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.
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