Like I said in the ‘about me‘ section, I discovered I had two common fertility issues when trying to conceive my son. I had high prolactin levels which caused me to have long cycles and a luteal phase defect. I will discuss these briefly here along with other common problems you can look out for including Polycystic ovary syndrome (PCOS), Endometriosis, low egg reserve, blocked Fallopian tubes, diabetes or being overweight/underweight. If you have any more suggestions please comment below and I will do some research and add it to my list.
What causes infertility in women?
If you have been trying to get pregnant for more than 12 months (or six months if you are over 35) and have not conceived then you should definitely go and speak to your doctor. There are many reasons why a woman is struggling to get pregnant but there are certain things that can be ruled out just with a simple blood test.
Problems with ovulation.
I recommend you start charting your ovulation as soon as your next cycle begins in order to confirm that you are actually ovulating. If you are having regular periods then it is a good sign that you are ovulating but by charting your cycles and by seeing a maintained temperature increase in the second half of your cycle you can be pretty sure you are ovulating. You can also have your Dr do a blood test around 5-7 days after you think you have ovulated to measure your progesterone levels. They will suggest to do this around 19-21 days since your last period started but if your cycles are longer than the ”average” 28 days then tell your Dr as the tests should be done later (ideally 7 days before your period is due). If you find you are not ovulating you may be given a medication called Clomid which will hopefully stimulate you to ovulate. You can read more about Clomid and how it works to stimulate ovulation here.
Alternatively, if you want to go down the more natural route you can try Soy Isoflavones (see my review here). Low estrogen is usually the cause of anovulation (when a woman is not ovulating) and this problem can often be resolved successfully.
Thyroid problems and ovulation.
Both an overactive or under active thyroid gland can prevent ovulation and you can have your levels of thyroid hormones checked with a simple blood test at your GP surgery. You can go on treatment to control either condition and you should start ovulating again.
Premature ovarian failure and ovulation.
Premature ovarian failure is when a the ovaries stop working while a woman is still at child bearing age and an egg will not be released. Although there is no treatment to prevent this there are options available. Your GP can do tests to confirm this and give you the advice you need.
High Prolactin levels and ovulation.
Prolactin is a hormone that is produced in high levels when a woman is breastfeeding and helps to control ovulation and the production of estrogen and testosterone. If a woman is breastfeeding then she is using up a lot of your resources and her body will cleverly try to prevent ovulation and therefore a further pregnancy during this time. This is to prevent further stress on her body. Women who are not breastfeeding may also produce fluctuating levels of prolactin and if levels become high, (a condition called hyperprolactinemia), it can prevent her from ovulating regularly. If your cycles are particularly long or you have charted your cycle and can see you are not ovulating then go to your GP and ask them to check your levels of prolactin along with your levels of estrogen.
Symptoms of high prolactin levels include irregular or lack of periods, milk discharge from the nipples when you squeeze them (when not breastfeeding) and a lack of cervical mucus. High prolactin levels in women who are not breastfeeding can be caused by a number of things and levels will be checked by your GP on a few separate occasions to double check. If your results show you have high levels of prolactin it is likely your GP will repeat the test again. This is because a temporary increase in prolactin can occur. Levels may be higher if you have the blood test during the luteal phase of your cycle (after ovulation) so ideally the blood test should be done during the follicular phase. Further reasons for a temporary increase include having sex and/or nipple stimulation the morning of the blood test, exercising, drinking alcohol, being dehydrated or having just eaten before the blood test. It is important not to do any of these things before the test to give an accurate result. Early morning is best and refrain from eating, exercising or having sex before the test. High levels of stress and thyroid problems and can also affect levels of prolactin so your GP should consider this as well. Natural treatment for high prolactin levels are available such as Vitex/Angus castus (see Fertility vitamins and herbs section for more information) which can treat slightly raised levels.
The first thing you should do if you have high prolactin levels and are not ovulating regularly is reduce your intake of alcohol. Alcohol can stimulate the production or prolactin (in particular beer as it contains yeast). You should also do the things that help you to relax.
Hyperprolactinaemia can cause infertility but treatment for a sustained rise in prolactin levels are available depending on the cause. If several consecutive blood tests show very high levels then it could mean you have a benign pituitary growth called a prolactinoma. A mediaction called Bromocriptine is often used to reduce the production of prolactin when trying to get pregnant and can hopefully reduce the size of the tumor. This drug must be stopped after conceiving however. If your vision becomes affected by the tumor then surgery is also an option.
Stress and Ovulation.
High levels of stress hormones such as Cortisol can inhibit ovulation or delay it substantially giving you long cycles (see more on this here). By taking steps to reduce your stress levels, ovulation can return and you may ovulate more regularly.
Luteal Phase deficiency.
I have covered the Luteal phase defect in a separate section (see here) as this is the fertility problem I suffer from and is very common. A luteal phase defect is when you are ovulating and may have regular periods but the time between ovulation and your period is short (less than 12 days). A short luteal phase may cause you to spot after ovulation or come on your period before a fertilised egg has time to attach to the uterus lining. An effective treatment for a luteal phase defect is progesterone suppositories which you would need to start using after you have ovulated (you need to be certain you have ovulated through charting your temperatures or having a progesterone blood test).
I used progesterone to conceive both of my children and I have given a review here. Be aware that your GP will not prescribe this to you and you will need to see a consultant gynaecologist to get it. The progesterone treatment can help you to maintain your uterus lining long enough for a fertilised egg to attach and you should carry on taking it until you are around 16 weeks pregnant. There are natural alternatives to progesterone too which I have covered here. One of these is a good vitamin B complex. The complex needs to contain at least 100mg of Vitamin B6 and it can be very effective in lengthening your luteal phase and reduce spotting if taken daily for several cycles.
Weight issues and infertility.
Being under or overweight can play a huge role in your success at getting pregnant. Being underweight can cause you to ovulate very rarely or stop ovulation altogether. Having a lower than normal body fat percentage can affect your hormone levels and in particular can cause low estrogen levels. Having low estrogen levels can prevent the release of an egg from the ovaries.
Being overweight can also be a huge issue. Your estrogen levels can be too high causing estrogen dominance (having too much estrogen relative to progesterone). Having excess fat in your tissues can promote estrogen dominance and having too much estrogen can cause more fat cells to be stored enhancing the problem. Having too much estrogen can prevent the release of an egg from the ovary and can reduce the quality of the uterus lining ready for implantation. Both poly cystic ovarian syndrome (PCOS) and endometriosis are linked to high estrogen levels and these are very common fertility problems. Being overweight is also linked to diabetes which again can affect a woman’s fertility.
Diabetes and fertility problems.
Diabetes is becoming a huge issue in the western world and although having a higher than normal blood glucose level does not prevent fertilisation of the egg it can prevent an egg from implanting properly. You may be able to get the egg fertilised but may miscarry before you even get a positive pregnancy test i.e. a chemical pregnancy.
High glucose levels can increase the risk of miscarriage by 30-60% so if you have diabetes you should concentrate on getting this condition under control before trying to conceive. You can help by loosing a bit of weight by exercising and eating a healthy diet. A treatment called Metformin can help get type 2 diabetes under control by reducing blood sugar levels.
High testosterone levels in women and infertility.
We usually associate testosterone as a male hormone but women have low levels as too. If these low levels become increased it can cause problems when trying to get pregnant and carrying a baby to term. High testosterone levels in women is more than likely linked to poly cystic ovary syndrome (PCOS) which can cause irregular ovulation and can lead to infertility if not treated. If you have high testosterone levels and are not ovulating or you are producing immature eggs you will be unable to conceive successfully. There are medications available to lower testosterone levels which are also used to control PCOS such as metformin and there are drugs available to stimulate ovulation such as Clomid.
Polycystic ovarian syndrome and infertility (PCOS).
Women with PCOS have an imbalance in their hormone levels which leads to irregular menstrual cycles and infrequent ovulation and even anovulation. Other symptoms of PCOS is high testosterone levels (as mentioned above), obesity, excess hair (hirsutism) on the face, back, arms and legs and chest which can be thick and dark in colour. thinning hair on your head and acne and oily skin. You can have a blood test and ultra sound to confirm PCOS and if you do have it you can be placed on treatment to help. Women with PCOS often have elevated blood glucose levels so metformin can be used or clomid to encourage ovulation.
Endometriosis and infertility.
Endometriosis is a condition where tissue that acts like endometrium (the lining of your uterus) is found elsewhere in the body e.g. the fallopian tubes, ovaries, inside your abdomen, bowel or bladder. It mostly effects women of childbearing age and can have long-term effects on fertility. Some women have no symptoms while many have some common symptoms including pain in your lower abdomen which is particularly bad when they are on there period, heavy periods, painful sex, pain when urinating or defecating during a period, nausea, diarrhoea or constipation.
This condition can be diagnosed with a laparoscopy or ultrasound. Treatments include painkillers, the contraceptive pill or surgery. Endometriosis can affect a woman’s fertility and prevent her from getting pregnant so if you have any of the symptoms go and see your GP. I know several friends with endometriosis who have sought help and have gone on to have babies and one friend who was told she would not be able to conceive and was actually waiting for IVF when she fell pregnant naturally.
Poor egg quality.
Our age and lifestyle are key factors when considering egg quality. Egg quality can affect a woman’s chances of conceiving and carrying a healthy baby to term as egg quality is related to the quality of the embryo. Egg quality is also known as ovarian reserve which relates to the number of immature follicles/eggs a woman has left in her ovaries. We are born with all our eggs in our ovaries and they slowly deplete as we age and decrease in quality. Once we hit our mid 30s however, egg quality starts to deteriorate at a faster rate. Doctors can do an ovarian reserve blood test to check the levels of AMH ( anti-mullerian hormone) which is a hormone given off by the remaining follicles in our ovaries. The levels of AMH in our blood can give us a good idea of our remaining supply of eggs. Antral follicle counts through ultrasound and FSH testing on day 3 of your cycle can also be done to determine your ovarian reserve. Although there is no treatment as such to can stop our decreasing ovarian reserve as we age, women who are infertile because of poor egg count or quality and want to get pregnant may use assisted reproductive technologies. IVF using donor eggs can be an option or if you have a low ovarian reserve at a young age but are not ready for a baby you can have your eggs frozen for future use.
Blocked Fallopian tubes.
The Fallopian tubes link a woman’s ovaries to the uterus and after ovulation the egg is fertilised in these tubes before travelling down to the uterus for implantation. If one or both of the Fallopian tube are blocked then the sperm may not get through to the egg to fertilise it. If the sperm cells do manage to make it to the egg, then the egg may not be able to make it to the uterus for implantation. There are no real symptoms of blocked Fallopian tubes and most women are not aware there is a problem until they have trouble trying to conceive. Sometimes however, the blocked Fallopian tube can lead to pain on one side of the abdomen if fluid builds up inside the tube enlarging it. If both tubes are completely blocked then conception without treatment is not possible. If they are only partially blocked then conceiving is possible but there is risk of an ectopic pregnancy. This is when the fertilised egg may not be able to make it through to the uterus and instead starts to implant outside the womb and usually inside one of the fallopian tubes. If only one of the Fallopian tube is blocked then a woman can still get pregnant when she ovulates on the side with the unaffected Fallopian tube.
Blocked Fallopian tubes are caused by scarring or adhesions which can be a result of Endometriosis, Pelvic inflammatory disease (PID), a previous ectopic pregnancy, surgery on the Fallopian tubes, sexually transmitted diseases such as gonorrhoea and Chlamydia or fibroids. To diagnose a blocked Fallopian tube you would need to have a special dye introduced into your uterus and Fallopian tubes and then have an xray which would show up any blockages. An alternative is a laparoscopy where a surgeon will use key hole surgery to investigate and if they see any scarring or adhesions they can hopefully clear them or repair any damage to the tubes. My friend developed a blockage in one of her fallopian tubes which led to PID and scarring. She had a laparoscopy and the tube was cleared. She was able to get pregnant naturally and now has two children. If surgery is not possible or does not work then IVF may be the next step.
Hostile or low quality cervical mucus.
Your cervical mucus should become thin, watery or like egg white as you approach ovulation. This special cervical fluid helps the sperm to swim through your cervix and into the uterus to reach the egg more easily. If there is a problem with your cervical mucus it can prevent pregnancy. If your cervical mucus is of low quality or scant during ovulation you can use a sperm friendly lubricant or try some supplements to increase and improve the quality of your cervical mucus – see section on ‘What is the fertile window’ or ‘What is sperm friendly lubricant‘.
Non-cancerous growths called fibroids can develop inside the uterus and can affect the chances of conception. Sometimes they can prevent a fertilised egg from implanting into the uterus lining or may block one or both of the Fallopian tubes. Symptoms of fibroids include heavy and painful periods, lower back pain or abdominal pains and pain felt during sexual intercourse. You should see your GP if you experience any of these problems.
Medicines and drugs
Some medicines and drugs can have side effects which can reduce fertility. Long term use of ibuprofen or aspirin in high doses can make it difficult to conceive and chemotherapy treatment can cause premature ovarian failure. Antipsychotic drugs can also cause missed periods and infertility. Recreational drugs such as marijuana and cocaine can also significantly reduce fertility and prevent ovulation, while tobacco can reduce egg quality. When trying to conceive you should stop using recreational drugs and ask your GP about the risk associated with getting pregnant while on painkillers and other long term medications.
Male fertility problems.
A low sperm count and low sperm mobility make it difficult for sperm to reach the egg in the Fallopian tubes. Sperm can also be abnormal in shape making it hard for them to fertilise an egg. There is thought to be a link between a prolonged increase in temperature of the testicles and reduced semen quality and something as simple as switching to looser fitted underwear may improve sperm quality.
Damage to the testicles themselves through injury, infection, cancer and surgery can significantly reduce sperm quality as can having undescended testicles or congenital defects. Erectile dysfunction or ejaculation problems can prevent sperm being released and low testosterone levels can cause hypogonadism which will result in a low sperm count. Medicines and drugs such as sulfasalazine , chemotherapy drugs and anabolic steroids can decrease the number of sperm and their mobility. Sometimes the effects are temporary and sperm count and mobility can get back to normal when you stop taking them. Drugs such as tobacco, marijuana, alcohol and cocaine can also affect sperm quality.
Unexplained infertility accounts for around 25% of incidences of infertility in the UK. This is when no reason can be pin pointed in the man or woman. If a healthy couple have failed to conceive after 2 years of having regular unprotected sex they should be considered for IVF treatment. In the mean time check out the section on ‘Fertility vitamins and Fertility Herbs‘ to see if you can boost your fertility naturally in the hope of conceiving without medical intervention. There is also a book called ‘Is your body baby friendly?‘ which has come highly recommended on popular trying to conceive forums.
If you have any comments or issues I have not covered, and you feel that I should add to the list then please comment below. I have also written a post on ‘Natural Killer Cells’ which may be of interest.