Female Infertility

A common condition, female infertility is an inability to get pregnant and have a successful pregnancy. This is typically diagnosed after a woman has tried to get pregnant (through unprotected sex) for 12 months without a pregnancy. There are many treatment options for infertility, including medications to correct hormonal issues, surgery for physical problems and in vitro fertilization (IVF).

OVERVIEW

What is female infertility?

Infertility is a medical condition in which a person is unable to conceive or carry a pregnancy to term. For heterosexual couples, this is typically diagnosed after a year of trying to conceive without success. In these cases, one third of the causes of infertility are due to a problem with the male partner, one third are due to a problem with the female partner, and the remaining third are due to a combination of factors or unknown causes. When the cause of infertility is found to be from the female partner, it is referred to as female infertility or "female factor" infertility.

How common is female infertility?

Infertility is a common medical condition that affects approximately 10% of women. As a woman gets older, her chances of experiencing infertility increases. This condition can be difficult to deal with, and it can take a toll on a person's emotional and physical well-being. Many women who struggle with infertility go through a range of emotions, including sadness, frustration, and anxiety. Some may even feel like they are less of a woman because they are unable to conceive a child. In addition to the emotional challenges, infertility can also be physically demanding, as women may need to undergo various medical treatments in order to become pregnant. Despite the challenges, many women who struggle with infertility are able to find effective treatments and eventually have the families they desire.

SYMPTOMS AND CAUSES

What causes female infertility?

There are several possible causes of female factor infertility, which refers to issues with a woman's reproductive system that prevent her from getting pregnant. Some of these causes include:

•Problems with the uterus: The uterus is a reproductive organ that is vital to the menstrual cycle and pregnancy. However, there are several problems that can affect the uterus, such as polyps, fibroids, septum, and adhesions.

*Polyps are small, benign growths that can form on the inner or outer lining of the uterus. They are usually harmless, but they can cause heavy or irregular periods, pelvic pain, and discomfort during sex.

*Fibroids are noncancerous growths that develop in the uterus. They can be small and cause no symptoms, or they can grow large and cause heavy periods, pain, and pressure on the bladder or rectum.

*A septum is a congenital abnormality in which the uterus is divided into two cavities by a wall of tissue. This can cause problems with fertility and pregnancy.

Adhesions are scar tissue that forms inside the uterus. They can develop after a surgery, such as a dilation and curettage (D&C), or as a result of infection or inflammation. Adhesions can cause pain and abnormal bleeding.

•Problems with the fallopian tubes: The leading cause of tubal factor infertility, a condition in which the fallopian tubes are damaged or blocked, is typically found to be pelvic inflammatory disease. This disease is often the result of infections with the sexually transmitted bacteria chlamydia and gonorrhea.

•Problems with ovulation: When a woman does not release an egg on a regular basis, it is known as irregular ovulation. This can be caused by a variety of factors, including hormonal imbalances, past eating disorders, substance abuse, thyroid conditions, severe stress, and pituitary tumors. Hormonal imbalances can occur for a number of reasons, such as changes in levels of certain hormones in the body. A past eating disorder, such as anorexia or bulimia, can also disrupt hormone levels and affect ovulation. Substance abuse, including the use of alcohol or drugs, can also interfere with the regular release of eggs. Thyroid conditions, such as an underactive or overactive thyroid, can also affect ovulation. Severe stress can also disrupt hormone levels and affect the regular release of eggs. Finally, pituitary tumors, which are growths on the pituitary gland, can also interfere with ovulation.

•Problems with egg number and quality: 
The female body is born with a finite supply of eggs, which are stored in the ovaries. As a woman gets older, this supply can start to dwindle, eventually leading to menopause. Additionally, not all of these eggs are viable for fertilization and growth into a healthy fetus. Some eggs may have chromosomal abnormalities, such as balanced translocation, which can affect all of the eggs in a woman's ovaries. Other chromosomal abnormalities may be random, but they become more common as a woman gets older.

Who is at risk for female infertility?

There are several factors that can cause female infertility, including health conditions, genetics, lifestyle choices, and age. These can all affect a woman's ability to conceive.

Specific factors can include:

• Age.
• Hormone issue that prevents ovulation.
• Abnormal menstrual cycle.
• Obesity.
• Being underweight.
• Having a low body-fat content from extreme exercise.
• Endometriosis.
• Structural problems (problems with the fallopian tubes, uterus or ovaries).
• Uterine fibroids.
• Cysts.
• Tumors.
• Autoimmune disorders (lupus, rheumatoid arthritis, Hashimoto’s disease, thyroid gland conditions).
• Sexually transmitted infections (STIs).
• Polycystic Ovary Syndrome (PCOS).
• Primary Ovary Insufficiency (POI).
• Excessive substance use (heavy drinking).
• Smoking.
• DES syndrome (DES is a medication that was given to women to prevent complications in pregnancy like premature birth or miscarriage. However, this medication has caused infertility in some of the children of mothers who took DES.).
• A past ectopic (tubal) pregnancy.

How does age impact female infertility?

As a woman grows older, her ability to become pregnant decreases. This is because age is becoming a more common factor in female infertility, as many couples are choosing to have children later in life. Women over the age of 35 are especially at risk of experiencing fertility issues. The chances of pregnancy decrease as a woman ages, making it more difficult for older women to conceive.

The reasons for this include:

• Overall number of eggs is lower.
• More eggs have an abnormal number of chromosomes.
• An increased risk of other health conditions.

DIAGNOSIS AND TESTS

What will my doctor ask during an appointment to diagnose female infertility?

Your healthcare provider will need to know about your menstrual periods, any past pregnancies, miscarriages, pelvic pain, unusual vaginal bleeding or discharge. You may also be asked about any past pelvic infections or sexually transmitted infections (STIs). Some questions may include:

• Have you had any previous pregnancies or miscarriages?
• Is your menstrual cycle normal and regular or painful and irregular?
• Do you have heavy bleeding or abnormal discharge?
• Do you have any pelvic pain?
• Have you had any abdominal surgeries in the past?

What tests will my healthcare provider run to diagnose female infertility?

Some tests may be done in your healthcare provider’s office as a physical exam. These tests may include:

• An overall physical exam.
• A Pap test.
• A pelvic exam.
• A pelvic ultrasound.
• An examination of the breasts for unusual milk production.

Other tests may need to be done in a lab. These tests can include:

• Blood tests: The type of lab tests will depend on your health history and what diagnoses your doctor is considering. Examples of lab tests include thyroid testing, prolactin levels, tests of ovarian reserve and progesterone (a hormone produced during the menstrual cycle that signals ovulation).
• X-ray hysterosalpingogram (HSG): A dye is injected into the cervix and the caregiver watches how the dye moves through the fallopian tube with an X-ray. This test checks for blockages.
• Laparoscopy: In this test, a small monitoring instrument called a laparoscope is inserted into the abdomen to look at the organs.
• Transvaginal ultrasound: Unlike an abdominal ultrasound (where the probe is placed over the belly), this test is done by inserting an ultrasound wand into the vagina. It allows the healthcare provider a better view of organs like the uterus and ovaries.
• Saline sonohysterogram (SIS): This test is used to look at the lining of the uterus and assess for polyps, fibroids or other structural abnormalities. Saline (water) is used to fill the uterus, allowing the healthcare provider to get a better view of the uterine cavity during a transvaginal ultrasound.
• Hysteroscopy: In this test, a device called a hysteroscope (a flexible, thin device with a camera on it) is inserted into the vagina and through the cervix. The healthcare provider moves it into the uterus to view the inside of the organ.

MANAGEMENT AND TREATMENT

How is female infertility treated?

If a woman is diagnosed with infertility, there are a few different treatment options available to her, depending on the cause of the infertility. For structural problems, surgery may be necessary to correct the issue. Hormonal imbalances can be treated with medications to help regulate the hormones and improve the chances of ovulation and conception.

In some cases, artificial insemination may be necessary. This involves washing sperm and injecting it directly into the uterus after ovulation has occurred. This can help to increase the chances of fertilization and pregnancy.

In vitro fertilization (IVF) is another option for women with infertility. This involves fertilizing eggs with sperm in a laboratory setting, creating embryos that can then be transferred into the uterus. This can be an effective treatment for women who are unable to conceive naturally.

For some women with infertility, adoption or gestational surrogacy may be the best option. Adoption involves bringing a child into the family who is not biologically related, while gestational surrogacy involves carrying a pregnancy for another person or couple using in vitro fertilization. Both of these options can help women and couples start a family when they are unable to do so on their own.

Prevention

Can female infertility be prevented?

Female infertility is a condition in which a woman is unable to conceive or carry a pregnancy to term. It is a common issue that can have many different causes, and for the most part, it cannot be predicted or prevented. However, there are certain risk factors that may increase a woman's likelihood of experiencing fertility issues.These can include things like excessive alcohol consumption, smoking, and being overweight or obese. By making healthy lifestyle choices and maintaining a healthy weight, a woman may be able to reduce her risk of infertility. Regular visits to a healthcare provider can also be helpful in identifying any potential risks and taking steps to prevent or manage them.

What is the outlook for female infertility?

The outlook (prognosis) for female infertility depends greatly on the individual and the underlying cause of infertility. In cases where medication can be used to treat an ovulatory condition, or a simple surgical procedure can be used to correct a structural abnormality (polyps or solitary fibroids), the outlook is generally positive. Talk to your doctor about your family history, risk factors and underlying medical issues to learn more about your prognosis.

LIVING WITH

When should I see my doctor about female infertility?

If you are a woman in a heterosexual relationship with regular intercourse and menstrual cycles, you should see your doctor after 12 months of trying to conceive (become pregnant) without using birth control (six months if you are over the age of 35). It’s also important to regularly visit your healthcare provider once you become sexually active.

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Infertility can be incredibly stressful. If you have been trying to get pregnant for 12 months without success . or six months if you are over the age of 35.  reach out to your healthcare provider. Once you are diagnosed, your provider can help you develop a plan moving forward.

References:

• Mayo clinic (https://www.mayoclinic.org/diseases-conditions/female-infertility/symptomscauses/syc)
• Wikipedia(https://en.m.wikipedia.org › wikiFemale infertility)
• American Pregnancy Association (https://americanpregnancy.org › fe.Infertility in Women)