Female Infertility

There are many potential causes of infertility that need to be considered in women having difficulty becoming pregnant. These causes may be problems with egg production (anovulation), tubal problems, and uterine problems. Each of these potential problems is evaluated before initiating fertility treatment.

Causes of female infertility:

  • Anovulation: When there is no production of eggs and no ovulation.
  • Blocked or damaged fallopian tubes.
  • Fibroid uterus.
  • Endometriosis.
  • Adenomyosis.
  • Cervical hostility.
  • Unexplained: When there is no specific cause of infertility.

Anovulation

Normal ovulation is essential for producing a mature egg that can be fertilized. Disorders in ovulation can impair conception and cause infertility. Women having problems with ovulation will not generally have menses at regular intervals.  Regular menses is very predictive of regular ovulation. Ovulation occurs 14 days before the first day of menses. Women can predict their fertile window by taking the number of days between the start of menses and the start of the next menses and subtract 14. For example, a woman with 32 days between menses would be most fertile on day 16 (counting the first day of flow as day 1).
Women not having regular menses will most likely experience difficulty getting pregnant. The lack of menses indicates a lack of ovulation. This makes timing ovulation and intercourse practically impossible. The most common cause of anovulation (associated with absence of menses) or oligoovulation (infrequent ovulation) is polycystic ovarian syndrome(PCOS). Other causes include premature ovarian failure (POF), age related factors, and endocrine abnormalities such as elevated prolactin or thyroid levels.

Tubal Factors

This may be bilateral blocked or damaged fallopian tubes. Fallopian tubes can become blocked by several different mechanisms. Some of the more common reasons include infections (pelvic inflammatory disease, or PID), surgery, and endometriosis. Blockage of the fallopian tubes can prevent the sperm and egg from uniting and forming an embryo. This blockage can also prevent the normal transport of an embryo and increase the likelihood of an ectopic pregnancy (pregnancy inside the tube). Sometimes blockage may cause accumulation of fluid inside the tube called hydrosulpings.

Endometriosis
Endometriosis is a chronic condition where endometrial tissue (the cells that line the inside of the uterus) implants outside of the uterus. This can be associated with chronic pelvic pain and infertility. Endometriosis is found in as many as 35% of women having laparoscopy for evaluation of their infertility. It can be a cause for pelvic pain as well as infertility. Commonest place of occurrence is in the ovary. Other locations include incisions from previous surgeries, the vagina and cervix, as well as the bowel and bladder. It causes severe pain during menstruation, excessive menstrual bleeding, formation of cyst and pain during intercourse.

 

There are many theories as to why endometriosis causes infertility problems. One of the more current theories is the displaced tissue causes an inflammatory reaction that kills sperm and eggs. Stopping menses is an effective method of controlling endometriosis though this is not a cure. laparoscopy and ablating (destroying) the endometriosis is another therapeutic option though it too is not a cure. In Vitro Fertilization offers a very effective way of “bypassing” endometriosis. Women often experience several years of relief from the discomforts of endometriosis following pregnancy.

Uterine Factors

Structural abnormalities of the uterus can result in decreased pregnancy rates and increased miscarriage rates. In addition to causing infertility, uterine abnormalities may also cause pregnancy losses. Fortunately, many of these abnormalities can be corrected.

Fibroids

Uterine fibroids are muscle tumors of the uterus that can interfere with pregnancy when they  compress the uterine cavity or lie within the cavity of the uterus. Fibroids can cause excessive bleeding during menstruation and sometimes irregular bleeding if it lies in the cavity. Fibroids interfere implantation of the embryos and causes infertility. It also causes abortions and premature labour.

Adenomyoma

Another form of uterine tumor which is like endometriosis that is formation of endometrial tissue within the muscle of uterus. It also causes excessive menstrual bleeding and severe pain during menstruation. It causes infertility by same mechanism as fibroid does.

Structural Abnormalities

Several developmental abnormalities of the uterus can be discovered during an infertility evaluation. A unicornuate uterus, septum or septate uterus, and a bicornuate uterus are among the numerous structural anomalies. These problems arise when the uterus is being formed. A unicornuate uterus is when only one side of the uterus is formed normally. A bicornuate uterus is a uterus that has two sides of the uterus that are attached at the cervix but not at the top of the uterus. A septum is a normal shaped uterus that has a dividing membrane on the inside of the uterus. Hysteroscopy is useful in evaluating and treating these abnormalities. Other effective means of evaluating the uterus include saline contrast ultrasound and hysterosalpingogram(HSG).

Cervical Hosility

Sometimes sperm can not ascend into the uterus due to some negative factors of cervix. This is called cervical hostility.

Unexplained Infertility

Unexplained infertility is a diagnosis of exclusion. This means that all other causes within reason have been ruled out. Unexplained infertility can be very frustrating because cause remained unknown.. Fortunately, treatment options offer significant improvements in couples with unexplained infertility.

Age Related Infertility

any women are not aware of the extreme effect that age can have on fertility. Women are born with all the eggs they will ever have in their lifetime. This pool of eggs declines continuously throughout a woman’s life. The effects can be seen in a woman’s early 30’s and becomes a common problem in women 35 and over. By the time a woman reaches 40 she will have a drastic reduction in her chances of becoming pregnant. This reduction in pregnancy is due to fewer available eggs and a reduction in egg quality. As the eggs age, the biologic process used to divide the cell becomes less efficient. This leads to non-viable eggs and an increase in chromosomal abnormalities. While there are tests to estimate a woman’s potential to produce eggs, there is not a very effective treatment to overcome this decline in egg function.