Female Infertility

Female Infertility

The inability of a woman to conceive after a year of having unprotected sex, or the inability of a woman to sustain pregnancy is known as infertility.

When to get Help?

You may have reason to be concerned if you have been trying to get pregnant for at least one year and:

  • You are in your late 30s and have been trying to get pregnant for six months or longer
  • Your menstrual cycles are either irregular or absent
  • You have painful periods
  • You have a known history of fertility problems
  • You have a history of pelvic inflammatory disease or endometriosis
  • You have had multiple miscarriages
  • You have been treated for cancer with drugs and radiation

What are the Causes of Female Infertility?

Infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include:

  • Problems with ovulation: Certain conditions such as polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (ovaries produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
  • Damaged fallopian tubes: Fallopian tubes carry eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
  • Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumours in the uterus can all contribute to infertility.
  • Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
  • Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
  • Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect your fertility.
  • Medications: Certain medications have been known to cause temporary infertility. Cessation of those medications can restore fertility in most of the cases.

Who is at Risk?

Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol or are overweight, obese, or underweight.

Diagnosis of Female Infertility

Female infertility can be confirmed with the following tests:

  • Blood tests measure your hormone levels and determine if you are ovulating.
  • Biopsies may be obtained to evaluate the inner lining of your uterus.
  • Ovarian reserve testing may be performed to determine the number and quality of eggs ready for ovulation.
  • Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your fallopian tubes and uterus.
  • Hysterosalpingography involves obtaining an X-ray image of your uterus and fallopian tubes after injecting a contrast material into your cervix, which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.
  • Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen to detect any abnormalities in your reproductive organs, such as the ovaries, uterus and fallopian tubes.

How is Female Infertility Treated?

Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated and placed directly into your uterus, when your ovary releases eggs to be fertilised. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilization (IVF) is a type of assisted reproductive technique that involves collecting multiple mature eggs from a woman and fertilising them with sperm outside the body, in the lab. Once fertilised, the embryos are implanted into the uterus within three to five days.

Some of the other techniques used in IVF include

  • Intracytoplasmic sperm injection, where a single healthy sperm cell is directly injected into a mature egg
  • Assisted hatching, where the outer covering of the embryo is removed to facilitate embryo implantation into the uterus
  • Using donor eggs or sperm

Gestational surrogates may also be considered if your pregnancy poses high health risks, or you have a non-functional uterus.

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