What You Need to Know About Female Fertility
If you and your partner are thinking about getting pregnant, you may also be wondering about fertility. Female fertility is a woman’s natural ability to conceive a child.1 Yet, for some couples having a child isn’t easy. In fact, 1 in 6 couples struggle with fertility worldwide.2 About one third of the cases are due to female issues, one third are due to male factors and the rest have unknown causes.1 When a woman cannot get pregnant or carry a pregnancy to term, this is called infertility.2
What is female infertility?
Women under the age of 35 are considered infertile if they are unable to conceive after 12 months. For women 35+, infertility is defined as the inability to conceive after 6 months. Infertility is divided into two types:
- Primary infertility – the inability to become pregnant or carry a pregnancy to term
- Secondary infertility – the inability to become pregnant or carry a pregnancy to term after a previous ability to carry a pregnancy to a live birth.2
A variety of factors can lead to female fertility problems. The most common, affecting 40% of women, is failure to ovulate. Other factors that put a woman at a higher risk are: 3-10,11
- Premature Menopause
- Excessive alcohol use
- Sexually transmitted diseases
- Some types of chemotherapy or cancer treatments
Exposure to environmental and workplace toxins such as lead and chemicals found in certain pesticides.
- Poor diet
- Medical Conditions
- Unexplained reasons
- Inherited reproductive disorders
Milestones in Female Fertility12-14
Women have been struggling with fertility challenges for years. Until recently, there have been few substantial or significant advances to help overcome infertility.
1928: Scientists identify the ovarian hormone progesterone, which plays a key role in pregnancy. A year later the sex hormone estrogen is also identified.
1934: Harvard scientist Gregory Pincus conducts in vitro fertilization (IVF) experiments involving rabbits that suggest similar fertilization is possible in humans.
1944: The first successful IVF of human eggs. The scientists do not attempt to implant the fertilized eggs in a woman.
1978: The first human baby is born after conception by in vitro fertilization (IVF).
1982: First pregnancy from IVF using donor eggs.
1983: First birth from IVF using frozen embryo transfer (FET).
1987: Use of transvaginal ultrasound is first reported as a technique for egg retrieval. IVF cases go from 1-2 hours of operating room time to 10-15 minute procedures that can be done in an office.
1990: Preimplantation genetic diagnosis (PGD) is introduced as a way to prevent sex-linked disease. The first application of PGD resulted in two sets of healthy female twins.
1991: First birth from IVF with intracytoplasmic sperm injection (ICSI).
2010: Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10% of all couples worldwide.
Important Terms to Know
Getting to know some basic medical terminology and the words used to describe the female reproductive system will help you get more from your discussions about fertility and the treatment options available to you.
Uterus – Pear-shaped female organ located in pelvic cavity, receives oviducts and connects with vagina, source of menstrual flow and site of pregnancy.
Ovaries – A pair of walnut-sized glands located on either side of uterus, they produce eggs and release the two hormones—estrogen and progesterone.
Cortex – The thick outer wall of the ovary composed of connective tissue cells and fibers, among which are scattered primary and secondary (antral) follicles in various stages of development; the cortex varies in thickness according to the age of the individual, becoming thinner with advancing years.
Medulla – The inner part of the ovary that is packed with blood vessels and nerve fibers.
Follicles – Small fluid-filled sacs within the ovary that hold an immature egg.
Follicular Atresia – The breakdown and reabsorption of follicles into the ovary.
Primordial Follicle – A follicle consisting of an egg enclosed by a single layer of cells.
Primary Follicle – An immature follicle in which the developing oocyte is surrounded by a layer or layers of cells.
Secondary Follicle – Follicles surrounded by several layers of cells.
Tertiary Follicle – Large ovarian follicles in which there is an antral cavity.
Antral Fluid – The fluid surrounding a follicle that contains steroids, hormones, proteins and enzymes.
Graafian Follicle – A mature follicle in the ovary that contains a liquid-filled cavity that ruptures during ovulation to release an egg.
Oocyte – An egg.
EggPCSM Cell (Egg Precursor Cells) – Found in the outer cortex of a woman’s ovary, these cells are exposed to limited blood flow, which may help protect them from the damaging effects of aging.
Mitochondria – The parts of a cell responsible for fueling cell division and growth. Also known as cellular “batteries.”
Egg Health – The condition and quality of eggs produced in the ovary. Egg health is a key factor in determining if an egg can be used in IVF treatments.
- The American Society of Reproductive Medicine. Frequently Asked Questions. http://www.reproductivefacts.org/awards/index.aspx?id=3012. [Accessed April 29, 2015].
- Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012 Dec; 12(9): 1-12. doi: 10.1371/journal.pmed.1001356.
- Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007; 75(6): 849–856.
- Zenzes MT. Smoking and reproduction: gene damage to human gametes and embryos. Hum Reprod Update. 2000 March; 6(2): 122-131.
- Wdowiak A, Sulima M, Sadowska M, Bakalczuk G, Bojar I. Alcohol consumption and quality of embryos obtained in programmes of in vitro fertilization. Ann Agric Environ Med. 2014; 21(2): 450–453.
- Buck Louis GM, Lum KJ, Sundarem R, et al. Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertil Steril. 2011 June; 95(7): 2184–2189.
- Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes. 2007 Dec; 14(6): 482-487.
- Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage—results from a UK-population-based case-control study. BJOG. 2007 Feb; 114(2): 170-86.
- National Collaborating Centre for Women’s and Children’s Health (UK). Fertility: assessment and treatment for people with fertility problems. London (UK): RCOG Press; 2004 Feb.[Accessed March 2007].
- Ohl J, Partisani M, Demangeat C, Binder Foucard F, Lang JM. Alterations of ovarian reserve tests in human immunodeficiency virus (HIV)-infected women. Gynecol Obstet Fertil. 2010 May; 38(5): 313-317.
- National Institutes of Health. Diseases and conditions that influence infertility. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/
Pages/health-factors.aspx. [Accessed April 29, 2015].
- Public Broadcasting System. Timeline: the history of in vitro fertilization. http://www.pbs.org/wgbh/americanexperience/features/
timeline/babies/1/. [Accessed April 29, 2015].
- White YA, Woods DC, Takai Y, Ishihara O, Seki H, Tilly JL. Oocyte formation by mitotically active germ cells purified from ovaries of reproductive-age women. Nat Med. 2012 Feb 26; 18(3): 413-421.
- Wang J, Sauer MV. In vitro fertilization (IVF): a review of 3 decades of clinical technological advancement. Ther Clin Risk Manag. 2006:2(4) 355–364.