Female Factor Infertility
Approximately 30 percent of infertility cases are female factor infertility. However, because the female reproductive system is more complex and less accessible than that of the male, diagnosis and treatment in women can be more difficult. While age is still the most important factor when dealing with female infertility, reproductive conditions can also be a factor. These conditions can affect the ovaries, uterus, fallopian tubes, and other associated organs can interfere with ovulation, fertilization, or implantation. While some women are diagnosed with a reproductive condition in their teens or early twenties, others are unaware of the problem until they try to become pregnant. During a female infertility assessment, certain symptoms or a family history will indicate testing for a reproductive condition. Two of the most common reproductive conditions are endometriosis and polycystic ovarian syndrome.
Age is the most important factor when dealing with female infertility. With advancing age, many biological changes take place that work against conceiving and carrying a pregnancy. It is common for women over the age of 35 to suffer from age-related infertility as their egg reserve declines and hormonal changes make conception and pregnancy more difficult. Unlike some types of female infertility, age-related infertility is progressive. After age 40, there is another sharp decline in the ability to conceive. Women in this age range wishing to conceive should seek treatment as soon as possible.
To understand age-related infertility further, it is important to understand that unlike males, every woman has her lifetime complement of eggs at birth. The total number of eggs at birth is between 1-2 million and by puberty this number has decreased to approximately 300,000. Only 1% of these eggs will be ovulated with the vast majority being reabsorbed by the body. The loss of eggs accelerates as a woman enters her mid to late 30’s and this coincides with her decreased pregnancy potential. Egg quality is also compromised as a woman ages and this may impair the eggs ability to be fertilized by a sperm. As a woman ages the chance of miscarriage and chromosomal abnormalities, such as those that cause Down’s Syndrome, also increase. Even the success of in vitro fertilization decreases with advancing age. Women with age related infertility wishing to conceive with their own eggs should consider using Pre-implantation Genetic Screening (PGS) with IVF treatment. PGS can test embryos for chromosomal abnormalities before they are implanted into the uterus.
Endometriosis is a common condition that can cause female infertility. Endometriosis is a condition that occurs when tissue found in the uterine lining (called endometrial tissue) grows outside your uterus, usually in the abdominal-pelvic cavity. Some women have no symptoms of endometriosis while others experience severe menstrual cramps and other pelvic pain, fatigue, and abnormal menstrual bleeding.
The endometrial tissue inside and outside of your uterus responds to your menstrual cycle hormones in a similar way – it swells and thickens, then sheds to mark the beginning of the next cycle. Unlike the menstrual blood from your uterus that is discharged through your vagina, the blood from the endometrial tissue in your abdominal cavity has no place to go. Inflammation occurs in the areas where the blood pools, forming scar tissue. Scar tissue can block the fallopian tubes or interfere with ovulation which can result in infertility.
Endometriosis is often hereditary and is considered to be a progressive condition. Depending on the severity of the problem, endometriosis may be treated with surgery, medication, or both.
Anovulation (irregular or absent ovulation) may be the result of premature ovarian failure, polycystic ovarian syndrome, or a different type of hormonal imbalance. Women who have this disorder may not menstruate for several months. Others may menstruate even though they are not ovulating. Although anovulation may result from hormonal imbalances, eating disorders, and other medical disorders, the cause is often unknown. Depending on the severity and source of the problem, ovulation disorders can be among the easiest or most difficult types of female infertility to treat. Quite often, fertility medications can be administered to stimulate the ovaries to produce eggs again.
Polycystic ovarian syndrome (PCOS) is caused by hormonal imbalances that prevent ovulation. Your body produces too much of some hormones and not enough of others. Rather than a single ovarian follicle developing and releasing a mature egg each cycle, multiple ovarian cysts form but do not release any eggs. Common symptoms of polycystic ovarian syndrome include irregular menstruation and signs of hyperandrogenism, such as excess body hair, acne, and thinning hair on the head.
While polycystic ovarian syndrome cannot be cured, its effects can be minimized with long-term treatment. To overcome female infertility due to PCOS, clomiphene citrate is usually prescribed to restore normal ovulation.
Obesity can have a great effect on PCOS. Nutritional changes and weight loss can often correct the body’s hormone levels and help restore the natural functioning of the ovaries
One of the many causes of infertility is tubal disease, in which a woman’s fallopian tubes become blocked or damaged. Blocked or damaged fallopian tubes prevent your partner’s sperm from getting to your egg, and prevent the fertilized egg from getting to your uterus. Scar tissue resulting from endometriosis or abdominal or gynecological surgery can cause tubal blockage. Infections, such as chlamydia, can damage the cilia (tiny hairs lining the fallopian tubes) that help to transport the egg.
Infertility can also be caused by problems in the uterine cavity such as fibroids, polyps, scarring, and an abnormally shaped uterus. Fibroids are non-cancerous tumors of the uterine muscle. The size and location of the fibroid are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function. A polyp is a non-cancerous overgrowth of tissue in the lining (endometrium) of the uterus. They are basically normal tissue, but growing in an abnormal formation. Many polyps are very small and do not represent a compromise to reproductive capabilities. However, large or multiple polyps can interfere with reproduction by causing infertility, or by increasing risks for miscarriage. Both fibroids and polyps can be removed rather easily through surgery.
Hormones are one of the body’s great communication networks used to regulate growth, reproduction, and other processes. When too much or too little of any given hormone is produced these processes are not carried out correctly and problems arise. Common hormonal imbalances that affect fertility are Polycystic Ovarian Syndrome, Hyperprolactinemia, and Hypothalamic amenorrhea. A hormonal imbalance can cause female infertility by disrupting ovulation, preventing the thickening of the uterine lining, or otherwise preventing a pregnancy from becoming established. Fortunately, once identified, a hormonal imbalance can usually be corrected through medication, lifestyle or dietary changes, or a combination of both.
If you would like to learn about egg freezing, please click here.