OVERVIEW
Infertility is defined as failure to achieve pregnancy after 12 months or more of regular and unprotected sexual intercourse. As roughly 85% of couples usually achieve an unassisted natural pregnancy in 12 to 18 months, around 15% of couples would require evaluation for infertility.
A couple in which the women is over 35 years of age after 6 months of attempting to conceive naturally should soon undergo evaluation.
When appropriate for the couple, both partners should undergo evaluation at the same time.
SYMPTOMS
women may be associated with following symptoms.
- Irregular menstrual cycle (A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating)
- Severe pain during menstruation
- Some hormonal fluctuations, causing skin issues, facial hair growth, and obesity.
- Pain during sex
. When to get evaluated for infertility:
- Below age 35- try for at least one year for pregnancy before consulting a doctor.
- 35 to 40 years- try for six months to conceive before meeting a doctor.
- Above 40 years- better to get evaluated right away and undergo some tests and treatments.
CAUSES
Healthy pregnancy in a woman is a multistep procedure, and to conceive successfully, these steps are essential. Failure of any of these steps can result in infertility:
- Your body must release an egg from the ovaries (ovulation).
- The egg should travel through the fallopian tube towards the uterus.
- Your male partner’s sperm should be adequate to fertilize the egg.
- The fertilized egg needs to attach to the uterus (Implantation).
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.
- A) Ovulation disorders
1 Polycystic ovary syndrome (PCOS):
PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
2 Hypothalamic dysfunction:
Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of the pituitary hormones and affect ovulation. Irregular or absent periods are the most common sign
3 Primary ovarian insufficiency :
It is an autoimmune condition causing premature loss of eggs from ovaries. Genetics or chemotherapy can be the reason for this condition
4 Too much prolactin: The pituitary gland may cause increase in production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility.
- B) Damage to fallopian tubes (tubal infertility)
Fallopian tubes transport your eggs from ovaries to the uterus. Any damage or block of this passage can prevent the meeting of sperm to the egg.
Damage or blockage of fallopian tubes occur due to;
Pelvic tuberculosis can also be the cause
- Pelvic inflammation, causing the infection of fallopian tubes in conditions like gonorrhea, chlamydia, or sexually transmitted diseases
- Previous surgery involving your abdomen or pelvis.
- C) Endometriosis
When uterine tissue that generally seen lining inside the uterus grows outside, it is called endometriosis. The presence of this extra tissue or scarring caused by the removal of this tissue can result in blockage of fallopian tubes. Endometriosis also affects the implantation of the fertilized egg leading to infertility.
- D) Uterine or cervical causes
Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage
• Polyps or benign tumors can cause blockage of fallopian tubes, or interfere with implantation affecting your fertility.
- Anatomical anomalies of the uterus can also be the reason for your infertility.
- Any damage to the cervix can cause cervical stenosis or narrowing of the cervix.
- The inability of the cervix to produce an adequate amount of mucus to allow the sperm to travel
- E) Unexplained infertility:
Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems.
Risk factors
Certain factors may put you at higher risk of infertility, including:
Age. The quality and quantity of a woman's eggs begin to decline with increasing age.
Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy.
Weight. Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes.
Alcohol. Stick to moderate alcohol consumption of no more than one alcoholic drink per day.
Female Infertility Diagnosis
Infertility evaluation involves physical examination followed by medical and sexual history. Your fertility doctor may advise you to undergo several tests, including a blood test to evaluate your hormonal levels and endometrial biopsy to examine your uterine lining.
Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you'll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
Ovarian reserve testing. This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply — including women older than 35 — may have this series of blood and imaging tests.
Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a sonohysterogram, also called a saline infusion sonogram, is used to see details inside the uterus
Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
Female Infertility Treatment
Infertility is commonly treated with medication, artificial insemination of washed sperms , surgery, or assisted reproductive techniques. Many times doctors preferred a combined approach for treating infertility. Depending on your test results, age, health, and history, your doctor will plan the line of treatment.
- During any tubal or pelvic diseases or any cysts, laparoscopy is done to treat the condition.
- Hysteroscopy is done to remove polyps or fibroid tumors or scar tissue and to open blocked tubes.
- Drugs will be prescribed if you are having issues with ovulation.
Intrauterine insemination
In this procedure,washed sperms are placed directly into your uterus during ovulation. Sometimes even medication is given to stimulate the release of an egg.
In vitro fertilization (IVF)
Your eggs are collected and placed in a petri dish. Sperms are also collected, washed, and placed in the same petri dish for fertilization. A healthy fertilized egg is then inserted into your uterus. This procedure is called IVF.
ICSI (intracytoplasmic sperm injection)
In this procedure, sperm is directly injected into the egg for fertilization. Then the fertilized egg is placed into your uterus.
Depending on the underlying cause of infertility and your health, your doctor will plan the treatment procedures. It is essential to discuss with your doctor to understand the IVF treatment procedures.
Final Note
There are many causes that result in female infertility. A skilled doctor can help you with the right diagnosis and treatment. Recent advances in infertility treatments have benefitted many couples with a healthy pregnancy. If you are unable to conceive, getting evaluated for infertility and opting for infertility treatment is the best solution.