Female infertility refers to a woman’s inability to conceive or get pregnant after 12 months of unprotected sex, or sustain a pregnancy throughout the pregnancy term. Frequent miscarriages also denote infertility. Female infertility represents a third of total infertility cases.
- Ovulation disorders, such as the one instigated by polycystic ovarian syndrome (PCOS).
- Issues with ovarian eggs or cervical mucus quality.
- Infrequent menstruation, fallopian tube occlusion or blockage.
- Pelvic inflammatory disease, endometriosis, uterine fibroids, and uterine scarring.
- A history of sexually transmitted diseases or pelvic infections.
- Alcohol consumption, caffeine usage, and smoking, which also increases miscarriage probabilities.
- Medications or treatments such as chemotherapy or NSAIDs.
- Weight issues – overweight or underweight.
- Over-exercising or working out for more than an hour a day could lead to ovulation problems such as premature ovarian failure, poor egg quality, and hyperprolactinemia.
- Age – 35 years or above.
It’s believed approximately 30 percent of female infertilities are linked to ovulation disorders. The failed ovulation could be due to:
- Inability of the ovaries to make mature eggs, hypothalamus malfunction, and pituitary gland problems.
- Scarred or physically damaged ovaries resulting in failed ovulation.
- Premature menopause, which could be due to depletion of natural egg supply.
- Ovarian follicle problems, or the inability of the follicles to rupture, resulting in the eggs trapped within the ovary.
Fallopian Tube Problems
Tubal disease accounts for approximately 25 percent female infertility cases. The fallopian tube may have mild adhesions or complete blockage. The main causes are:
- Infections caused by viruses and bacteria. These conditions cause inflammation, which result in damage and scarring.
- Abdominal diseases such as colitis and appendicitis that cause abdominal cavity inflammation, which end up as fallopian tube blockage and scarring.
- Prior surgeries could have caused tubal disease and damage. For instance, abdominal or pelvic surgery may cause adhesions that alter the tube path, making it impossible for eggs to move through them.
- Congenital defects or cases wherein a woman could have tubal abnormalities right from birth.
Aging can hurt fertility in women in the following ways:
- Make the ovaries less efficient to release eggs.
- Unhealthy eggs and also a decrease in normal egg count.
- More vulnerable to health issues that may lead to infertility.
- A miscarriage, much likely.
Women 35 years or older must see an infertility specialist post six months of unprotected sex. In fact, any woman keen on having a baby should preferably consult a doctor prior to making any attempts as the doctor would help prepare the body for a healthy pregnancy and childbirth.
Close to 30 percent of estrogen produced in women is courtesy fat cells; the credit for the remaining 70 percent goes to the ovaries. Extreme weight imbalance (such as being overweight or underweight) disturbs the hormonal balance, thereby contributing to infertility.
Obesity is also connected to PCOS that causes infertility. Women with eating issues, such as bulimia nervosa or anorexia nervosa, or those on restrictive or extremely low-calorie diets also risk their fertility, especially if they have irregular periods.
Detection and Tests
To determine female infertility, the doctor would first conduct a general physical exam to learn more about the patient’s medications, medical history, sexual habits and menstrual cycle. Other tests include blood test (hormones), laparoscopy, hysterosalpingography, hysteroscopy, genetic testing, ovarian reserve testing, pelvic and transvaginal ultrasound, chlamydia test, and thyroid function test.
Urine and blood tests help evaluate hormone levels. A blood test is also conducted for measuring thyroid function and prolactin levels. An ultrasound helps evaluate the ovaries and uterus, and is also used to detect ovarian cysts, fibroids, tumors and urinary tract obstructions.
Hysteroscopy is used for detecting presence of fibroids, endometriosis, polyps, fallopian tube blockages and pelvic scar tissue. Hysterosalpingography is carried out to detect possible fallopian tube blockages and uterus abnormalities. In certain cases, hysterosalpingography could restore fertility by getting rid of the tubal blockages. A laparoscopy is performed to identify endometriosis or similar adhesions affecting fertility.
Since the major cause of female infertility is ovulation disorder, the treatment primarily focuses on prescription drugs and other medications to induce or regulate ovulation. A fallopian tube surgery and laparoscopic surgery are the surgical options available. The assisted reproductive technology or assisted conception options include intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), etc.
Initially, fertility drugs are used as sole treatment for inducing ovulation. If the drugs don’t work on their own, they’ll be administered in tandem with assisted reproductive procedures.
Lifestyle measures to restore or sustain fertility would include healthy weight maintenance, quitting drinking and smoking, and having sex keeping the ovulation cycle in mind. Doctors also recommend against excessive exercising, especially if the activity hurts the menstrual cycle.