Female infertility is the inability of a female of reproductive age to conceive biologically despite consistent attempts for conception for one or more years. Infertility in couples can stem from both male and female infertility, or either one. Female infertility is alone responsible for one-third of the fertility issues in couples or individuals, whereas male infertility is responsible for another one-third, and the rest of one-third of fertility issues are caused by a combination of female and male factor infertility.
If a woman has infertility, fertility treatments are inevitably required to achieve pregnancy. There exist different fertility treatments, from medicinal, and surgical to non-surgical, which aid with different fertility issues.
Why does infertility occur?
To achieve pregnancy, a woman must ovulate, releasing one or more eggs for fertilization. Generally, a woman has 1-2 million eggs inside the ovaries from birth; as she reaches puberty, her ovaries start to release one egg per month during ovulation, and the egg travels to the uterus through the fallopian tubes. In the uterus, it gets reabsorbed into the uterine wall, later causing menstruation.
If the egg meets a sperm on its way to the uterus, it may get fertilized and develop into an embryo which will implant on the uterine lining upon reaching the uterine cavity. Successful implantation leads to fetus development and hence pregnancy. If any interruption occurs in this sensitive process, it can cause infertility. For example, the woman does not produce adequate eggs for fertilization, and the sperm cannot meet the eggs, the embryo implantation can’t occur, etc. Here either male and female or both infertility factors can cause fertility issues.
In this post, we will be focusing on female factor infertility only.
Don’t Feel Isolated
You are not alone; approximately 15% of couples cope with fertility issues, out of which 35-37% of fertility issues are related to female infertility. Female infertility is a condition of female reproductive disorder, such as ovulatory disorder, hormonal disorders, endometriosis, damaged fallopian tubes, etc. These fertility issues are common among women of childbearing age. To treat or to provide fertility treatment, it is crucial to find the underlying cause of infertility in women.
Cause of infertility among females
Various causes of female infertility include:
Ovulation Disorders and Hormonal imbalance:
Ovulation disorders caused by hormonal imbalance are the leading cause of female infertility, owing to 25% of fertility issues in women. It is because ovulation dysfunction can affect the production and release of eggs. It can be caused by hormonal disorders, or it can be idiopathic anovulation. Hormonal disorders, namely PCOS, thyroid, hypogonadotropic hypogonadism, hyperprolactinemia, etc., lead to ovulation disorder in women.
In endometriosis, the endometrial lining grows outside of the uterus, damaging the pelvic organ and hence causing infertility in women. One in three women with endometriosis also has fertility issues.
Any damage to the fallopian tubes can prevent the fertilization process. The eggs travel through the fallopian tubes, and here they also meet sperm; therefore, tubal blockage, damage or infection may prevent eggs from meeting the sperm. The sperm may not be able to reach the eggs. Tubal damage or blockage, past ectopic pregnancy, congenital tubal defects, tubal ligation etc., can cause tubal infertility.
Uterine and Cervical issues:
Uterine disorders include uterine fibroids, polyps, too-thin uterine lining (amenorrhea), congenital uterine malfunction, intrauterine scarring and adhesion, adenomyosis, Asherman’s syndrome-uterine synechiae, etc., which prevents embryo implantation on the uterine wall, hence preventing pregnancy. Uterine abnormalities also increase the likelihood of miscarriages in pregnant women.
Cervical abnormalities such as cervical mucus, cervical fibroid, etc., can restrict sperm from entering the uterine cavity and prevent them from fertilizing the eggs.
The age of a woman directly affects her fertility due to diminished ovarian reserve. As mentioned above, after puberty, a woman releases one egg per month, so with time, both the quantity and quality of eggs decline in women. Women’s twenties are considered the optimal fertility age, and after 35, their fertility declines dramatically.
Premature Ovarian Insufficiency:
Sometimes, women in their twenties and early thirties encounter premature ovarian insufficiency as a consequence of genetic or medical abnormalities. It negatively affects the quality and production of eggs in women.
Lifestyle choices can affect your fertility, e.g. alcohol consumption and smoking reportedly affect fertility in women. Poor diet, lack of physical work, and too much stress can upset hormonal balance in women causing infertility. Overweight women seem to have decreased fertility compared to underweight women.
Other Medical Conditions:
Other medical conditions like TB, HIV, AIDS, Endocrine disorders, autoimmune disorders, celiac disease, cancer treatment, etc., can cause infertility in women. Past tubectomy is another cause of infertility.
If the cause of infertility in a woman can’t be recognized even after diagnosis, then it is considered unknown infertility. One-fourth of infertile women are diagnosed with unexplained infertility.
Symptoms and Diagnosis
The symptoms of female infertility include:
- Abnormal or absent menstrual cycle
- Difficulty in achieving pregnancy
- Have endometriosis or uterine fibroids
- Have PCOs or thyroid
The diagnosis of infertility may involve screening of ovulation and tubal status:
- Ovulation analysis through bloodwork
- Transvaginal ultrasound for ovarian reserve testing
- Infectious diseases test
- Diagnostic Hysteroscopy or Laparoscopy (if required)
- Genetic screening (if required)
Treatment options for female infertility
Different treatment approaches are required to treat different fertility problems. The primary focus is to treat the underlying cause of infertility, like restoring ovulation or ovulation management, treating tubal damage or uterine issues, etc. But if treatment of underlying fertility problems is not possible, then secondary treatments focus on assisting the patient in getting pregnant with advanced fertility treatments.
Infertility is a complex medical condition, and its treatments require a strong physical, emotional and financial commitment. The infertility treatment depends on the following factors;
- Age of the female
- The underlying cause of infertility
- The severity of the infertility
- How long you’ve been infertile
- If the male partner also has infertility
- Record of previous pregnancies (if any)
The following are the infertility treatments:
Fertility medications are used for restoring and regulating ovulation cycles in women. Fertility drugs are the first-line treatment for ovulation and hormonal disorders in infertile women. Fertility medication includes hormonal drugs such as Clomid, Letrozole, Gonadotropins, etc., containing FSH and LH. They help to restore hormonal balance and stimulate egg production (ovulation).
Other medications, such as Metformin, may also be used to manage the symptoms of ovulatory dysfunction, such as PCOS. Fertility drugs are also used to stimulate ovulation for multiple egg production for other fertility treatments.
Surgical treatments are rarely performed for fertility treatments as they are invasive, and less invasive treatment for infertility does exist. Moreover, surgeries can’t fix every fertility problem, and other ART treatments are more successful than surgical treatments.
Surgical treatments include; Hysteroscopy, Laparoscopy and tubal surgeries to correct the problems in the uterine, endometrium and fallopian tubes. For example, blocked fallopian tubes can be treated with Laparoscopy, but the pregnancy rate after tubal surgeries is still significantly low. Uterine polyps and fibroids can be removed with surgical treatment as well.
Assisted Reproductive Treatments:
Assisted reproductive treatments (ARTs), such as IUI, IVF, etc., are the best effective treatment for many infertility factors. Although ART treatment cannot necessarily treat the infertility factor itself, it can help you get pregnant. Some common ART treatments are:
IUI (Intrauterine insemination)
In IUI treatment, the sperms are artificially inseminated inside the uterus for fertilization near the ovulation period. This treatment is effective for mild female infertility, namely cervical mucus, ovulatory disorders if one fallopian tube is functioning, and unknown cause of infertility. The success rates of IUI treatment are 7-9% without fertility drugs and 10-25% with fertility medications.
IVF (In Vitro Fertilization)
IVF treatment involves ovulation induction or stimulation, egg retrieval, fertilization of egg with sperm outside the uterus in a lab, and transfer of developed embryo inside the uterus for implantation. IVF is the most effective treatment for both female and male factor infertility, with success rates of 50-80% for women under 35 and 35-45% for women over 35.
IVF treatment is helpful with various female infertility, such as tubal infertility, ovulation dysfunction, age-related infertility, endometrium and uterine abnormalities, etc. IVF treatment can be modified with other assisted reproductive technologies such as ICSI, assisted hatching, Blastocyst transfer, PGS, etc., depending on the infertility factor and its severity.
Infertility is challenging for patients as well as healthcare providers. Finding the underlying root of female infertility is critical to provide effective treatment options. While patients suffer both mentally and physically due to infertility, for doctors, it is crucial to investigate the infertility cause. Only an experienced and competent fertility centre can provide the best of their service to lift the burden of childlessness from their patients’ shoulders.
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