Female Infertility
Female infertility refers to all those factors in the female partner which leads to infertility. Female infertility is responsible for about 1/3rd of the total cases of infertility.
Causes of female infertility can be grouped into one of the four categories:
Ovulation problems
Tubal problems
Impaired egg production
Disorders of implantation
Ovulation Problems
Ovulation problems can arise as a result of defects in the hypothalamus, the pituitary or the ovary. Factors that disrupt the normal pulsatile release of GnRH will lead to disordered ovulation. These factors include stress, psychological disturbances, weight change and systemic diseases as well as tumours and structural lesions in the hypothalamus. Both hyperthyroidism and hypothyroidism may result in ovulatory failure and will if severe lead to anovulation and amenorrhoea. Hyperprolactinaemia (a condition associated with high levels of prolactin in blood and a tumour in the pituitary gland), renal failure, hepatic dysfunction and some medication impair the pulsatile release of GnRH, leading to anovulation.
The commonest cause of anovulatory subfertility is polycystic ovary syndrome (peOS). Women affected by this condition have a range of symptoms that may occur singly or in combination and include menstrual cycle disturbances, obesity, hirsutism, acne and infertility.
Premature ovarian failure is a condition in which there is total failure of the ovaries in women under the age of 40 years. This condition is seen in 1 per cent of the female population. The aetiology is often not determined but can be linked to genetic causes, especially if ovarian failure occurs before puberty. Other causes include damage by viruses and toxins, pelvic irradiation, chemotherapy and auto immune disease.
Tubal Factors
The fallopian tubes transport the egg released from the ovary to uterus. Theses tubes are commonly damaged by infections, including tuberculosis, Chlamydia, gonococci and pelvic sepsis. Other causes of tubal dysfunction are endometriosis and pelvic surgery. Damage to the tubes causes impairment of tubal pick up of the egg thus leading to infertility.
Disorders of Implantation
There may be causes related to the endometrial lining of the uterus that leads to problem with implantation. Sub mucous fibroids may cause infertility due to this reason Smoking is known to reduce fertility by two-thirds, but other environmental and psychological factors can also have an impact on conception.
Investigation Of Female Infertility
As mentioned in the causes female infertility can be sub divided into four types. Hence while working up a case of female infertility all these four causes be looked for and ruled out.
Investigation which are most commonly done include hormonal assays of sex hormones as well as thyroid. Ovulation studies also need to be done to see if ovulation is occurring or not. Ovulation is inferred from either ultrasound findings or through a hormonal assay for progesterone with the sample taken seven days before your next menstrual period. In women with irregular menstrual cycles, prolactin level and androgen levels should be analysed to look for any underlying endocrine abnormalities.
Tests of Fallopian tube patency all rely on the visualization of solutions passing through the tubes into the abdominal cavity. The three commonly used techniques of visualization are ultrasound scan, X-ray and direct visualization at laparoscopy.
Hysterosalpingograms: (an X-ray exam of your uterus with a radio-opaque dye injected into your uterus through a small urine tube) are used in women with no history of pelvic damage or infection. The X-ray image obtained shows the uterine cavity, the outline of the Fallopian tubes and the presence or absence of dye in the abdominal cavity. When dye is seen to flow freely into the abdominal cavity, tubal patency is confirmed. However, if the dye spill appears to be loculated or the tube appears to be in an abnormal position, peri-tubal adhesions are likely to be present: Uterine adhesions and sub mucous fibroids appear as filling defects on the X-ray image and require further assessment by hysteroscopy.
Hysteroscopy is direct visualisation of the uterus cavity by means of a scope. It can define any adhesions(bands of fibrous tissue which fills up the insides of the uterus)or sub mucous fibroids.
Using these investigations judiciously will enable us to reach a conclusion about the causes of infertility and accordingly initiate treatment.
For Natural Treatment For Infertility Click here