Causes of Female Infertility

There might be different reasons for female infertility.

To touch briefly on those reasons:

Poor Functioning Ovaries

Anovulation (Lack of Ovulation): Many factors might lead to ovulatory dysfunction in women. Hormonal disorders, polycystic ovarian syndrome (PCOS), early menopause, over-exercise, an irregular diet, smoking and drinking alcohol might affect ovulation.

Polycystic Ovarian Syndrome (PCOS):  Polycystic ovarian syndrome is a condition that progresses with anovulation (lack of ovulation) and infertility, hairing, pimples, late periods and menstrual irregularity arising due to anovulation. Polycystic means “a high number of cysts” and is used to define this condition. It is called a syndrome because it is observed as a a group of symptoms (a group of symptoms=syndrome) such as hairing, menstrual irregularity and increased body weight. The problem in 70% of women having ovulatory dysfunction induced infertility problem is PCOS. This condition is more apparent in fat patients. The first thing that must be done by women with PCOS who would like to have a child is to lose weight. A weight loss of around 5% is usually sufficient for ovulation to start. The first among follicle stimulating medications that must be tried by patients with PCOS is clomiphene citrate. This medication is taken in care of a doctor. Two main approaches come into question if clomiphene citrate fails. The first one is to stimulate the ovaries with hormones and then carry out insemination. Success rates reaching up to 62% have been reported with this treatment. The most important complication of this treatment is the hyperarousal of the ovaries and multiple pregnancies.

The treatment must be administered extremely captiously, under close follow-up and by doctors having full knowledge of the issue. The second alternative is laparoscopic diathermy (LOD). Here, abdomen is entered into via laparoscopy and small holes are made on the ovaries by etching them with actual cautery or laser. The mechanism of the treatment is not known but it is observed to ensure ovulation and improve the response to clomiphene. Rates of spontaneous pregnancy within the 12 months following LOD are between 60 and 80%. Success of LOD is higher in those with a infertility period of less than 3 years and LH levels higher than 10. Surgical treatment must be administered as the last option in special conditions.

Problems relating to the tubes:

Clogged Tubes : Any adhesion or clogging in the tubes might prevent pregnancy as this will prevent the egg cell from reaching the uterus. Damages to the tubes might be due to previous operations, ectopic pregnancy, endometriosis and previous infectious diseases. Hydrosalphinx : Tubes are the structures ensuring the passage between the uterus and the ovaries. Closing of one or two of the tubes on the right or left sides due to inflammation or adhesion might lead to fluid accumulation. The tubes enlarge as a result of fluid accumulation. This condition is called hydrosalphinx, in other words, the tube is filled with fluid. In these patients, it would be appropriate to remove or close the tubes filled with fluid.

Structural defects, adhesions or tumors in the uterus

Endometriosis : Endometriosis is a disease observed in women in the reproductive age. Presence of the cells that are normally in the endometrium layer lining the intra uterine in other parts of the body outside the uterus   is called  endometriosis. Infertility is observed in 30-40% of patients with endometriosis.

Myoma : Myoma are nonmalignant tumors that develop from the smooth muscle tissue of the uterus. Myoma are observed most frequently between the ages of 25 and 35. Myoma might render it difficult for women to become pregnant or for the uterus to carry the pregnancy after the woman becomes pregnant.

Age Factor

When does fertility start to get impaired?:

Fertility is impaired as we age. Quality and number of egg cells start decreasing as we get older. Such decrease accelerates after the age of 35. Infertility problem exists in one out of three women over 35 and in two out of three women over the age of 40.

Why does fertility decrease with age?: The number and quality of the egg cells in the ovaries decreases directly as we get older. While women have a certain number of egg cells at birth, such number decreases slowly in childhood and women start ovulating every month starting from adolescence and such decrease continues until menopause. Quality of the egg cells, on the other hand, decrease with age. Egg cells that are not inseminated and that do not settle into the uterus are removed by the body via absorption.

How is the decrease in fertility understood?: Information about fertility can be obtained thanks to the hormone tests performed in specific periods of menstrual flow. Ovarian reserve is assessed by checking the levels of FSH and estradiol hormones in blood on the 3rd day of menstrual flow.

If the levels of these hormones are identified to be high, a decrease in the pregnancy rates is in question. Another test performed to assess ovarian reserve is the clomiphene citrate withdrawal test. Levels of FSH hormone before and after giving clomiphene citrate are checked. Clomiphene citrate normally stimulates FSH and LH1 increasing the FSH and LH levels in blood. FSH levels exceeding a certain value are indicators of poor prognosis.

Metabolic and hormonal reasons

Sexual Intercourse When The Probability of Falling Pregnant Is Very Low

Unexplained Infertility (Smoking, weight etc)

Results of all examinations turn out to be normal in some infertile patients. Pregnancy does not occur in these couples although examinations show that there is ovulation, the uterina tubes are open and spermiogramme is normal. This group is called the unexplained infertility group. 10-15% of all infertile couples belong to this group.

Smoking : Smoking not only leads to a decrease in estrogen by having an adverse effect on the cells of the ovaries that secrete estrogen but also cause ovaries to be more inclined to genetic abnormalities. Furthermore, it leads to early menopause by causing early ovarian insufficiency and depletion of reserves. Toxic effects of smoking come into question in pregnant women, as well, and might lead to low birth weight babies, preterm delivery and miscarriage.

Weight : Weight of the woman is another factor affecting fertility. Weight increase or decrease affects fertility. It might lead to ovulation disorders and menstrual irregularities by affecting hormone secretion if weight drops below 10-15 percentile. Athletic women, women who dance professionally or over-exercise or those who have a low calorie diet or bad eating habits are considered to be in the risky group. It is reported that a high amount of estrogen secreted from excessive fatty tissues in those with a weight increase of over 10-15 percentile also affect fertility and that ovulating problems develop again in these women as a result of increasing serum insulin levels.

Venereal Diseases: Genital tract infections might sometimes cause clogging of the tubes by progressing up to the tubes.