FEMALE INFERTILITY

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis. Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

FEMALE INFERTILITY – age factor

Aging is very important factor in female infertility - age is the single most important factor affecting a woman’s fertility. The ability for ovaries to produce eggs declines with age, especially after age 35. At 25, a woman has a 25% of becoming pregnant during unprotected sexual intercourse. This percentage begins to decrease between the ages of 32 and 34. After that, the decline is steady so that the chance for pregnancy is only 5 to 10% per menstrual cycle after a woman reaches age 40. In general the number of infertile women rises with increasing age. Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30. This reduction in fertility is noted to a much greater extent after age 40.

The most important is depletion of a woman’s ovarian reserve - the eggs she is born with. Modern medical diagnosis can estimate women chances for pregnancy by checking her AMH (Anti-Müllerian hormone) - estimation of ovarian egg reserves.

FEMALE INFERTILITY – hormonal dysfunctions

Main female infertility cause could be ovulation problems (anovulation – absence of ovulation) which occur when one part of the reproductive system that controls reproductive function malfunctions. Without ovulation, eggs are not available to be fertilized. It is a result of different types of hormonal dysfunctions. Synchronized hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur.

Ovulation problems can be discovered during several types of hormonal dysfunctions. Ovulation problems may be due to polycystic ovary syndrome, thyroid gland disorders, adrenal gland disorders, excessive exercise, diabetes, weight loss, obesity, or psychologic stress. Sometimes the cause is early menopause—when the supply of eggs has run out early.

Any dysfunction in menstrual cycles – irregular periods, amenorrhea, oligomenorrhea, menstrual bleedings, light periods, uterine bleedings, etc. – all can be a reason for absence of ovulation.

Polycystic ovary syndrome (PCOS), a condition that makes it more difficult for ovaries to produce mature egg. PCOS is usually, but not always, associated with obesity. Sclerocystic ovaries fail to ovulate;

Endometriosis - when endometrial tissue grows outside the uterus (on tubes, ovaries, other organs) – this can cause infertility because the new growths form adhesions (sticky areas of tissue) or cysts (fluid-filled sacs) that can block or distort the pelvis. These make it difficult for an egg to be released and become implanted into the womb. Endometriosis can cause infertility because it can disturb the way that a follicle (fluid-filled space in which an egg develops) matures and releases an egg.

Premature ovarian failure, where a woman’s ovaries stop working properly before she is 40. Premature ovarian failure or premature menopause causes secondary amenorrhoea. Premature ovarian failure occurs in about 1% of women and, in the majority of cases, no cause is found.

Hyperandrogenemia (increased androgens - male hormones) developed because of different conditions including PCOS, tumors and adrenal diseases.

Thyroid problems - abnormalities of the thyroid gland - both hyperthyroidism (overactive thyroid glands) and hypothyroidism (underactive thyroid glands) can prevent ovulation. 

Hyperprolactinemia - overproduction of prolactin (a hormone leading to breast milk production) – hyper production of prolactin can stop periods and ovulation. Hyperprolactinaemiamay present with galactorrhoea or amenorrhoea.

Adrenal deficiency can also cause hormonal and ovarian problems.

Chronic (long-term) conditions - some chronic conditions, such as cancer, diabetes, kidney disease, high blood pressure or AIDS, can prevent ovaries from releasing eggs and may cause infertility.

Cushing’s syndrome, a rare hormonal disease that can prevent ovaries from releasing an egg.

Pituitary tumors will displace or destroy normal tissue and the production of follicle-stimulating hormone (FSH) and luteinising hormone (LH) is often the first to be affected. Panhypopituitarism is also called Simmonds' disease.

A number of chromosomal disorders result in inadequate ovaries and usually primary amenorrhoea.

• These include Turner's syndrome in which the ovaries are just streaks.
• The condition may be a mosaic.
• In testicular feminisation there is primary amenorrhoea.
• The karyotype is XY but there is androgen insensitivity.
• XXY or Klinefelter's syndrome appears as a male.
• The XXX karyotype is sometimes called super-female, but is anything but super.

Egg quality – sometimes even after ovulation women cannot conceive because of eggs’ poor quality. If the egg is damaged or has a chromosomal abnormality it may not result in a pregnancy. This is more common as the woman gets older (over 35).

FEMALE INFERTILITY – infections including STDs

Pelvic Inflammatory Disease (PID) is the most common cause of infertility worldwide. It's an infection of the pelvis or one or more of the reproductive organs, including the ovaries, the fallopian tubes, the cervix or the uterus. Sometimes PID spreads to the appendix or to the entire pelvic area. PID usually stems from the same bacteria that cause sexually transmitted diseases (STDs), such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75% of fallopian tube infections. PID may also develop from bacteria that reach the reproductive organs through abortion, hysterectomy, childbirth, sexual intercourse, use of an intrauterine contraceptive device (IUD) or a ruptured appendix.

Sexually transmitted diseases (STDs) can damage reproductive organs – cervix, uterus and fallopian tubes.

FEMALE INFERTILITY – cervical factor

Some women could have a cervical condition in which the sperm cannot pass through the cervical canal - whether due to abnormal mucus production or a prior cervical surgical procedure.

Cervical factor of infertility could be difficult to discover. Cervical infertility involves inability of the sperm to pass through the cervix due to damage of the cervix. Main reasons for cervical infertility could be:

• inadequate or inhospitable cervical mucus;
• cervical narrowing or "stenosis";
• cervical infections during sexually transmitted diseases (SYDs) - chlamydia, gonorrhea, or trichomonas, as well as mycoplasma hominis and ureaplasma urealyticum;
• immune attack of sperm or "sperm allergy".

FEMALE INFERTILITY – Uterus and Fallopian Tubes

Uterus and fallopian tubes are very important for fertilization and implantation. Successful pregnancy depends upon the sperm being able to reach the egg and the fertilized egg reaching the womb, to implant safely in the wall of the uterus. Any problems in uterus and/or tubes can prevent and/or interrupt possible pregnancy. If there are blockages in the fallopian tubes, the chances of a successful pregnancy will be greatly impeded. Blocked tubes could be a main reason for female infertility due to pelvic inflammatory disease (PID), sexually transmitted infections (STDs) such as clamydia, infection from the previous birth and blockages from previous surgery (following ectopic pregnancy or sterilisation procedures).

Uterus problems can cause infertility at different stages of possible pregnancy.

Pelvic causes include any disruption of the normal pelvic anatomy:

1. Scar tissue or "adhesions";
2. Endometriosis;
3. Blocked, scarred, or distorted fallopian tubes;
4. Benign tumors (fibroids) of the uterus.

Uterine causes include:

1. Thin or abnormal uterine lining;
2. Anatomic problems (polyps, uterine fibroids, abnormal shape of the uterus, septum or "dividing wall" within the uterus).

FEMALE INFERTILITY – unexplained

Approximately 10-15% of infertile women suffer from unexplained infertility. This simply means that the commonly performed tests to diagnose the cause of infertility are all normal and do not define the reason for infertility.

FEMALE INFERTILITY – drugs

Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in the body, impairing fertility.

The side effects of some types of medication and drugs can affect female fertility:

• Non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use, or a high dosage, of NSAIDs, such as ibuprofen or aspirin, can make it more difficult for you to conceive.
• Chemotherapy. The medicines that are used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means that your ovaries will no longer be able to function properly. Ovarian failure can be permanent.
• Neuroleptic medicines are antipsychotic medicines that are often used to treat psychosis. They can sometimes cause missed periods or infertility.
• Spironolactone is a medicine that is used to treat heart failure, and can cause irregular periods and infertility.
• Illegal drugs such as marijuana and cocaine can seriously affect your fertility, making ovulation (the monthly cycle where an egg is released from the ovaries) more difficult. Drugs may also adversely affect the functioning of your fallopian tubes.

Millions of women face infertility. If you are having trouble getting pregnant or staying pregnant, you are not alone. In spite of many possible causes of female infertility, there are several very effective methods for having baby. You just need to be organized and follow all modern methods for correct diagnosis and effective treatment.