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What are the main causes of infertility in females?

Ovulation disorders

Fertilization and pregnancy cannot occur without ovulation, the expulsion of an egg from a mature ovarian follicle. Ovulation disorders are characterized by irregular ovulation complete absence of ovulation (anovulation).

The complete absence of menstruation (amenorrhea) or low frequency of menstruation (spaniomenorrhea) is usually an indicator of ovulation problems. However, women who have normal menstruation may also experience ovulation disorders.

Damage to the fallopian tubes

Damage to the fallopian tubes is one of the most common causes of female infertility (about 30 - 40%). The fallopian tubes must be patent (unblocked) to allow sperm to pass through to fertilization the egg and for oocyte and embryo transport to the uterus.

Various factors can cause tubal infertility, including endometriosis, infection, or adhesions that form due to surgery. An ectopic pregnancy can also damage the fallopian tubes.

Endometriosis

Endometriosis is defined as a condition in which the endometrium (uterine tissue) flourishes outside the uterus. Lesions of the endometrium can block the fallopian tubes or interfere with ovulation. This can be painful and cause damage that can lead to infertility. Statistics show that about 70% of women with endometriosis suffer from infertility.

Common symptoms of endometriosis

Common endometriosis symptoms include chronic pelvic pain, pain during menstruation, pain during sexual intercourse, and bladder or intestinal pain.

Diagnosing endometriosis

A laparoscopy and a histological (tissue biopsy) examination are needed to confirm this diagnosis.

Treatment

Treatment for endometriosis depends on the stage of the disease and other personal and biological factors, such as the desire for children, the presence of nodules or cysts. Typically, surgery is conducted, possibly in combination with hormone therapy. Endometriosis ablation increases the chances of pregnancy.

Cervical and Uterine Factors

Cervical abnormalities that can cause infertility include: cervical infections, anatomical problems and poor cervical mucus quality. Cervical mucus plays an important role in fertility by facilitating the movement of sperm through the reproductive system. Mucus varies in quantity and quality under the action of estrogen and progesterone throughout the menstrual cycle.

Infertility can also be caused by benign tumors or deep scarring of the uterine wall.

Immune Factors

Bodily immunity also plays an important role in infertility, however, it is currently difficult to diagnose and even harder to treat, partly because factors may involve both partners. For example, the woman's cervical mucus may contain anti-sperm antibodies, or the man may even produce antibodies against his own sperm.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS), which also called Stein-Leventhal syndrome, is a hormone disorder that affects between 6 to 10 percent of women.

With PCOS there is an unusual increase in androgens (male hormones) in the ovaries, which creates interference with normal egg maturation. The eggs, instead of being released during ovulation, develop into cysts, which are small fluid-filled sacs. These cysts build up in the ovaries and can increase in size.

 

Symptoms of PCOS

The most common PCOS symptoms include:

  • Total absence of menstruation (amenorrhea)
  • Irregular menstrual periods (oligomenorrhea)
  • Excessive bleeding during menstruation (polymenorrhea)
  • Infertility
  • Increased ovarian volume, with many small, painless cysts or follicles that have grown inside the ovaries
  • Thickening and darkening of the skin in the neck, armpits, groin and skin folds
  • Small growths on the skin (up to the size of a raisin) and typically appearing under the arm and around the neck
  • Loss of hair
  • Excessive hair growth on all parts of the body, including the face (hirsutism)
  • Obesity or weight gain 
  • Acne on the face and body
  • Increase in blood-sugar level

 

Causes of PCOS

Medical science does not yet know what causes PCOS. There are some scientists who speculate that high levels of bodily insulin, a hormone  that regulates blood sugar, plays a role. If the body overproduces insulin, abnormal amount of male hormones are released. 

Polycystic Ovary Syndrome may also be related to family history. There is currently no cure for PCOS, however, there are treatments that help hormonal balance or reduce symptoms such as weight gain or acne.

Early menopause

Early menopause is the premature cessation of menstruation due to the lack of follicles before the age of forty. The causes could be: radiation exposure, chemotherapy treatments, immune system diseases, excessive alcohol consumption or excessive smoking. Genetic conditions can also cause premature menopause.

Uterine Fibroids

Uterine fibroids are benign tumors on the uterine wall that may block the fallopian tubes or prevent a fertilized egg from implanting normally.

Thyroid Problems

Thyroid gland orders disturb the menstrual cycle, which can cause infertility.

Cancer Treatments

Both chemotherapy and radiation can dramatically affect female fertility.

Hyperprolactinemia

Hyperprolactinemia is a hormonal condition in which the pituitary gland produces excessive amounts of prolactin. The hormone prolactin stimulates women's milk production. Ordinarily, in women who are not pregnant, prolactin circulates in the blood in small amounts. During pregnancy and right after delivery, large amounts of prolactin are produces.

Hyperprolactinemia can cause irregular ovulation or inhibit ovulation completely, causing infertility. Women with this condition often have an irregular menstrual cycle and may also produce milk when not pregnant (galactorrhea).

Benign tumors on the pituitary gland—the gland that produces prolactin—is one of the most common causes of hyperprolactinemia. An under-active thyroid (hypothyroidism) or certain medications can cause excess prolactin production.

Unexplained infertility

Even following thorough medical examinations, a couple's infertility may still remain unexplained. Couples who have unexplained infertility for up to three years are usually considered normal. However, after three years of unexplained infertility, the chances of natural conception decrease considerably. At that point, if a couple wants to have a child, they should begin assisted reproductive methods without additional delay.

Additional reading: other factors

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