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Female Infertility

Female infertility

 

Introduction

 

Female infertility refers to inability of a couple to conceive despite unprotected sexual intercourse due to factors affecting or attributable to the female partner. About one-third of the time, infertility in a couple arises from female infertility factors.

 

Causes

 

Infertility in females could be due to several reasons. For pregnancy to occur, the ovaries should be producing and releasing an egg (ovulation) that travel to the fallopian tube. Sperm travels through the uterus and reaches the egg in the fallopian tube. After this, the fertilized egg reaches the uterus and attaches itself to the lining. This requires a healthy and normal reproductive system and a problem in any of the above steps could lead to difficulties in conceiving.

 

Common causes for infertility in females are ovulation disorders. Infrequent or no ovulation could be the result of hormonal imbalances or problems in the ovary. Polycystic ovarian syndrome or PCOS is a common condition that affects ovulation. Severe stress or excessive weight gain or loss can affect the production by the pituitary gland of hormones responsible for ovulation. A less common factor is excessive production of prolactin by the pituitary gland which could also impact fertility.

 

Other causes include damage to the fallopian tubes which restricts sperm from reaching the egg or a fertilized egg from reaching the uterus. Damage to the fallopian tubes may be caused by pelvic inflammatory disease (an infection that occurs in the ovaries, uterus or the fallopian tubes), prior pelvic or abdominal surgeries, and endometriosis (a condition in which the tissue that usually grows inside the uterus starts to grow outside the uterus).

 

Certain polyps or fibroids in the uterus may be blocking the fallopian tubes and interfering with implantation. Some women may also suffer from uterine abnormalities such as an abnormally shaped uterus. In some cases, a cervical condition restricts sperm from passing through the cervical canal. This may be an inherited malformation or the result of some damage to the cervix or due to abnormal production of mucus.

 

It may not always be possible to ascertain the cause of infertility. The inability to conceive could be the result of a combination of factors affecting both male and female partners. It is possible for pregnancy to occur even after years of being unable to get pregnant.

 

Advancing age is a major risk factor associated with female infertility. Certain other risk factors that increase the likelihood of infertility are smoking, excessive drinking, being overweight or significantly underweight and history of sexually transmitted infections like gonorrhea and chlamydia.

 

Symptoms

 

The primary symptom of infertility is inability to conceive despite unprotected sexual intercourse for a substantial period of time, usually more than a year. There may be no other symptoms except when infertility is caused due to an underlying medical condition or an infection. Possible signs could include absence of menstruation, irregular menstrual cycle, painful periods or abnormal bleeding. Hormonal problems may lead to changes in the body, such as acne, excessive facial and body hair, loss of hair or weight gain.

 

Age is an important factor in fertility and those in their twenties or early thirties are usually advised to try conceiving for over a year before seeking medical attention or treatment. Older women, especially those in their forties may wish to begin testing sooner since they are at high risk of infertility.

 

Diagnosis

 

Testing would typically involve ovulation testing. This can be performed at home as well with over-the-counter kits that detect the level of luteinizing hormone (LH) (the level of this hormone rises before ovulation). Level of progesterone (hormone produced after ovulation) may also be monitored. Other hormones including those associated with thyroid and pituitary gland may also be tested. Tests may also be performed to ascertain the quality of eggs being produced. Pelvic ultrasounds may be advised to detect problems in the uterus or fallopian tubes.

 

A procedure known as hysterosalpingography could also be performed which involves injecting X-ray contrast into the uterus and then taking an X-ray to ascertain if the fluid passes normally out of the uterus through the fallopian tubes.

 

In some cases, procedures like laparoscopy may be carried out to identify problems with the uterus, fallopian tubes or ovaries and to detect conditions like blockage of tubes or endometriosis.

 

Treatment

 

Treatment would depend on the underlying cause, age and personal choices.

 

For women suffering from ovulation disorders, fertility treatments are the primary option. The drugs involved in such treatment work like the natural hormones that affect ovulation, namely follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Commonly used fertility drugs include clomiphene citrate, gonadotropins, metformin, bromocriptine and metformin.

 

In some cases, surgical procedures may be performed to correct abnormalities. These include laparoscopic or hysteroscopic surgery to correct abnormal uterine shape or remove fibroids and polyps.

 

Other treatment options include intrauterine insemination (IUI) whereby sperm are placed inside the uterus, and assisted reproductive technology (ART) whereby fertilization is carried out in a lab and the embryo transferred subsequently into the uterus.