Infertility in Women

Infertility is generally defined as inability to get pregnant after trying for at least a year with no success.

Up to 20% of couples are having difficulty getting pregnant.

The cause is of infertility is still poorly understood as it can be a result of multiple factors in the male or female partner or even in both.

Infertility in women can be difficult to determine because of the variety of causes. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, up to 95 percent of couples successfully conceive.

Causes of Infertility

1.    Ovulation disorders

Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.

ü  Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.     

ü  Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.

ü  Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.

ü  Excess Prolactin. The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces oestrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you're taking for another disease.

2.    Autoimmune Disorders

 Autoimmune disorders cause the body’s immune system to attack body tissues it would normally ignore. Autoimmune disorders, such as lupus, Hashimoto’s and other forms of thyroiditis, and rheumatoid arthritis, may affect fertility. The reason for this are not fully understood and differ between diseases, but they are thought to involve inflammation in the uterus and placenta or medications used in treating the diseases. Both men and women can make antibodies that attack sperms, eggs or the reproductive organs.

 

3.    Damage to Fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

ü  Pelvic inflammatory disease (PID), an infection of the uterus and fallopian tubes due to Chlamydia, gonorrhoea or other sexually transmitted infections

ü  Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus

ü  Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States

4.    Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

5.    Uterine or Cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:

ü  Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.

ü  Endometriosis scarring or inflammation within the uterus can disrupt implantation.

ü  Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.

ü  Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.

ü  Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

 

Risk factors

Certain factors may put you at higher risk of infertility, including:

ü  Age. The quality and quantity of a woman's eggs begin to decline with increasing age. In the mid-30s, the rate of follicle loss speeds up, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.

ü  Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy (when a fertilized egg implants and grows outside of the main cavity of the uterus). It's also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.

ü  Weight. Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.

ü  Sexual history. Sexually transmitted infections such as Chlamydia and gonorrhoea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.

ü  Alcohol. Stick to moderate alcohol consumption of no more than one alcoholic drink per day.

 

 

Suggested Measures to Prevent Infertility

For women thinking about getting pregnant soon or in the future, these tips may help optimize fertility:

ü  Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.

ü  Stop smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a foetus. If you smoke and are considering pregnancy, quit now.

ü  Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing foetus. If you're planning to become pregnant, avoid alcohol, and don't drink alcohol while you're pregnant.

ü  Avoid stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.

ü  Eat a healthy, balanced diet. If you are trying to get pregnant, avoid trans fats and unhealthy diets like red and processed meats, greasy and fried foods, sweetened beverages, cookies, cakes etc. You would do well in your quest to conceive by concentrating on natural and fresh food sources rich in folic acid, vitamin B₁₂ and omega-3 fatty acids.  

In general, not all infertility cases end up resolved with favourable results. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it can be frustrating for both doctor and patients to get no specific answers, this problem may correct itself with time.