Female Infertility

In simple terms, infertility means not being able to get pregnant despite trying for at least 12 months for women under the age of 35 and six months for women over the age of 35.  If a woman is having miscarriages time and again, it can also be called an infertility issue.  Female infertility can arise from age, physical problems, hormonal imbalance and environment or lifestyle factors.  In the unlikely event, if you are suffering from female infertility, relax – it is not a one-off.  Studies show that one out of every six couple is suffering from this issue.  If the cause of the infertility is on account of the female partner, it is called female infertility.  It can be said that up to 50% of all the infertility cases happen on account of female infertility.  The cause of infertility can be known or unknown.  In some cases, it can be a combination of male and female factors.  Happily, many couples treated for infertility are able to have babies.  Having said that, let’s go through female infertility in a bit more detail.

Primarily, female infertility is not something that can be diagnosed easily as there is a host of issues that can influence fertility.

Symptoms of female infertility:

As infertility itself is a symptom, there is no need to wait for any other signs to realize the issue.  However, it is advisable to check if your ovulation is proper or not.

Too long a menstrual cycle, say 35 days or more or too short a cycle, say less than 21 days, could be a sign of improper ovulation.  Irregular or absence of menstrual cycle is also the sign of being infertile, though there may be no other outward symptoms.

How does fertility happen?

How does fertility happen?

Every step in the human reproductive system has to work like a well-oiled machine for fertility to happen.  The steps in this process involve the following:

  • A mature egg being released by one of the two ovaries
  • Fallopian tube picking up that egg
  • Sperm reaching the cervix, through the uterus and into the fallopian tube to reach the egg and subsequently fertilization happens
  • Through the fallopian tube, the fertilized egg reaches the uterus
  • The fertilized egg implants in the uterus
  • Growth of the fertilized egg takes place in the uterus 

It is time to see a doctor…

Here age is the principal factor that determines if you have to go and seek the opinion of a fertility specialist.  As a rule of thumb, up to age 35 infertility tests and treatments are not started before one year of active sex.  For women between the age bracket of 35 and 40, at least six months of active intercourse are recommended before disclosing your concerns with the doctor.  For ladies who are older than 40, your doctor may go for tests and treatments without losing any further time.

However, if you are suffering from any known fertility issues, for example, past medical history of erratic or painful menstruation, endometriosis, chemotherapy or radiation therapy, repeated miscarriages, pelvic inflammatory disease etc., your doctor may go against the age-linked guidelines and begin testing and treatments straight away.

It is high time you contacted your healthcare provider, if you are suffering from any one of the following symptoms:

  • Abnormal bleeding
  • Abdominal pain
  • Fever
  • Unusual discharge
  • Pain or discomfort during intercourse
  • Soreness or itching in the vaginal area

Causes of female infertility:

Though there is only single symptom of infertility (not being able to get pregnant), the causes of infertility can be multiple.

Ovulation:  In order to facilitate pregnancy, your ovaries must produce and release an egg every month, this process is called ovulation.  Your fertility specialist can evaluate and confirm if your ovulation is normal or not.  However, if your ovulation is irregular or not at all, it can throw a spanner in your efforts to being fertile.  Ovulation disorders are one of the leading causes of female infertility.  It happens as a result of hypothalamus or pituitary gland regulating the reproductive hormones.  Problems related to ovary can also lead to ovulation issues.

PCOS:  Polycystic ovary syndrome or PCOS is something that harms ovulation due to hormonal imbalance.

Hypothalamic dysfunction:  Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are the two hormones produced by the pituitary gland that influence ovulation.  Production of these hormones can be impaired due to various factors such as mental and physical stress, weight gain and loss etc.  Watch out for irregular menstrual cycles as it is the most common sign. 

Fallopian tubes damage:  As you may be aware, your ovaries produce eggs.  It is the duty of the fallopian tubes to carry the eggs to the uterus, where the growth of the baby takes place.  But these eggs can be spoiled or damaged if there are scars from pelvic infections or pelvic surgery.  That can thwart sperm reaching an egg.

Hormonal imbalance:  Your body has to go through the usual hormonal change to keep yourself fertile.  Hormonal change in you leads to an egg being released and thickens the lining of the uterus. 

Cervical factors:  In some women sperm may not be able to pass through the cervical canal.

Uterine troubles:  Polyps and fibroids in the uterus may hinder your prospects of getting pregnant.  They come into being as a result of too many cells growing in the endometrium (the lining that covers the uterus).  Other abnormalities of the uterus can also play a role in infertility.

“Unexplained” infertility:  In about 20% of the couples, it is difficult to pinpoint the exact cause of infertility.  It could be because of a combination of several seemingly minor factors that contribute to infertility.  Though it may correct itself with time, one should not leave it to chance and should seek treatment immediately. 

Risk factors:

The following factors may put you at an increased risk of infertility.

Age:  As you age, the quality and quantity of your egg begin to dwindle.  In the mid 30s, rate at which follicle loss happens is high, resulting in fewer and inferior quality eggs.  This impairs conception and increases the risk of miscarriage.

Smoking:  Apart from causing harm to your fallopian tubes and cervix, smoking heightens your risk of miscarriage and ectopic pregnancy.  It may also lead to premature depletion of eggs from your ovaries.

Weight:  For proper ovulation to take place, you should be having an ideal height-to-weight ratio.  Being overweight and underweight may affect normal ovulation and thereby likelihood of conception.

Sexual history:  Sexually transmitted infections like gonorrhea and Chlamydia can impair the health of fallopian tubes.  Having unprotected sex with multiple partners can increase the risk of sexually transmitted diseases and infections which may lead to fertility problems later.

Alcohol:  Abstaining from the bottle is the best way to keep the fertility quotient high.

Tests for infertility:

Your doctor may send you for several tests including blood tests to diagnose your infertility.  Your hormone level may be checked and an endometrial biopsy may be taken to examine the lining of your uterus.

Pelvic exam or breast exam:  Your doctor may do a thorough physical exam including your pelvis and breast to find out any possible abnormality

A cervical mucus or tissue sample:  A sample from your cervical mucus or tissue may be taken and sent for biopsy to rule out anything untoward

Hysterosalpingography (HSG):  X-rays or ultrasound of your reproductive organs may be taken.  A dye or saline and air may be injected into your cervix by the doctor, which goes up to your fallopian tubes.  This way doctor can find out if your fallopian tubes are blocked. HSG tests are becoming obsolete since only tubes and uterine cavity can be imaged.

Laparoscopy (Keyhole surgery):  A slender tube with a camera at one end is inserted into your body through a small cut near your navel.  This device is called laparoscope.  This device is connected to a monitor, which enables the doctor to see outside of your uterus, ovaries and fallopian tubes to check for abnormalities around.  The doctor can also see if there is any blockage in your fallopian tubes.

Treatment for female infertility:

Laparoscopy:  If you are suffering from pelvic or tubal abnormalities, one option is to surgically reproduce the organs.  It can be done laparoscopically.  Problems in terms of scar tissue, endometriosis, blocked tubes, ovarian cysts can be removed this way.

Hysteroscopy:  A device called hysteroscope is placed into your uterus through your cervix.  This method is usually followed to remove polyps and fibroid tumors, divide scar tissue and open up blocked tubes.

Medication:  If the problem is with the ovulation, issues are generally sorted out via medications such as such as clomiphene citrate, gonadotropins or letrozole.  Gonadotropins can spur ovulation.  These drugs induce your ovaries to release multiple eggs as against the norm of one egg each month.  Gonadotropin is usually given for “unexplained” infertility or the fertility treatments thus far failed to bring the desired result.  However, if you are suffering from insulin resistance or PCOS (polycystic ovarian syndrome), glucophage is the medicine to go for.  It should be noted that you can take medications only in consultation with your doctor.

Intrauterine insemination:  In this procedure, semen is injected into your uterus directly after getting it rinsed with a special solution.  This is done during the time of your ovulation.  At times it is done in conjunction with your medications that help trigger the release of an egg.

In vitro fertilization (IVF):  IVF is a series of medical procedures that is used to help with fertility or prevent genetic abnormalities so as to assist with the conception of a child.  In an IVF procedure, mature eggs are collected from ovaries and fertilized with sperm in a lab.  Then the fertilized egg or eggs (as the case may be) are transferred to the uterus.  A full cycle of IVF takes about three weeks.  As each case is different, sometimes these steps are split into different parts and the process can take longer.

ICSI (Intracytoplasmic Sperm Injection):   Sperm is injected directly into the egg in a dish and subsequently the fertilized egg is placed into your uterus.

GIFT (Gamete Intrafallopian Tube Transfer) and ZIFT (Zygote Intrafallopian Transfer):  These procedures are almost like IVF, where eggs are retrieved, mixed it with sperm in a lab and finally transfer them into your body.  In ZIFT, fertilized eggs are called zygotes and are implanted within 24 hours.  In GIFT, sperm and eggs are combined before being placed into your uterus.

Egg donation:  This is ideal for women who have healthy uterus but ovaries don’t function right.  In this procedure, eggs from the ovary of a donor are removed and after IVF the fertilized egg is implanted into your uterus.

Can female infertility be prevented?

Sadly, there is nothing we can say with 100% conviction that this will prevent infertility, especially if it is related to genetic disorder or disease.  However, adhering to certain standards can raise your bar of fertility a few notches.  Some of them are the following:

  • Take proper steps to prevent sexually transmitted diseases and infections
  • Avoid illicit drugs
  • Kick out the bottle and say “no” to alcohol
  • Practice good personal hygiene and health habits
  • Last but not the least, fix an appointment with your gynecologist at least once a year once you are sexually active

For enquiries related to female infertility, send a message to www.kjkhospital.com/contact

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