Female infertility is the inability of a woman to conceive or carry a pregnancy to term after one year of regular, unprotected sexual intercourse. Female factor infertility refers to infertility issues that primarily originate from the female reproductive system.

There are different levels or types of female infertility which can affect women in varying degrees.

Primary infertility, which accounts for about 10-15 percent of all cases of infertility, refers to a woman who has never been able to get pregnant. It can be caused by issues with ovulation, fallopian tube blockages, and uterine problems.

Secondary infertility, which is more common than primary infertility, accounts for about 25-30 percent of all cases of infertility. This occurs when a woman who has previously been able to get pregnant, becomes unable to do so. Causes include scarring from previous pregnancies/deliveries, hormonal imbalances, or other reproductive health issues.

Unexplained infertility is relatively common and accounts for about 10-30 percent of all cases of infertility. In these cases, the underlying cause of a woman’s infertility cannot be determined through testing.

Partial infertility refers to reduced fertility, where a woman may be able to get pregnant but has difficulty doing so. Various factors like age, lifestyle, and certain medical conditions can contribute. Partial infertility has no specific prevalence data, as it exists on a spectrum. Many women experience some degree of reduced fertility over time.

Absolute infertility is a complete inability to get pregnant, often due to structural or hormonal issues. Examples include the absence of ovaries, uterus, or fallopian tubes. Absolute infertility is relatively rare, affecting around 1-2 percent of women of reproductive age.

In many parts of the developing world, women are defined and valued by their ability to bear children. The social and cultural pressures around fertility in these contexts can have severe negative impacts on the lives and wellbeing of infertile women.

Infertility can have significant physical and emotional effects on women. Physical effects include hormonal imbalances and irregular menstrual cycles, pelvic pain or discomfort, sexual dysfunction, and an increased risk of certain medical conditions like endometriosis or polycystic ovarian syndrome.

Emotional effects include depression, anxiety, and mood swings, feelings of low self-worth, loss of control and grief, strain on relationships with partners, family, and friends, and social isolation.

Infertile women often face intense social stigma and marginalization within their communities. In many African cultures, a woman’s identity and social worth is deeply tied to her ability to bear children. They may be viewed as cursed, less of a woman, or a burden on the family.

They also frequently have a lower social status compared to fertile women and may be denied participation in certain cultural/social events or rituals.

Infertility often leads to marital problems, abandonment or polygamy as men may choose to take another wife who can bear children. This can cause economic hardship as infertile women often have fewer economic opportunities, particularly if they are uneducated and are financially dependent on their husbands/families, making them vulnerable.

This can cause psychological distress including depression, anxiety, low self-esteem and feelings of worthlessness.
Access to infertility diagnosis and treatment is very limited in much of sub-Saharan Africa, leaving many women without options.

Bridge Clinic has spent the last 25 years helping women with female factor infertility complete their families by making access to care straightforward and by ensuring that every encounter is driven by empathy, compassion and a lack of stigmatisation or blame.

Our Welcome Forums have been, and continue to be, a platform for engaging couples trying to conceive in order to educate them on the causes of infertility and that both male and female factors can contribute to the challenges.
Female infertility can be caused by a variety of factors, including ovulation disorders which are problems with the ovaries that can prevent the regular release of mature eggs, such as polycystic ovary syndrome (PCOS), premature ovarian failure, and hypothalamic dysfunction. Other ovarian factors such as premature ovarian failure or ovarian cysts can also impact fertility.

Conditions like pelvic inflammatory disease, endometriosis (a condition in which tissue similar to the lining of the uterus grows outside the uterus, leading to inflammation and scarring) or scarring from previous surgeries can block or damage the fallopian tubes, preventing the egg from traveling to the uterus.
Uterine or cervical problems such as fibroids, polyps, or abnormal uterine shape can interfere with implantation or embryo development. Cervical stenosis or incompetence can also contribute to infertility.

Disorders affecting hormone balance such as thyroid problems or high levels of prolactin can interfere with ovulation and fertility. In addition certain genetic conditions, such as Turner syndrome or fragile X syndrome can cause infertility.
Female fertility declines with age, especially after the age of 35, due to a decrease in egg quality and quantity as their ovarian reserve diminishes.
Lifestyle factors such as excessive alcohol consumption, excessive exercise, smoking, obesity, or extreme stress can also contribute to female factor infertility.

Some symptoms of female infertility, other than the inability to conceive after one year of regular unprotected intercourse, include irregular periods or absence of periods, heavy or light bleeding, pelvic pain or discomfort, unexplained weight gain or loss, and fatigue or mood changes.

These symptoms on their own do not indicate infertility. A definitive diagnosis of female infertility will involve various tests, such as ovulation assessment, hormone testing, hysterosalpingography (to check for fallopian tube blockage), and laparoscopy (to visually inspect the reproductive organs). Treatment options can include medications, assisted reproductive technologies, lifestyle changes, and surgical interventions, depending on the underlying cause.

At Bridge Clinic, comprehensive assessments are carried out to determine the possible female factors that may be causing infertility. Blood tests are done to check the woman’s ovarian reserve, rule out infections or thyroid disorders and other hormonal tests. A transvaginal ultrasound scan is done to check for any abnormalities of the uterus such as fibroids or polyps and to assess the ovarian follicular count and check for any cysts. An assessment is also done to rule out any blockages in the cervix (neck of the womb) that may impede the transferring of embryos into the uterus.

If any abnormalities are found, the appropriate management is instituted to ensure that the best chance at a successful outcome with IVF is given.

It is important for women experiencing infertility to seek support from their healthcare team. The right treatment depends on the underlying cause of infertility. A fertility specialist can evaluate a woman’s individual situation and recommend the most appropriate options. With the right care and coping strategies, many women can manage the difficulties of infertility.

Toyin Ajayi is the Managing Director, Bridge Clinic Nigeria.