FEMALE INFERTILITY
- According to ‘WHO’ female infertility can be described as the “Inability to become pregnant, maintain a pregnancy or carry a pregnancy to live birth”.
- A clinical definition of infertility described by WHO is “A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”.
Around the globe, infertility in females is estimated at about 48 million.
Factors affecting female infertility are classified into two groups…
Acquired
Genetic
1 Acquired Factors
Any factor which is not based on genetic mutation.
Acquired factors causing infertility in females are further classified as…
1. Age-related factors
2. Smoking
3. Sexually transmitted infections
4. Weight factors [over weight and underweight]
AGE
A women’s fertility is affected by her age …
The first period [menarche] commences on average of 12 to 13 years.
As age is concerned a women’s fertility peaks in the early and mid20 and after this fertility declination slowly continues up to age 35 years and further women’s infertility accelerates its declination rate.
Tobacco smoking
Tobacco smoking directly affects fertility, irrespective of its mode [Active smoker or passive smoker]
The nicotine and other harmful chemicals present in cigarettes interfere with the body’s estrogen-producing ability.
[Estrogen is a Harmon that regulates the process of formation of follicles [Follicle genesis] inside the ovary and it also affects ovulation which is a release of a mature egg from the follicle.
Despite these factors, smoking also co-relates with female infertility by interfering with embryo transport, endometrial receptivity, endometrial angiogenesis, uterine myometrium and uterine blood flow.
Sexually transmitted infections
Female infertility can be caused by sexually transmitted infections but the no. display few. And with early diagnosis and treatment [in no time] female infertility can be prevented.
BODY WEIGHT
Woman’s body weight [either overweight or underweight]
is responsible for around 12% of all infertility cases.
As the fat cells in a woman’s body produce estrogen hormone,
If a woman is overweight she will produce too much estrogen hence her body can react [as a feedback response]
As it is on birth control resulting odds of getting pregnant
Likewise, if a woman is underweight, her too little body fat causes an insufficient amount of estrogen which disturbs the woman’s fertility.
In addition to this, overweight women can also suffer from PCOD resulting in female infertility.
OTHER ACQUIRED FACTORS
A. RADIATION
Exposure to radiation can leads to a high risk of infertility
But it depends on power, duration of exposure and the frequency of radiation.
High doses of radiation can destroy some or all eggs in the ovaries and might cause infertility or early menopause.
B. Immune infertility
Around 10 to 30 % of infertile couples may face ASA factors, resulting in infertility.
ASA interferes with sperm motility and its transport through the female reproductive tract.
It also inhibits capacitation and acrosome reaction impaired fertilization.
C. SURGICAL ADHESIONS
Infertility in females may occur because of adhesions occurred due to any type of surgery in the peritoneal cavity.
D.DIABETES MELLITUS
Women with type 1 diabetes mellitus are at higher risk of infertility due to delayed puberty or menarche, menstrual irregularity special in DB and
relative amenorrhea.
E. COELIAC DISEASE
F.THROMBOCYTOPHILIA
2. GENETIC FACTORS
Several types of mutations occurred in the genes that cause infertility
It results due to chromosomal abnormalities including TURNER’S SYNDROME.
Genetic factors can further be classified by their locations such as…
- Polycystic ovarian syndrome.
- Ovulatory infertility…female infertility caused due to anovulation is called ovulatory infertility.
- Diminished ovarian reserve.
- Pre-mature menopause.
- Luteal dysfunction.
- Menopause.
TUBAL FACTORS
It includes…
Pelvic adhesions.
Tubal dysfunction.
Endometriosis.
Previous ectopic pregnancy.
UTERINE FACTORS
Uterine fibroids.
Implantation failures.
Asherman’s syndrome.
Uterine malformations.
CERVICAL FACTORS…
1. Non-receptive cervical mucus.
2. Anti sperm antibodies.
3. Cervical stenosis.
VAGINAL FACTORS…
1. Vaginal obstruction.
2. Vaginismus.
- Female infertility can be classified as…
- Primary infertility.
- Secondary infertility.
- Primary infertility is the inability to give birth because of not able to be pregnant or the inability to carry a child to live birth.
- Secondary infertility is the inability to conceive or give birth when there was already a previous pregnancy or live birth.
DIAGNOSIS of female infertility
Infertility in females can be diagnosed through medical history received from the patient and by physical examination of the patient.
Beyond a physical examination, patients can undergo some lab tests such as…
- Hormone testing…
- Hormones responsible for female fertility undergo tremendous changes in their levels throughout an average 28-day menstrual cycle.
Fertility in females is directly proportional to the level of these female hormones at a particular time or phase of the cycle.
For instance,
- Ovarian reserve can be assessed by measuring FSH and Estrogen levels on day 2 or 3 of the cycle.
- Measurement of thyroid function test.
- To confirm ovulation in the second half of the cycle progesterone level is measured.
- Antimullerian hormone directly causes female infertility by affecting ovarian reserve hence a test is conducted for measurement of the antimullerian hormone.
IMAGING…
- An endometrial biopsy is done to visualize the lining of the uterus and to verify ovulation.
- To inspect the pelvic organ laparoscopy is done.
- An advanced surgical technique used for early diagnosis and treatment in no time is called “ fertiloscopy ”.
- For diagnosis of any sort of cervical infection, a PAP smear is carried out.
- Fallopian tube patency is checked by hysterosalpingography [HSG].
PREVENTION of female infertility
Acquired female infertility can be prevented by …
- Maintaining a healthy lifestyle.
- Daily regular exercise.
- A healthy and well-balanced diet containing plenty of fresh veggies and fruits.
- Treating existing diseases such as diabetes mellitus, hypothyroidism, and STDs.
- By early planning of parenthood.
- By freezing the egg.
TREATMENT of female infertility
As infertility in females is a true matter of age, one cannot reverse the advanced maternal age but one can take the help of assisted reproductive techniques such as…
- Ovulation induction for an ovulatory cycle.
- I.U.I.
- I.V.F.