Female Infertility: Causes, Diagnosis, and the Path to Motherhood

Infertility is a serious issue affecting millions of couples worldwide. For women, this condition is not only physiological but also a deeply emotional ordeal that can significantly reduce quality of life, cause family conflicts, depression, anxiety disorders, and even post-traumatic stress disorder [1]. Understanding the causes, timely diagnosis, and adequate treatment are key steps on the path to long-awaited motherhood.

What is Female Infertility and Its Impact?

Female infertility is defined as the inability to conceive after regular attempts for a certain period of time (usually one year for women under 35 and six months for women over 35). This is a common phenomenon, and its impact goes far beyond physiology. Women facing infertility or pregnancy loss often experience significant psychological distress. High-risk groups for developing mental disorders include young women, those lacking adequate social support, those who have experienced repeated pregnancy losses, or those with a history of trauma and/or mental illness [1].

It is important to note that mental symptoms, such as depression or anxiety, can not only be a consequence of infertility but can also cause or exacerbate it themselves [1]. Therefore, a comprehensive approach that includes the assessment and treatment of psychological status is an integral part of managing patients with infertility.

Key Causes of Female Infertility

The causes of female infertility are diverse and can be related to both the reproductive system and overall health:

• Hormonal Disorders: Hormone imbalance is one of the most frequent causes. This includes ovulation disorders associated with polycystic ovary syndrome, thyroid dysfunction, or other endocrine problems. For example, thyroid diseases such as hypothyroidism or hyperthyroidism can directly affect reproductive function. Studies show the importance of early detection of thyroid diseases, especially in women with comorbidities [7]. Fluctuations in estradiol levels, including those caused by hormone therapy in assisted reproductive technologies (ART), can also affect co-occurring conditions such as migraine [8].
• Structural Abnormalities and Diseases of the Reproductive Organs: These include tubal obstruction (e.g., after inflammatory diseases or ectopic pregnancy), endometriosis, uterine fibroids, polyps, and adhesions. Ectopic pregnancy, in which the fertilized egg implants outside the uterus, is an emergency condition and can lead to damage to the fallopian tubes, subsequently affecting fertility [2].
• Systemic Diseases and Their Treatment: Certain chronic illnesses can affect the ability to conceive. For example, in women with epilepsy undergoing infertility treatment, the interaction of anticonvulsant drugs with the hormone therapy used in ART must be taken into account. It is important to understand how assisted reproductive technologies (IVF, ovulation induction) affect seizure control in such patients [5].
• Psychological Factors: As mentioned earlier, depression, anxiety, and stress can not only be a consequence of infertility but also contribute to its development or exacerbation. Young women who have experienced repeated pregnancy losses or have a traumatic history are particularly at risk of developing mental disorders that can affect fertility [1].

Comprehensive Examination: A Step Toward Diagnosis

Diagnosis of infertility requires a comprehensive approach and a thorough examination of both partners. For women, the examination typically includes:

• Anamnesis Collection and Physical Examination: The physician gathers information about the menstrual cycle, previous pregnancies, past illnesses, and surgeries.
• Hormonal Studies: Blood tests for hormone levels (FSH, LH, estradiol, prolactin, thyroid hormones, testosterone, etc.) to assess ovarian reserve and identify endocrine disorders [7].
• Pelvic Ultrasound Examination (Ultrasound): Allows for the assessment of the state of the uterus and ovaries, and the identification of abnormalities, cysts, fibroids, and polyps. Ultrasound is also used to monitor ovulation [2].
• Assessment of Fallopian Tube Patency: Can be performed using hysterosalpingography (HSG) or laparoscopy. It is important to rule out tubal damage, including after an ectopic pregnancy [2].
• Screening for Comorbidities: In women with chronic conditions such as epilepsy or migraine, their impact on reproductive function and pregnancy planning must be taken into account [5, 8].
• Psychological Assessment: Screening for depression, anxiety, and other mental symptoms is an important part of the examination, as these conditions can affect fertility and require appropriate treatment [1].

Modern Approaches to Treatment and Support

Infertility treatment is always individualized and depends on the identified causes. It may include:

• Drug Therapy: For correcting hormonal disorders and stimulating ovulation.
• Surgical Treatment: To eliminate structural abnormalities (e.g., removal of fibroids, polyps, lysis of adhesions, restoration of tubal patency).
• Assisted Reproductive Technologies (ART): These include insemination, in vitro fertilization (IVF), and other methods. When performing IVF in women with chronic conditions such as epilepsy, careful selection of anticonvulsant drugs and adaptation of stimulation protocols are required to minimize the risk of exacerbating the underlying disease and ensure safety [5]. It is also necessary to consider that hormonal stimulation can affect the frequency and severity of migraine attacks in predisposed women [8].
• Psychological Support: Extremely important at all stages of treatment. Psychoeducation, provision of resources, and the opportunity to discuss feelings, losses, and future plans can significantly ease the emotional state [1]. Women at risk for or already experiencing mental symptoms should be offered a comprehensive treatment plan that includes psychological help [1].

The path to motherhood can be long and difficult, but modern medicine offers many solutions. It is important to remember that timely consultation with specialists, comprehensive diagnostics, and individually tailored treatment incorporating both medical and psychological aspects significantly increase the chances of success.

Sources

1. Infertility and perinatal loss: when the bough breaks. (Current psychiatry reports, 2016)
2. Obstetric and gynecologic emergencies. (Emergency medicine clinics of North America, 1997)
3. Macro- and microhematuria: guidelines for obstetricians and gynecologists. (Obstetrical & gynecological survey, 2009)
4. Gestational diabetes insipidus: a review of an underdiagnosed condition. (Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2010)
5. Infertility treatment in women with epilepsy: a systematic review. (Epilepsy & behavior : E&B, 2026)
6. A rare case of pregnancy-associated thrombotic thrombocytopenic purpura. (Oxford medical case reports, 2026)
7. ASSESSMENT OF THYROID DISEASES SCREENING AMONG FEMALE POPULATION WITH BREAST PATHOLOGIES IN THE REGION OF KVEMO KARTLI (GEORGIA). (Georgian medical news, 2021)
8. Migraine in women undergoing infertility treatment: a prospective study. (Headache, 2026)

Disclaimer: The information provided in this article is for informational purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.