Female Infertility Causes
50 percent of infertility is directly or indirectly linked to the female. About 30 percent of all female infertility is unexplained. Of the explained reasons for female infertility, Ovulation Disorders are the most common cause. There are also many other causes. Following are some of the most common causes of female infertility.
Ovulation Disorders involve the inability to release an egg or the egg not being released at the right time in the cycle to facilitate conception. Ovulation Disorders can be characterized by absent ovulation (anovulation) resulting in infrequent periods (oligomenorrhea). Several different things can cause Ovulation Disorders. It may be due to:
- Hormone imbalances
- Vitamin or Mineral deficiency
- Low body weight
- High body weight
- Chronic illness
- Luteal Phase Defect
The problem with Ovulation Disorders in women who are trying to conceive is that there is less chances to conceive. It also causes a difficult time determining when to try to conceive because of the lack of knowledge as to when ovulation will occur.
Diagnosis for Ovulation Disorders involves blood tests for FSH, LH, Prolactin, Testosterone, and a Free Androgen Index. The use of CAT Scans or MRI’s, Endometrial Biopsies, and Specific Antibody Tests may also be used. Blood tests can determine the majority of hormone problems.
Treatment is dependent upon the diagnosis made by your doctor. Treatment may include fertility medications (both oral and injectable), nutritional changes, surgery (for tumors or cysts), stress reduction and a variety of drugs. When fertility medications are given, close monitoring may be needed because these drugs can cause hyperstimulation of the ovaries. Hormonal problems can be treated with medications and regulate ovulation in approximately 90 percent of women.
Blocked Fallopian Tubes
The fallopian tubes are a part of the female anatomy that sweeps the egg up after it is released from the follicular sac on the ovary and passes it to the uterus. The fallopian tube is also where fertilization takes place. When the fallopian tube is blocked, it makes it nearly impossible for a woman to conceive. The sperm wait in the fallopian tube for the egg to be released and swept up. But, if the tube is blocked then there is no way that the egg and sperm can meet and for the egg to be transported to the uterus where it would burrow in and begin to grow. There are two fallopian tubes (one coming from each ovary). It is possible for one or both to become partially or totally blocked.
Several different conditions can cause the fallopian tubes to become partially or fully blocked including:
- A history of ectopic pregnancies
- Endometriosis adhesions
- Infections (PID Pelvic Inflammatory Disease)
- Surgical procedures in the abdominal area
- Certain types of fibroids (rarely)
If there is a suspicion of tubal blockage due to the inability to conceive, an HSG (Hysterosalpingogram) may be performed. Laparoscopy can be used to diagnose other damage to the tube. Treatment may involve tubal surgery. This is a procedure in which the doctor will try to open the tube or tubes and to reduce damage to the tubes. Or the other option is in-vitro fertilization. I will be discussing these various procedures in later sections.
Polycystic Ovarian Syndrome
PCOS (Polycystic Ovarian Syndrome) is a common cause of anovulation. It is a syndrome in which many follicles with eggs form but do not mature properly resulting in the woman’s inability to ovulate. The woman may rarely or never ovulate. This happens, at times, because the ovaries produce an excessive amount of testosterone and androstenedione (male hormones). The physical symptoms of PCOS are hirsutism (excessive hair growth) such as on the face, irregular menstrual cycles and acne. Many times, this condition can be treated with medications such as Clomiphene (Clomid) or injectable Gonadotropins. Recently, a new method of treatment has been introduced for PCOS. This is the use of two oral medications used simultaneously: Metformin and Clomiphene Citrate. There may be side effects and the patient is usually closely monitored.
Endometriosis affects five million women in the United States and 30 – 40 percent of women with endometriosis are infertile. The cause of endometriosis is unknown although there are several theories. Endometriosis (endo) is a disease in which the endometrium (the lining of the uterus) starts to grow outside of the uterus causing adhesions. These adhesions can cause the obstruction of organs and can cause some organs to stick together. It can grow inside of the woman on the ovaries, fallopian tubes, vagina, rectum, lining of the pelvic cavity, outer surfaces of the uterus, bladder, cervix and even the vulva. On very rare occasions, it can grow outside of the abdominal cavity. Every month during the cycle the body goes through many hormonal changes that cause an increase in the lining of the uterus in preparation for a fertilized egg. During the menstrual period, hormones cause the shedding of the lining of the uterus. While these hormones affect the endometrium, in the uterus, it also affects areas where the endometriosis has migrated. It causes these areas to have the same effects as the lining of the uterus. There are four stages of endometriosis. The stages are:
- Stage I (Minimal)
- Stage II (Mild)
- Stage III (Moderate)
- Stage IV (Severe)
Stages are dependent upon how many areas and which areas are affected by the endometriosis. Endometriosis is diagnosed through laparoscopic surgery.
The most common symptom of endometriosis is pelvic pain. Other symptoms include mild to extreme pain before, during or after the menstrual period, pain during bowel movements or urination, pain during sex, bleeding from unusual places during the menstrual period such as from the rectum, nausea and vomiting during the menstrual period, and infertility. Sometimes, there are no symptoms at all. Keep in mind that a woman with Stage I (minimal) endometriosis can have severe pain and a woman with Stage IV (severe) can have little or no pain. Pain is not always an indicator of severity.
Treatment usually falls into one or both categories: Hormone Therapy and Surgery. Hormone therapy consists of Birth Control Pills, GnRH, and Danazol. These hormones are used to halt the cycle and give the endometriosis the chance to go away or lessen. Surgery is used to try to remove adhesions. Hysterectomies are sometimes recommended as an ultimate solution for endometriosis, but it can still return.
A Congenital Anomaly is a malformation of the reproductive organs. This can, at times, cause difficulty with conception or carrying a pregnancy to term. Usually an anomaly can be found during a routine pap smear. It can also be found during an Ultrasound, Hysteroscopic Exam or a Laparoscopy. Signs of this condition are recurrent miscarriages, difficulty with coitus, vaginal tampons not effective in absorbing menstrual blood, and pregnancy despite the use of IUD (Intrauterine Device).
Although Uterine Fibroids rarely cause infertility, it does occur. A fibroid is a tumor that grows from muscle tissue. A Uterine Fibroid is the result of the uterine muscle tissue growing into a mass. They can vary in size. If a fibroid grows too large or gets in the way of the reproductive organs proper functioning then it can create problems with conception. There is no sure cause of fibroids although estrogen levels do appear to play a role in the formation of them. Symptoms can consist of painful and heavy periods, disrupted urination, pressure on the abdomen and constipation. They can be diagnosed through a typical pelvic examination or through an ultrasound.
Depending on the doctor’s diagnosis the fibroid may be removed if it is creating a hindrance to conception.