Female infertility

Overview

Female infertility is difficult in getting pregnant despite engaging in regular, unprotected sexual intercourse for at least 12 months. Infertility includes having miscarriages or unsuccessful pregnancy. About 10% of women experience infertility. It is one of the most common diseases in women.

For heterosexual couple, it is considered female infertility or female factor if the infertility comes from the woman. Generally, infertility is usually one-third male factor, one-third female factor and one-third combination of both or unknown factor.

Several causes of female infertility include problems with reproductive system organs, age, genetics, among others. The treatment plan is usually developed based on the cause of the infertility. Although it can be challenging to treat female infertility, some women eventually become mothers without any intervention.

Symptoms

For a woman to get pregnant, the body has to go through lengthy process. It starts with releasing an egg from the ovaries, a man’s sperm fertilizes the egg, then it proceeds to the fallopian tube and towards the womb. Lastly, the embryo must be implanted inside the uterus. Any problems within the process may prevent pregnancy, resulting in infertility.

Inability to conceive is the main sign of infertility. A menstrual cycle that is overly lengthy (35 days or more), too short (less than 21 days), irregular, or nonexistent may indicate that the patient are not ovulating. There might be no additional symptoms or indicators.

Women’s fertility declines with age and therefore women should:

• Up to age 35, with no known health or fertility issues should try conceiving for at least one year before seeing a doctor.
• Between ages 35 and 40, should try getting pregnant for 6 months and seek medical advice if unsuccessful.
• Older than 40, is recommended to have immediate assessment and necessary treatment.

Couples who have health problems should consult an infertility specialist before trying to get pregnant to ensure a healthy pregnancy. If the couple has a history of known fertility issues, irregular or painful periods, pelvic inflammatory disease, recurrent miscarriages, cancer treatment, endometriosis or other suspected diseases, the doctor may require testing and treatment immediately.

Causes

For a woman to become pregnant, she must have healthy ovaries, fallopian tubes, and uterus. Female infertility can be caused by illnesses that affect any one of these organs. The main cause of infertility can sometimes be difficult to identify. In some, it can be unexplained. The common causes of female infertility are:

• Ovulation disorders: Most cases of infertility are caused by irregular or absent ovulation. Ovulation abnormalities can be brought on by issues with the ovary, the pituitary gland, or the hypothalamus, which regulate reproductive hormones.
  • Polycystic ovary syndrome (PCOS): PCOS is a common cause of female infertility. It contributes to the abnormal levels of androgen hormone which affects ovulation. Common related conditions are insulin resistance and obesity, hirsutism, acne, and irregular periods.
  • Hypothalamic dysfunction: Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), two hormones made by the pituitary gland, are in charge of triggering ovulation each month. The production of these hormones can be disturbed and impair ovulation by excessive physical or emotional stress, extremely high or extremely low body weight, or a recent major weight gain or decrease. The most frequent signs are irregular or missed periods.
  • Primary ovarian insufficiency (POI): Or premature menopause is a condition where the woman’s ovaries stop functioning and reduce estrogen production before the age of 40. POI can be caused by a variety of medical disorders, certain exposures (such as chemotherapy or pelvic radiation therapy), and other factors, although the exact cause is frequently unknown.
  • High prolactin levels: Or hyperprolactinemia, this reduces the production of estrogen and may result in infertility. Paitent may be taking drugs for another condition, which could possibly be the cause of this.
• Endometriosis: This is when tissue that normally grows in the uterus implants and grows in other areas such as the fallopian tube, pelvic cavity, or ovaries. The surgical excision of this excess tissue growth may result in scarring, which may obstruct fallopian tubes and prevent the process of fertilization of an egg and sperm. Endometriosis can prevent a fertilized egg from implanting properly.
• Damage to fallopian tubes (tubal infertility): The fallopian tube is where the sperm and the egg meet. It also brings the fertilized eggs to the uterus. Obstruction or damage in the tubes will prevent the natural process of pregnancy. Some factors that may contribute to the injury or obstruction of the fallopian tube are:
  • History of pelvic inflammatory disease such as chlamydia, gonorrhea, or other sexually transmitted infections
  • Prior abdominal or pelvic surgery such as surgery for ectopic pregnancy
• Uterine or cervical causes: Problems with the uterine and cervix can prevent successful pregnancy in women.
  Common issues include:
  • Uterine fibroid or polyps which reduce fertility by preventing implantation or blocking fallopian tubes. The excessive cell growth in the endometrium results in uterine polyps, whereas fibroids develop in uterine wall. Successful pregnancy in still in this case.
  • Uterine issues that are present at birth, such as an abnormally shaped uterus, might make it difficult to get pregnant or maintain a pregnancy.
  • A cervical injury or congenital abnormality can lead to cervical stenosis. In this condition, the cervix is narrowed or completely closed which impacts natural fertility.
  • Inability of the cervix to produce a good mucus that will allow sperm to pass through and enter the uterus.
• Unexplained infertility: Approximately 20% of couples have difficulty in determining the main cause of infertility. In some cases, unexplained infertility can be multifactorial infertility such as a combination of multiple small factors present in both partners. However, treatment, lifestyle changes or medication can still be beneficial.

Risk factors

Risk for female infertility is known to increase with:

• Age: Age-related infertility is mostly caused by deteriorating egg quality since older women have fewer eggs and are more likely to have health issues that can affect fertility. A woman’s risks of miscarriage and bearing a child with a genetic disorder both rise as she gets older.
• Sexual history: Unprotected sexual activity with numerous partners raises one’s risk of contracting a sexually transmitted infection (STIs) that could impact female fertility. The fallopian tubes can suffer damage from STIs such chlamydia and gonorrhea.
• Weight: Obesity and being underweight can cause hormone imbalances that affects ovulation and fertility. Maintaining a healthy weight and a healthy diet is important for women who are trying to get pregnant.
• Smoking: It is known to prematurely age the ovaries and diminish the egg supply which makes conceiving difficult for some women. Smoking raises the risk of ectopic pregnancy and miscarriage. It is advised to stop smoking prior to starting fertility therapy.
• Alcohol: Excessive substance use such as alcohol can decrease fertility.