Infertility in Women

Infertility in women - Description, Causes and Risk Factors:

Infertility in WomenFemale infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile. According to various studies conducted across India 20%-30% couples face some kind of infertility related issues at some point in time in their lives.

Causes of infertility in women:

  • Hormonal Problems: Failure to produce mature eggs: In approximately 50% of the cases of anovulation, the ovaries do not produce normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilization becomes almost nonexistent.
  • Malfunction of the hypothalamus: The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. If the hypothalamus fails to trigger and control this process, immature eggs will result.
  • Malfunction of the pituitary gland: The pituitary's responsibility lies in producing and secreting FSH and LH. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced.
  • Scarred Ovaries: Physical damage to the ovaries may result in failed ovulation. For example, extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur. Infection may also have this impact.
  • Premature Menopause: Some women cease menstruation and begin menopause before normal age. It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise. There is also a genetic possibility for this condition.
  • Follicle Problems: Although currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it, every month yet the follicle fails to rupture.
  • Poorly Functioning Fallopian Tubes: A blocked fallopian tubes Infection: Caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation resulting in scarring and damage. Genital Tuberculosis: It is one of the commonest chronic/long standing infections which results in Blocked fallopian tubes and is often overlooked.
  • Abdominal Diseases: The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.
  • Previous Surgeries: This is an important cause of tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.
  • Ectopic Pregnancy: This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition.
  • Congenital Defects: In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.
  • Endometriosis: This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries, and the pelvis. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.
  • Behavioral Factors: It is well-known that certain personal habits and lifestyle factors impact health; many of these same factors may limit a couple's ability to conceive. Diet & exercise, smoking, and alcohol are some of the major reasons.
  • Environmental and Occupational Factors: The ability to conceive may be affected by exposure to various toxins or chemicals in the workplace or the surrounding environment.

Infertility in women - Symptoms:

  • Inability to become pregnant.
  • A range of emotional reactions by either or both members of the couple. In general, such reactions are greater among childless couples. Having at least one child tends to soften these painful emotions.

Diagnosis:

A complete history and physical examination of both partners are essential.

Tests may include:

  • Semen analysis - the specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.
  • Measuring basal body temperature - taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 °F temperature increase associated with ovulation.
  • Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy, and slippery mucus associated with the ovulatory phase.
  • Postcoital testing (PCT) to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
  • Measuring serum progesterone (a blood test).
  • Biopsying the woman's uterine lining (endometrium).
  • Biopsying the man's testicles (rarely done).
  • Measuring the amount of luteinizing hormone in urine with home-use kits to predict ovulation and assist with timing of intercourse.
  • Progestin challenge when the woman has sporadic or absent ovulation.
  • Serum hormonal levels (blood tests) for either or both partners.
  • Hysterosalpingography (HSG) - an x-ray procedure done with contrast dye that looks at the route of sperm from the cervix through the uterus and fallopian tubes.
  • Laparoscopy to allow direct visualization of the pelvic cavity.
  • Pelvic exam for the woman to determine if there are cysts.

Treatment:

Treatment depends on the cause of  infertility in women. It may involve:

  • Simple education and counseling.
  • Medicines to treat infections or promote ovulation.
  • Highly sophisticated medical procedures such as in vitro fertilization.

It is important for the couple to recognize and discuss the emotional impact that infertility in women has on them as individuals and together and to seek medical advice from their health care provider.

In 35% of infertility in women cases, problems are found with the fallopian tubes or problems with the lining of the pelvis and abdomen. Usually, this problem is diagnosed through a test called an HSG or hysterosalpingogram. If the HSG shows possible blockage of the tubes, the doctor may perform laparoscopic surgery to evaluate the situation, and possibly repair the problem.

Intrauterine insemination, also known as artificial insemination, is a procedure that involves placing specially washed sperm directly into the uterus. This treatment may be used in some cases of male factor infertility, if there's a problem with the woman's cervical mucus, or in cases of unexplained infertility. IUI may also be used for donor sperm.

Assisted reproductive technologies (ART) refer to infertility treatments that involve the handling of eggs or embryos. This includes IVF (in vitro fertilization), GIFT (gamete intrafallopian transfer), and ZIFT (zygote intrafallopian transfer). IVF is the most common form of ART in use today. GIFT treatments make up for less than 2% of all ART procedures, and ZIFT is used less than 1.5% of the time.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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