Fembryo Fertility & Gynaecology Clinic

Female Infertility

Knowing what you are faced with is one of the most important steps to getting the necessary treatment.

Fembryo Fertility Clinic – Gqeberha/Port Elizabeth

Infertility in people younger than 35 is defined as trying to get pregnant for at least a year while having frequent, unprotected sex. This time period is reduced to 6 months for people over the age of 35.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.

A basic understanding of female reproduction will be explained during your initial consultation.

To explain in a nutshell why age is such an important prognostic marker, the most important fact is that women have a limited amount of eggs (oocytes) with which she is born, after losing more than 50% of their eggs between 20 and 40 weeks of her growth in utero. (At birth an estimated 2 million oocytes are present in the neonatal ovary. This is reduced to about 400 000 at the time of puberty and thereafter women lose an estimated 900-1000 eggs per month, leaving the female with 400 months of reproductive potential from puberty till sterility, which is about 10 years prior to menopause.)

Not only does the amount or quantity of eggs diminish over time, the quality of eggs also diminishes rapidly after 30 years of age and this process accelerates after 35 years of age. It is therefore not uncommon to find that the average age in our clinic is 37 years for the female partner. Although modern research questions the age-old concept of “women’s limited egg pool”, it is true that women of advanced age, as well as women who lost an ovary through surgery or ovarian damage from medications, smoking, etc., will have poorer outcomes in IVF due to low egg retrieval counts.

It is indeed a situation of “the more, the merrier, the younger the better” Saying this, we will evaluate and assist all patients to make their dream come true as far as a medical intervention may make this possible.

We also stay true to the Ethics of Medicine of always doing good, and never doing harm. For some women, this may be to be advised not to pursue further treatment when medically the chance of a live-born baby is extremely low. This may be due to uterine abnormalities or depleted ovarian reserve, in which case alternatives, like donor eggs, may be offered.

When to see a doctor

How old you are can affect when you should get help:

At age 35, the average woman has lost 50% of her genetic potential to conceive of what she had at 25 years of age. Ideally, women should have their first pregnancy by age 30, as advanced age is not only associated with lower Live Birth Rates (LBR), but pregnancies in older women are also complicated by metabolic diseases like hypertension and diabetes mellitus.

We recommend that until age 35, you should try to get pregnant for at least a year before starting any tests or treatment.

If you’re between 35 and 37, discuss your concerns with your doctor after you’ve tried for six months.

If you are over 37, your doctor might suggest testing or treatment right away.

Although these reference ages are more strict than international guidelines (37 years and not 40 years of age), we feel that basic investigations in men and women should rather be done earlier and not later, as more conservative treatments may still be offered if patients are younger.

Very few clinics will offer insemination treatment to patients older than 40 years of age and will fast tract to IVF, but this is also problematic as the quality and quantity of eggs at this age is significantly less than at age 37.

Your doctor may also want to start testing or treatment right away if you or your partner have known fertility problems or if you have a history of painful or irregular periods, pelvic inflammatory disease, multiple miscarriages, cancer treatment, or endometriosis.

Causes of female infertility

For a woman to get pregnant, every step of the process of reproduction has to go right. This is a very delicate orchestra of events and in a very basic explanation entails the following steps:

  • The selected or dominant follicle grows during the first 10-14 days of the female menstrual cycle. The follicle produces Estrogen, which in turn stimulates the Uterus to prepare for implantation, and harbours the egg which will grow into a mature egg at mid-cycle, ready to be fertilised.
  • One of the two ovaries releases the mature egg when it is ready.
  • The fallopian tube picks up the egg.
  • Sperm swim up the cervix, through the uterus, and into the fallopian tube to reach the egg and fertilise it.
  • Over the next 3-4 days, the fertilised egg moves from the ovary to the uterus by way of the fallopian tube.
  • The fertilised egg sticks to the lining of the uterus (implants) and undergoes differentiation into what will become a new human being!
  • Several steps in this process may go wrong or be negatively affected by disease, lifestyle, and aging as well as non fertile sperm, leaving the egg to waste.

Two very common conditions preventing spontaneous pregnancy are PCOS and Endometriosis.

Ovulation disorders

Ovulation disorders can be caused by problems with how the hypothalamus or pituitary gland control reproductive hormones or by problems in the ovary.

Polycystic ovary syndrome (PCOS).

PCOS causes hormones to be out of balance, which makes it hard to ovulate. PCOS is linked to insulin resistance, being overweight, acne, and hair growth on the face or body due to an excess of Androgen (a male hormone produced by the ovary and adrenal gland). It’s the most common reason for women not to ovulate and having irregular periods .

Hypothalamic dysfunction.

Each month, ovulation is caused by follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of which are made by the pituitary gland. The production of these hormones can be disrupted by too much physical or emotional stress, a very high or very low body weight, or a recent big weight gain or loss, and can affect ovulation. Irregular or absent periods are the most common signs of hypothalamic dysfunction.

Premature insufficiency of the ovaries.

This is also called premature ovarian failure and is sometimes caused by an autoimmune response or the early loss of eggs from your ovary, which could be due to genetics or chemotherapy. The ovary stops making eggs and makes less estrogen in women under the age of 40.

Too much prolactin.

Hyperprolactinemia is a condition in which the pituitary gland makes too much prolactin, which makes less estrogen and can make it hard to get pregnant. This can also happen if you’re taking medicine like antiemetics and antidepressants.

Tubal Infertility

Damage to fallopian tubes

If the fallopian tubes are damaged or blocked, sperm can’t get to the egg, or the fertilised egg can’t get to the uterus. Damage or blockage of the fallopian tubes can be caused by:

Pelvic inflammatory disease

This is an infection of the uterus and fallopian tubes caused by chlamydia, gonorrhea, or other sexually transmitted diseases. Previous surgery in the abdomen or pelvis, such as surgery for ectopic pregnancy. PID usually also causes damage to the terminal end of the tube (fimbriae) which is responsible for egg pickup after ovulation.

Ruptured appendix

When bowel content spills and damages the tubes.


Especially with advanced disease and in patients in with whom repetitive surgery has been performed which leads to adhesion formation.

Uterine or cervical causes

Several problems with the uterus or cervix can stop the egg from implanting or raise the risk of a miscarriage.

The uterus often has benign polyps or tumors (fibroids or myomas) that changes the intra-uterine anatomy. Some can block the fallopian tubes or get in the way of implantation, which can make it hard to get pregnant. But many women with fibroids or polyps do end up falling pregnant.

Both fibroids, septums (divisions), and polyps may negatively affect implantation and may also cause irregular menstrual bleeding or heavy bleeding.

Congenital or birth anatomical abnormalities of the uterus (anomalies) are the result of incomplete uterine development during early pregnancy and may result in several abnormalities of the uterus. Some are mild, like uterine septae, whereas some may result in the almost total absence of the uterus.

Currently, a lot of emphases is placed on investigating and treating chronic infection/ inflammation of the uterus, including evidence that colon organisms may alter the organisms in the vagina and uterus. Tuberculosis of the uterus is a common reason for infertility in Sub-Saharan Africa.


Endometriosis is a chronic, inflammatory condition of the female pelvis affecting between 10-15% of women during their reproductive years. Although the exact causes are still unknown, we think it is caused by menstruation through the tubes (Retrograde menstruation), which happens in all women. In some genetically susceptible women, these menstrual cells cause an inflammatory reaction in the pelvis which is followed by scarring and tissue damage.

Nerves grow into these inflammatory areas and cause severe pain with menstruation (dysmenorrhoea) and damage in several ways to eggs, sperm, and the Fallopian tubes, decreasing fertilisation and impairing successful implantation in the uterus. In many patients undergoing surgery for endometriosis, the damage is caused by excessive energy applied to the tissue and therefore endometriosis surgery should ideally be performed by specialists in the field of Reproductive Medicine.

Unexplained infertility

Sometimes, the cause of infertility is never found. Unexplained fertility issues could be caused by a variety of minor factors in both partners. Even though not getting a clear answer is frustrating, this problem may be fixed over time. But you shouldn’t wait to get help if you are suffering from infertility.

Risk factors

Certain factors may put you at higher risk of infertility, including:


As a woman gets older, both the quality and number of her eggs start to get worse. By the time a woman is in her mid-30s, the rate of follicle loss has increased, leading to fewer and less healthy eggs. This makes it harder to get pregnant and makes it more likely that the pregnancy will end early.


Smoking hurts your cervix and fallopian tubes and makes you more likely to have a miscarriage or an ectopic pregnancy. It’s also thought that it ages your ovaries and makes you run out of eggs too soon. Stop smoking before beginning fertility treatment.


Ovulation may be affected if a woman is very overweight or very underweight. Getting to a healthy body mass index (BMI) could make you ovulate more often and make it more likely that you will get pregnant.

Sexual history

The fallopian tubes can be damaged by sexually transmitted diseases like chlamydia and gonorrhea. If you have unprotected sex with more than one person, you are more likely to get an STD that could affect your ability to have children in the future.


Too much alcohol can make it harder to get pregnant.

Female Infertility Prevention

These tips might help women who want to get pregnant:

Maintain your weight in a healthy range

Women who are overweight or underweight are more likely to have problems with ovulation. If you are exercising to lose weight, then exercise with mild to moderate intensity.

Quit smoking

Tobacco is bad for your fertility, your general health, and the health of a fetus in many ways. If you smoke and are thinking about having a child, stop now.

Avoid excessive alcohol

Heavy drinking may make it harder to have children. And any amount of alcohol use can hurt the health of a fetus. Don’t drink alcohol if you want to get pregnant, and don’t drink while you’re pregnant.

Reduce stress

Some studies have shown that stress can cause couples to have poorer results with infertility treatment. Try to reduce stress in your life before trying to become pregnant.