  • Laparoscopy: Your provider inserts a laparoscope (thin tube with a camera) into a small abdominal incision. This allows to visualise the entire female reproductive antatomy.