Female Infertility: An overview
Infertility, whether male or female, is defines as the inability of a couple to achieve conception or bring a pregnancy term after a year or more of regular, unprotected sexual intercourse. According to WHO, 2.2-10% of couples worldwide are unable to conceive a child and further 10-25% experience secondary infertility, i.e. they are unable to conceive a second or subsequent child. WHO believes that around 60-80 million couples in the world are infertile. Becoming pregnant is not that easy even for people who do not have fertility problems, human beings are one of the least fertile creatures on earth. There is only a fairly short time within the menstrual cycle when conception possible, making the chances of conception only 25% each month. It is estimated that 10% of the normally fertile couple fail to conceive within their first year of attempt and 5% after two years.
CAUSES OF FEMALE INFERTILITY
The most common causes of female infertility are ovulatory disorders. These account for approximately 20-30% of female infertility. Ovulatory disorders are often the result of hormone imbalances. Polycystic ovarian disease (PCOD), a condition commonly characterized by hirsutism, obesity, menstrual abnormalities, infertility and enlarged ovaries.
FALLOPIAN TUBE DAMAGE
Damage to the fallopian tubes is another common cause of female infertility, occluding or partially obstructing the tube and thus preventing the egg from travelling down for fertilization by the sperm. Tubal damage can result from salpingitis (inflammation of the tubes) cause by bacterial and/or viral infection, sometimes but not always, caused by sexually transmitted diseases. Surgery, itself can cause abdominal adhesions and scar tissues that can also damage the fallopian tubes.
UTERINE AND CERVICAL DISORDERS
Abnormalities of the uterus such as fibroids, and polyps can contribute to infertility by causing damage to the uterine wall. Likewise, abnormalities of the cervical mucus can reduce fertility. Mechanical problems account for 20% to 30% of female infertility.
Endometriosis, although reasonably uncommon, is associated with a high incidence of infertility (approximately 70% of sufferers experience infertility). Endometriosis is a condition whereby endometrial tissue grows outside the uterus. Endometriosis lesions can cause blocked fallopian tubes and/or impaired ovulatory function.
TREATMENT OF FEMALE INFERTILITY
Today there is a wide range of medical help that can be offered to infertile couple. In the past five to ten years, there has been an explosion of new information about infertility and there had been great advances in fertility treatment. These new therapies include advances in hormonal treatment, a wider acceptance of donor insemination, the development of intrauterine insemination (IUI), and advances in micro surgery and laser surgery.
OVULATION INDUCTION (OI)
Agents most commonly used for ovulation are:
Clomiphene citrate: acting on the hypothalamus to increase the release of gonadotropin releasing hormone (GnRH), which, in turn, stimulate the pituitary gland to release FSH and LH.
Gonadotropins: FSH and LH acting directly on the ovary, promoting follicular development and hCG triggering ovulation after follicular stimulation.
OI is usually combined with timed intercourse or with artificial insemination (also called intrauterine insemination – IUI) in order to increase the probability of successful fertilization. If conception has not taken place after approximately three to five cycles with clomiphene citrate and a further three to five cycles with gonadotropin treatment, the patient may be referred to ART (assisted reproductive technology).
INTRAUTERINE INSEMINATION (IUI)
This technique is recommended when infertility is:
- Secondary to male factor, cervical factor, mild tubal factor
- Caused by endometriosis, but tubal patency (opening) is established
Female partner’s follicular phase is monitored through hormonal testing and ultrasound, which assists in adjusting medication scheduling the insemination to coincide with ovulation. The insemination procedure involves placing a fraction of motile sperms into the uterine cavity via catheter, with chances of success maximized by ovulation induction. Progesterone supplement may also be administered during the patient’s luteal phase.
The follicular phase is the first part of the menstrual cycle where ovarian follicular development and egg maturation occurs. The luteal phase is the last part of the cycle after ovulation when the follicle becomes the corpus luteum that produces the hormone progesterone.
Opportunities for conception are significantly increased by times intercourse to ovulation. This is determined through hormonal and ultrasound monitoring. Patients with ovulatory dysfunction are treated with fertility medications.
– Gurdeep Singh