Patient's Complete Guide to Female Infertility

Overview of Female Infertility

Female infertility (خواتین بانجھ پن) or female factor infertility is the inability to get pregnant even after trying for an year. A woman is said to be infertile after facing failure to conceive for at least 12 months.

Infertility can come from several causes that affect the couple’s chances of having a child. The reasons for infertility can come from both male and female partners. When the cause of infertility is coming from the female partner, then it is termed as female factor infertility. Female infertility is responsible for almost one third of the total infertility cases.

Signs and Symptoms of Female Infertility

Primary sign of female infertility is the inability to get pregnant. However, several other signs and symptoms can indicate fertility problems. These include:

  • Irregular periods
  • No periods
  • Too long or too short menstrual cycle
  • Extremely painful periods

Types of Female Infertility

Female infertility can be broadly classified into two types, including:

  • Primary Infertility: This type of female infertility in which the female has never got pregnant.
  • Secondary Infertility: In contrast to the primary infertility, secondary female infertility occurs when the female is unable to conceive but has previously given birth.

Causes of Female Infertility

As told earlier, female infertility can come from problems in different parts of the reproductive tract. Here are  some of the prominent reasons behind female infertility.

1: Ovulation Disorders

Ovulation is the process in which one out of two ovaries releases a mature egg every month. Disorders that are associated with ovulation serve as an important reason behind the female factor infertility. Here are some of the common ovulation disorders that are important to know about. These include:

  • PCOS - PCOS or polycystic ovary syndrome is a common condition in which there are cysts in your ovaries that affect ovulation.
  • Hypothalamic Dysfunction - In this case, there is a problem with the hypothalamus function that affects the production of hormones required for normal sexual development or funciton. It affects the level of following hormones  that are responsible for egg production and release:
  • Follicle Stimulating Hormone (FSH) - required for the synthesis of egg
  • Luteinizing Hormone (LH) - plays role in release of eggs from the ovaries
  • Estrogen - required for healthy menstruation
  • Primary Ovarian Insufficiency (POI) - It is the condition in which female ovaries stop functioning before she enters her 40s. POI is mainly caused by cancer therapies, chromosomal changes, or autoimmune disorder.
  • Excess Prolactin - Prolactin is mainly responsible for the breast milk production among females. However, too much prolactin in the body can affect the levels of other hormones such as FSH resulting in female infertility.

2: Fallopian Tube Problems (Tube Infertility)

Fallopian tube problems are the next prominent cause of female infertility. Fallopian tube, also known as uterine tube or oviduct, is the tube-like structure that links ovary (site of egg production) to uterus (womb where fertilized egg is implanted). It is mainly responsible for the transport of egg from the ovary.  Any damage or blockage of the fallopian tube can result in female infertility as it prevents the egg and sperm fusion. Here are some of the causes  of fallopian tube damage.

  • Pelvic Inflammmatory Disease (PID) - Sexually transmitted bacteria infection results in the inflammtion of fallopian tubes
  • Ectopic Pregnancy - History of ectopic pregnancy (in which a fertilized egg starts growing in parts outside than your womb) can also result in scarring of fallopian tubes
  • Pelvic Surgery - Abdominal or pelvic surgery is another important reason behind the blockage of the tubes by scarring.

3: Uterine Problems

Sometimes problems with your uterus or womb can also contribute to female infertility. Here are the uterine troubles that are important to know about:

  • Uterine Polyps or Fibroids - Overgrowth of cells that are usually localized in the uterine lining (polyps) or uterine walls (fibroids) that can interfere with female fertility.
  • Abnormal Uterine Shape - Sometimes women are born with an abnormally shaped uterus that can cause infertility in later years.

4: Cervical Problems

Just like all other parts of reproductive systems, cervical problems can also contribute to female infertility. These include:

  • Cervical Stenosis - This is the narrowing of cervical opening that prevents the entry of sperms to the female body.
  • Cervical Mucus - Sometimes abnormal production of cervical mucus can also interfere the sperm entry or result in sperm damage.

5: Unknown Causes

Sometimes there is no exact known cause of female infertility and the problem could be coming from the combination of minor factors.

Risk Factors of Female Infertility

Some of the common risk factors for female infertility include:

  • Maternal Age: Fertility problems are more common in older females. This is simply because of the fact that aging reduces the quality and number of eggs in females.
  • Over Weight: Being overweight or obese can also affect your chances of getting pregnant.
  • Underweight: Just like excessive body weight, being underweight is a significant risk factor for female infertility.
  • Hormonal Imbalance: Females who suffer from the hormonal imbalance, the problem of infertility is relatively common than others.
  • Smoking: Smoking is another important risk factor of female infertility.
  • Medical Conditions: Suffering from certain medical conditions also puts you at a greater risk of suffering from female infertility.

Prevention

Female infertility, as it comes from several causes, can't be predicted and prevented. However, following good lifestyle practices can ensure your chances of a successful pregnancy. Here are some of the tips that can help you:

  • Management of body weight
  • Choosing the right foods
  • Doing physical activity
  • Quitting habits like smoking

Diagnosis

When it comes to the diagnosis of female infertility, here are some of the  common diagnostic methods that serve the purpose.

  • Medical History: Your doctor analyzes your existing and previous medical condition. A routine medical examination covers questions regarding your reproductive health, including:
  • Previous pregnancies
  • History of miscarriages
  • Vaginal bleeding patterns
  • Regularity of your menstrual health
  • History of any pelvic infection
  • Blood Tests: Next step in female infertility diagnosis comes the blood test. A series of blood tests, especially the ones that detect your hormonal levels are important in this regard. These tests are performed during different phases of your menstrual cycle. Some of the commonly performed hormonal tests include:
  • Progesterone
  • Prolactin
  • Thyroid-Stimulating Hormone (TSH)
  • FSH (Follicle Stimulating Hormone)
  • LH (Luteinizing Hormone)
  • Image Testing: Image testing helps your physician to visualize your reproductive structures such as uterus, ovaries, cervix etc. A pelvic ultrasound scan is commonly used. Sometimes other scans are also used. These include:
  • Hysteroscopy - This is the internal examination of reproductive structures done by inserting a thin tube through the vagina
  • Sonohysterogram - It is also known as saline infusion sonography, which is a special type of ultrasound in which internal images are obtained after adding saline fluid in your uterus.
  • Hysterosalpingography (HSG) - HCG is a special type of X-ray examination that helps with the visualization of the uterus and fallopian tube. In HSG, images are obtained using fluoroscopy technique resulting in better images.
  • Laparoscopy: Laparoscopy is used when image scans are not enough. Your doctor uses a viewing instrument to visualize the structures internally. Small cuts are made in the abdominal section to insert the viewing instrument.

Treatment of Female Infertility | When to Consult a Doctor

After your doctor figures out the exact cause behind female infertility he/she can recommend a variety of treatment options. Some of the common treatment options include:

1: Fertility Medications

Different types  of fertility medications can be used to treat infertility. These medicines help to stimulate ovulation by affecting the production of different types of  such as FSH and LH. to relieve the severity of pain. Some of the common fertility medications include:

  • Clomiphene - This medicine works by stimulating the production of FSH and LH hormones. This is the most commonly used medicine for infertility treatment.
  • Tamoxifen - Tamoxifen is the class of medication that helps to stimulate ovulation by blocking the estrogen receptors.
  • Metformin - This is commonly recommended for the females suffering from PCOS. Metformin works by fighting insulin resistance that increases the chances of fertility.
  • Gonadotropins - These gonadotropin medications can help to treat the infertility by inducing the egg maturation and their release at the right time. Further, these hormones can also help with the production of multiple eggs at once.

Note: Consult your doctor before taking any medication as these medicines come with side effects.

2: Lifestyle Management

Lifestyle changes can also increase the chances of becoming pregnant. Some of these changes include: These lifestyle changes include:

  • Maintenance of a healthy weight
  • Stress management
  • Supplements
  • Physical activity

3: Fertility Treatments/ Assisted Conception

A number of fertility treatments can be a ray of hope for the couples struggling with infertility. Some of these include:

  • Intrauterine Insemination (IUI): In this technique, sperms from male counterpart are directly transferred to the female reproductive tract that increases the chances of pregnancy.
  • Assisted Reproductive Technology: Assisted reproductive procedures such as  in vitro fertilization (IVF) are also very helpful. In IVF eggs and sperm are fertilized outside the female body and then the fertilized embryo is transferred to the female body for development.

4: Surgical Treatments

  • In some cases, surgical treatment options are also helpful. Structural abnormalities in the female reproductive tract are the ones treated through surgeries.
  • If none of these methods work well, then surrogacy and adoption can be the ultimate option.

Healthcare Providers

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