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Female infertility problems

Summary

Female infertility problems

Female infertility occurs when the woman does not conceive after one year of attempting to become pregnant. Other signs and symptoms depend on the underlying cause of the woman's infertility.

In about 15% of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible infertility problems could be that the egg is not released at the optimum time for fertilisation, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilisation may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognised that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilisation

Normal female fertility

“Normal” fertility could be defined as conceiving within a 12 – 15 month period, during which time you are having regular unprotected sex. Of course, you may still become pregnant naturally, but it would be wise to make an appointment with your GP if you could be having difficulty conceiving.

Fertility is a highly complex process and many different factors need to coincide in order for pregnancy to occur. A woman must ovulate, have at least one fully functioning fallopian tube, produce watery mucus by the cervix near the time of ovulation that permits the ejaculated sperm to pass into the uterus from the vagina, and have a uterus that permits implantation of the embryo.

At the beginning of the menstrual cycle the pituitary gland in your brain releases a follicle-stimulating hormone (FSH), which stimulates the ovary to produce follicles. One of these follicles grows faster to become the "dominant follicle". It is from this follicle that the egg will be released.

The ovaries produce many hormones, most importantly oestrogen and progesterone. Oestrogen promotes growth of the follicles and development of the endometrium, while progesterone, released after ovulation, prepares the endometrium for pregnancy.

When the egg is released, it is swept into the fallopian tube and then begins to move slowly downwards to be fertilised in the outer third of the tube. The fertilised egg continues to the uterus to implant in the lining ( endometruim ) resulting in a pregnancy. If the egg is not fertilised, the endometium is shed as a menstrual period approximately 14 days after ovulation.

Possible side effects of infertility drugs

Side effects from drugs used to treat infertility tend to be minor, although some patients have reported mood changes, tiredness and muscle aching. Rarely, allergic reactions have been reported. In less than 5% of women, a condition called Ovarian Hyperstimulation Syndrome (OHSS) can occur when using drugs for ovarian stimulation. OHSS is most commonly seen in younger women and those with polycystic ovaries. Symptoms include lower abdominal pain and swelling, nausea or vomiting. Women at risk of developing OHSS must stop drugs whilst continuing with GnRG analogue. Egg collection is arranged when oestrogen drops to an appropriate level or, alternatively, the cycle may be cancelled. The clinic must be contacted immediately for any symptom, however mild.

Common causes of female infertility

Ovulatory disorders

Ovulatory disorders occur as a result of hormonal imbalance either within the hypothalamus, the pituitary or in the ovaries. Common causes include stress, excessive changes in body weight and polycystic ovaries. Polycystic ovaries (POC) can affect up to 30% of women with infertility problems. The ovaries contain many tiny cysts, and women with POC may experience menstrual irregularities, fertility problems, excessive body hair, acne and obesity. Treatment usually involves the use of drugs to correct the hormonal imbalance. Laparoscopic ovarian drilling using diathermy or laser could also be performed.

Fallopian Tube Blockage

Fallopian Tube Blockage may occur as a result of a previous infection or abdominal surgery complicated by adhesions. Excess fluid (hydrosalpinx) may also become a source of chronic infection and inhibit fertility. Although some blockages may be treated surgically, IVF is often the best option.

Endometriosis

Endometriosis is a condition where the tissue, which normally lines the uterus, is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Blood filled cysts may develop within the ovaries, causing pelvic scarring that affects the fallopian tubes and leads to infertility.

Treatment of endometriosis is either medical using drug therapy or surgical using laparoscopy or open surgery, depending on the extent of the disease. IVF is an appropriate treatment for endometriosis-induced infertility when other methods have failed.

Cervical Factors

Some women have either antisperm antibodies or produce very little mucus at the time of ovulation, both of which interfere with sperm migration through the cervical canal. It may be possible to bypass hostile mucus by intrauterine insemination (IUI).

Unexplained Infertility

Although perhaps no comfort, unexplained infertility affects up to 25% of infertile couples. It is not always possible to determine if the eggs are actually released from the follicles, if the fallopian tubes are patent, if the sperm is capable of reaching and fertilising the egg. Intrauterine insemination (IUI) using washed sperm suspended in culture medium combined with ovarian stimulation offers a simple relatively non-invasive procedure. If pregnancy does not occur within three IUI cycles, alternative methods such as IVF should be considered.

Some infertility investigations which may be sought by your consultant are a fully monitored cycle to check for ovulation, POST coital test, hysterosalpingogram, hysteroscopy or diagnostic laparoscopy.

Counselling

The HFEA considers counselling to be a key element in the provision of infertility services for all patients. Infertility hospitals and clinics are generally sensitive to the emotions experienced by the infertile couple and the stress of the treatment itself and will offer implication counselling and confidential support counselling, often with the first session free of charge.

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