Female Infertility

Female infertility can result from

➢ Infections of Malformations of the female genital tract

➢ Due to age, as age increases fertility decreases

➢ Hormonal imbalances

➢ Other conditions preventing conception or maintenance of a full term pregnancy.

➢ Prolonged exposure to radiation or certain chemicals can cause infertility

➢ Women who smoke have enough nicotine in their cervical mucus to kill sperm.

The most common female-related causes of infertility are

Causes of Female Infertility -AGE

Age is the most important factor affecting a woman’s fertility. With age, the chance for pregnancy decrease and odds for miscarriage increase. At 25, a woman has around 20% to 25% chance of getting pregnant naturally every month. This gradually decreases with age and is at around 10% to 12% at an age of 35. After that, the decline is steady. The chance of getting pregnant is at 40 is around 5% to 10% per menstrual cycle.

Although older women are more likely to experience scarring and blockages caused by Endometriosis or other medical conditions, these are not significant contributors to infertility. Instead, infertility often is the result of age-related changes occurring in the reproductive hormones that stimulate egg development, trigger ovulation and support pregnancy. Most important, is depletion of a woman’s ovarian reserve- (the eggs she is born with). During her reproductive years, some eggs never mature and others are released during her menstrual cycles. Those remaining, age with her and the older she is, the more likely they are to have hard shells (zona pellucida)- that prevent sperm from penetrating or result in genetic defects that prevent fertilization or cause miscarriage.

When the store of healthy eggs is depleted, menopause occurs.

Causes of female Infertility – Tubal Disease

The fallopian tubes carry eggs from the ovaries to the uterus. When tubes are blocked by scar tissue from Endometriosis, due to surgery or infection, the egg and/or the sperm cannot travel through. If a fertilized egg is trapped in the fallopian tube, it results in Ectopic pregnancy, which is treated with medication or surgery.

Tubal problems include

Infections:

Sexually Transmitted Diseases, Gonorrhea and Chlamydia, often go unnoticed and untreated, causing Pelvic Inflammatory Disease (PID). Serious infections can cause scar tissue and damage to the CILIA (the small hairs lining the tubes to help the eggs move through). Symptoms of sexually transmitted diseases include inflammation and abnormal discharge. PID can result in pelvic or abdominal pain. Severe, untreated infections have been linked to Cervical and other Cancers, Chronic Hepatitis and Cirrhosis of the liver.

Hydrosalpinges:

This condition is caused by a severe blockage resulting from infection. It significantly reduces the chance of pregnancy without IVF because it stretches or distorts the fallopian tubes to the extent that they cannot be opened and/or repaired. When the tubes fill with fluid, there is a chance that it can leak back into the uterus. Because this fluid is toxic to embryos placed into the uterus during IVF, physicians often remove or surgically block the tubes before a cycle to improve embryo implantation rates.

Endometriosis:

Tissue lining the uterus (Endometrium) grows and thickens during a menstrual cycle to receive a fertilized egg (implantation). Without a pregnancy, the lining sheds and is discharged with blood during a menstrual period. Endometriosis occurs when this tissue grows outside the uterus and the shedding process deposits blood and tissue in the abdomen. As a result, scar tissue can form in the fallopian tubes, adhere to the ovaries and/or cause misalignment of the organs, preventing natural conception. Although some women have no discomfort even with severe endometriosis, others experience abnormal menstrual bleeding and pain, tenderness in the abdomen and pelvis, and/or painful intercourse.

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Tubal Ligation:

A form of birth control, this surgical procedure involves tying, clamping off or burning the ends of the fallopian tubes so pregnancy cannot occur.

Causes of Female Infertility- Fibroids and Polyps

These growths (Fibromas, Myomas and Leiomyoma’s) are benign tumors made up of thread-like tissue that clump together to form masses. Usually found inside the uterus, they affect implantation of the fertilized embryo. Symptoms associated with fibroids – especially if they are large – include heavy bleeding, pain and abdominal pressure.

Treatment Options for Fibroids and Polyps is done through medications that can shrink fibroids in some cases, but the result is not permanent. Instead, they can only temporarily reduce symptoms, delay surgery or shrink the fibroid enough to allow for a less invasive surgical procedure.

Fibroids, large enough and affecting fertilization and/or embryo implantation are removed by Surgery

Causes of Female Infertility– Ovulatory Dysfunction

Ovulatory Dysfunction results from Congenital Defects, Hormonal Deficiencies and/or the ageing process. Common forms of Ovulatory Dysfunction include:

➢Some women don’t have menstrual periods while others menstruate but don’t ovulate. -Women with Amenorrhea have never had a period or had irregular periods that stop prematurely.

➢With Anovulation, eggs are not released from the follicles.

➢Luteal Phase Defects which occurs when a woman has a menstrual cycle and is ovulating, but the cycle is too short for the uterine lining to thicken properly.

➢Premature Ovarian Failure: Menopause usually occurs after several decades of menstrual cycles and natural depletion of the ovarian reserve. Premature ovarian failure or early menopause can be caused by

❖exposure to certain chemicals

❖Chemotherapy and radiation Treatment for Cancer.

❖Other conditions such as Genital Tuberculosis and Endometriosis that affect the cycle-regulating hormones or damage the ovaries so they no longer produce eggs.

❖Certain Genetic Disorders can trigger premature ovarian failure

❖Autoimmune diseases such as Lupus or Rheumatoid Arthritis – that cause the body to mistakenly attack the ovaries.

Polycystic Ovarian Syndrome: Genetically linked hormonal imbalances can cause Poly Cystic Ovarian Syndrome (PCOS), a condition that prevents ovulation. Without the necessary level of Follicle Stimulating Hormone (FSH), the follicles don’t develop properly and the eggs don’t mature. An imbalance of Luteinizing Hormone (LH) causes overproduction of Estrogen, abnormal thickening of the uterine lining and very heavy and/or irregular periods. High levels of LH can trigger over production of male hormones including testosterone, which cause acne and facial hair in women. Over time the elevated estrogen levels associated with PCOS may create an increased risk of uterine cancer and diabetes.

Hyperprolactinemia: This condition is associated with the pituitary gland located in the brain, which produces Prolactin to help regulate ovulation and stimulate breast milk production in pregnant women. Overproduction of Prolactin results from tumors of the pituitary ,an under active thyroid (Hypothyroidism) or an adverse reaction to certain prescription medications( including Antihistamines, Oral Contraceptives, Tranquilizers and Antihypertensive). As a result, women experience irregular or no ovulation, and they may produce breast milk even though they aren’t pregnant.

Hypothalamic Amenorrhea: The Hypothalamus gland, also located in the brain, produces Gonadotropin Release Hormone (GnRH). This chemical stimulates the pituitary gland to release Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). When the Hypothalamus stops producing GnRH as a result of this condition, it affects the FSH and LH levels needed for egg development and ovulation.