Dr Anju Yadav, Senior Consultant- Fertility, Cloudnine Group of Hospitals, Gurgaon
Infertility is a common problem affecting around 10-15% of couples worldwide. Infertility can be caused by both female and malefactors. About a third of infertility problems are due to female factors and another third are due to malefactors. In remaining cases infertility may be due to problems in both partners or the cause is unclear.
What causes infertility in females?
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility.
- Disturbed ovulation: Synchronized hormonal changes occur during the menstrual cycle leading to the release of an egg from the ovary (ovulation) and the thickening of the endometrium (inner lining of the uterus) in preparation for the fertilized egg (embryo) to implant inside the uterus. When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following
- Polycystic ovary syndrome(PCOS) PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of male hormones, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility and around 70-80 % of females with PCOS face difficulty in conceiving.
- Diminished ovarian reserve or premature ovarian aging: Women are born with all of the eggs that they will ever have, and a woman’s egg count decreases over time. Diminished ovarian reserve is a condition in which there are fewer eggs remaining in the ovaries than normal. It may occur due to congenital, medical, surgical, or unexplained causes. Women with diminished ovarian reserve may be able to conceive naturally, but will produce fewer eggs in response to fertility treatments.
- Disorder of hypothalamus or pituatry : The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovarian function. Production of too much of the hormone prolactin by the pituitary gland (often as the result of a benign pituitary gland tumor), or improper function of the hypothalamus or pituitary gland, may cause a woman not to ovulate. Excessive exercise, stress, obesity or very low body weight can disturb ovulation and cause amenorrhoea (absent periods).
- Premature ovarian insufficiency: POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries stop working before she is 40 years of age. Although chemotherapy, radiothearpy and certain genetic conditions may cause POI, the cause is often unexplained.
- Menopause. Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50.
- Damage to fallopian tubes: Damage to the fallopian tubes (carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. The most common cause of tubal damage is pelvic inflammatory disease, usually caused by chlamydia and gonorrhea. Endometriosis, unsafe abortions , pelvic or abdominal surgery are also common causes of tubal factor infertility.
- Uterine causes: This includes polyps, fibroids, septum or adhesions inside the cavity of the uterus. Polyps and fibroids can form on their own at any time, whereas other abnormalities (like a septum) are present at birth. Adhesions can form after a surgery like a dilation and curettage (D&C).
- Endometriosis: Endometriosis is a condition where the lining of the uterus grows in places outside of the uterus. It causes inflammatory reaction and pelvic anatomy such as the fallopian tubes, can be distorted or damaged by scar tissue. This may make it difficult to become pregnant or increase the risk of developing an ectopic pregnancy.About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.
What increases a woman’s risk of infertility?
Female fertility is known to decline with
- Age. Aging decreases fertility because older women have fewer eggs left, the eggs are less healthy, and the woman is more likely to have health conditions that can cause fertility problems. Women over age 35 have a higher risk of having fertility issues. Aging also increases a woman’s chances of miscarriage and of having a child with a genetic abnormality.
- Excessive alcohol use.
- Extreme weight gain or loss.
- Excessive physical or emotional stress that results in amenorrhea (absent periods).
Some health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their doctor when they are trying to become pregnant:
- Irregular periods or no menstrual periods.
- Very painful periods.
- Pelvic inflammatory disease.
- Autoimmune disorders (lupus, rheumatoid arthritis, Hashimoto’s disease, thyroid gland conditions).
- More than one miscarriage.
- Past ectopic pregnancy
- H/o ovarian surgery