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Female infertility

Definition


Disease: Female infertility Female infertility
Category: Gynecological diseases

Disease Definition:

Female infertility accounts for about 40 to 50% of all the couples classified as infertile. The man’s sperm is the cause in 30 to 40% of infertile couples and about 10 to 30% is unexplained, or is attributed to both male and female infertility.

 

Even though there are many resources and therapies that are available to treat female infertility, however, its cause could be difficult to diagnose. In some cases, treatment may not be necessary because almost half of all infertile couples will spontaneously conceive a child within the next 36 months.
 

Work Group:


Symptoms, Causes

Symptoms:

The inability to get pregnant is the main symptom of infertility. There may be no other outward signs or symptoms other than an abnormal menstrual cycle; either too long or too short.
 

Causes:

The process of human reproduction is quite complex. In order for pregnancy to occur, all the steps, including the ovary’s release of a mature egg, the fertilization of the egg and the fertilized egg’s implantation and growth in the uterus, should take place just right.

 

Numerous factors can disrupt this process in women at any stage. The cause of female infertility could be one or more of these factors.

OVULATION DISORDERS:

In 25% of infertile couples, the cause is ovulation disorders. Flaws in the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary itself could cause these disorders. In case a woman ovulates infrequently or not at all, it means that she has an ovulation disorder.

Abnormal secretion of FSH and LH:

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are the two hormones responsible for stimulating ovulation each month. During the menstrual cycle, these hormones are produced by the pituitary gland in a specific pattern. This pattern could be disrupted and the ovulation affected due to excess physical or emotional stress or a very high or very low body weight. Irregular or absent periods is the main sign of this problem. In some rare cases, the cause of infertility could be specific diseases of the pituitary, usually associated with other hormone deficiencies.

Premature ovarian failure:

Usually, an autoimmune response causes this disorder, which is when the body mistakenly attacks ovarian tissues. This could result in decreased estrogen production and loss of eggs in the ovary.

Polycystic ovary syndrome (PCOS):

In this condition, the male hormones called androgens are overproduced due to complex changes in the hypothalamus, pituitary and ovary, which affect ovulation. This syndrome could also be associated with obesity and insulin resistance.

Luteal phase defect:

When the ovary doesn’t produce enough of the hormone progesterone after ovulation, luteal phase defect happens. The hormone progesterone is very important in preparing the uterine lining for a fertilized egg.

 

DAMAGE TO THE FALLOPIAN TUBES:

The sperm will be kept from getting to the egg or the passage of the fertilized egg into the uterus will be closed off in case a woman's fallopian tubes are damaged or blocked. Some of the causes of the damage or blockage of the fallopian tubes are:

 

  • Previous surgery in the abdomen or pelvis
  • Inflammation of the fallopian tubes (salpingitis), as a result of gonorrhea or chlamydia
  • Previous ectopic pregnancy when a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of in the uterus

 

ENDOMETRIOSIS:

In case the tissue that normally grows in the uterus implants and grows in other locations, endometriosis occurs. Scarring could be caused due to this extra tissue growth and its surgical removal. This scarring impairs fertility.
It is also thought that the excess tissue might produce substances that interfere with conception.

 

UTERINE CAUSES:

By blocking the fallopian tubes or by disrupting implantation, benign polyps or tumors (fibroids or myomas) in the uterus could impair fertility. These conditions are common in women in their 30s. But many women who have fibroids could become pregnant. Implantation could be disrupted due to scarring within the uterus. Some women could also have problems becoming or remaining pregnant in case they are born with uterine abnormalities, including an abnormally shaped (bicornate) uterus.

 

CERVICAL NARROWING OR BLOCKAGE:

This condition, also known as cervical stenosis, could be due to an inherited malformation or damage to the cervix. This could result in the inability of the cervix to produce the best type of mucus for sperm mobility and fertilization. In some cases, the cervical opening could be closed, which will prevent any sperm from reaching the egg.

 

UNEXPLAINED INFERTILITY:

Sometimes, the cause of infertility could never be found. It could be possible that these unexplained fertility problems could be due to a combination of several minor factors in both parents.
Of all infertile couples, the highest rates of spontaneous pregnancy have the couples with unexplained infertility.
 

Complications

Complications:

None

Treatments:

Treatment of infertility depends on:

 

  • The cause
  • The woman's age
  • Personal preferences
  • How long she's been infertile.

 

A woman may have to undergo several different types of treatment before she's able to conceive, however, some women need only one or two therapies in order to restore fertility.

 

Treatment could assist in reproduction with sophisticated techniques, or it could attempt to restore fertility with medications or surgery.

 

FERTILITY RESTORATION: STIMULATING OVULATION WITH FERTILITY DRUGS:

The main treatment for women who are infertile due to ovulation disorders is fertility drugs that regulate or induce ovulation.

 

A woman's chances of getting pregnant with twins or other multiples are increased when she uses fertility drugs. With injectable medications, she will have about 20% chance of multiples, while with oral medications, her risk of multiples are quite low; 5 to 8%. In case a woman's carrying more than one fetus:

 

  • She will have an increased risk of premature labor
  • Low birth weight
  • Later developmental problems.

 

In some cases, in order to lower the risk of multiples, the amount or timing of the medications can be altered.
In the case of abnormal LH and FSH production, there are several fertility drugs that could be used, such as:

Gonadotropins:

These treatments increase the production of LH and FSH from sources other than the pituitary gland. Some of the gonadotropin medications are:

 

  • FSH, also known as follicle-stimulating hormone. This hormone works by stimulating the ovaries to produce mature egg follicles.
  • HCG, also known as human chorionic gonadotropin. This drug stimulates the follicle to release its egg (ovulate), and is used in combination with clomiphene, FSH and hMG.
  • Human menopausal gonadotropin, also known as hMG. This is an injected medication used for women who don’t ovulate on their own because of the pituitary gland’s failure to stimulate ovulation. Other gonadotropins, along with hMG contain both FSH and LH and directly stimulate the ovaries to ovulate.

 

Clomiphene citrate:

This oral drug stimulates ovulation in women suffering from PCOS or other ovulation disorders. This drug allows the pituitary gland to release more FSH and LH, stimulating the growth of an ovarian follicle containing an egg. This drug improves fertility in women who ovulate normally and is the initial treatment in cases of unexplained infertility.

Aromatase inhibitors:

These drugs are used to treat some breast cancers, but they could also induce ovulation. However, the effect of the medication on early pregnancy is still not known.

Metformin :

In case insulin resistance is a known or suspected cause of infertility in women with PCOS, this oral drug is used. Metformin normalizes ovulation by improving insulin resistance.

 

RESTORING FERTILITY WITH SURGERY:

There are several surgical procedures that could improve female fertility and correct problems. These procedures include:

Tubal reversal surgery (microscopic):

When a woman has had her tubes cut and tied for permanent contraception, these tubes could be reconnected with surgery and fertility could be restored. Whether a woman's a good candidate for this surgery or not will be determined by the doctor.

Tissue removal:

This surgery improves a woman's chances of achieving pregnancy by removing endometriosis or pelvic adhesions with lasers or ablation.

Tubal surgeries:

Tubal surgery could improve a woman's chances of becoming pregnant in case her fallopian tubes are blocked or filled with fluid (hydrosalpinx). In order to remove adhesions, dilate a tube or create a new tubal opening, laparoscopic surgery is done. In case the blocked or narrowed part of the tube is closer to the ovary than to the uterus, tubal surgery is more successful. A woman's risks of ectopic pregnancy could be increased in case the tubal blockage is closer to her uterus. In these cases, along with other cases of severe blockage or hydrosalpinx, the chances of pregnancy could be improved with in vitro fertilization if the tubes are removed (salpingectomy).

 

REPRODUCTIVE ASSISTANCE: IN VITRO FERTILIZATION

This technique is quite effective. It involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a laboratory, and then implanting the embryos in the uterus three to five days after fertilization. This technique is usually recommended when both of the fallopian tubes are blocked. This method is also used in case of endometriosis, unexplained infertility, cervical factor infertility and ovulation disorders. However, because in IVF multiple fertilized eggs are implanted into the uterus to ensure that at least one of them will develop into a baby, the chances of having twins or other multiples are increased. Frequent blood tests and daily hormone injections are required in IVF.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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