Female infertility, also known as female sterility, refers to the absence of pregnancy due to reasons originating from the woman during the process of couples trying to conceive. In this article, we will discuss the causes and treatment options of female infertility in detail.
What are the main causes of female infertility?
Ovulation disorders
Having regular menstruation accompanied by premenstrual symptoms (such as breast tenderness, edema in the body) is sufficient for ovulation to occur in a woman. According to the World Health Organization, ovulation disorders account for approximately 25% of infertility causes. When menstruation is irregular, ovulation should be suspected if menstrual cycles are less than 21 days or longer than 35 days.
Ovulation usually occurs about 14 days before the onset of menstruation. Ovulation can be detected by the serum progesterone level obtained in the mid-luteal phase approximately 1 week before the expected menstruation. The most common cause of ovulation problems is polycystic ovary syndrome (PCOS). Obesity itself is associated with the absence of ovulation except for PCOS. In women with a body mass index (calculated by dividing weight in kilograms by the square of height in meters) greater than 27, the risk of infertility due to the absence of ovulation is 3 times higher compared to women with a normal range of body mass index.
Other causes include thyroid disease (2–3%), pituitary disease such as prolactin elevation (13%), androgen elevation due to adrenal hyperplasia or adrenal tumor (2%), unexplained chronic anovulation (7-8%), and functional hypothalamic amenorrhea (e.g., excessive weight loss, eating disorders, and excessive exercise).
Blockage in the Fallopian Tubes
Blockage in the fallopian tubes is observed in 11% to 67% of infertility cases among women. Sexually transmitted infections (the most common cause of tube disease), cervical infections, having undergone abdominal surgery, or having previously experienced intra-abdominal infections (e.g., ruptured appendix) can lead to blockage in the fallopian tubes in women.
Hysterosalpingography (HSG), a method in which a radiopaque substance (soluble in oil or water) is injected from the cervix into the uterine cavity to evaluate its passage through the tubes, is an important diagnostic method for determining tubal blockage.
In HSG, in women where hydrosalpinx (fluid-filled tubes, typically due to a long-standing untreated infection) is detected, consideration should be given to either ligating or removing the tube with hydrosalpinx through laparoscopy before undergoing IVF treatment. Performing this surgery before transferring embryos into the uterus during IVF treatments is an approach that increases the pregnancy rate.
Endometriosis
Endometriosis is the presence of endometrial tissue outside the uterine cavity and affects 25% to 40% of women with infertility. Endometriosis is a chronic condition characterized by intra-abdominal adhesions. It can lead to adhesions in the fallopian tubes or around the tubes, preventing the egg from being taken up by the tubes or causing ovarian cysts such as endometriomas, leading to both a decrease in egg reserve and impaired egg quality.
Additionally, data on whether endometriosis affects embryo implantation are contradictory. Although laparoscopic surgery for endometriosis improves spontaneous pregnancy rates in the first 6 months after surgery, the chances of pregnancy decrease over time.
Diminished Ovarian Reserve
The decline in fertility with age occurs partly due to a decrease in follicles, i.e., egg count, and a deterioration in the quality of the female germ cell with age. Other risk factors for diminished ovarian reserve include a history of ovarian surgery, chemotherapy, radiation therapy to the ovaries, a family history of early menopause, or a mutation in the Fragile X (FMR1) gene.
Ovarian reserve can be assessed by anti-Müllerian hormone (AMH) or egg count on ultrasound.
Uterine and Uterine Canal Factors
Uterine abnormalities are associated with adverse pregnancy outcomes such as miscarriage and preterm birth. Factors disrupting the uterine cavity include uterine polyps, fibroids, intrauterine adhesions, and congenital uterine anomalies. If uterine anomalies are suspected, further evaluation may be necessary with pelvic magnetic resonance imaging (MRI) or 3-dimensional ultrasound.
Anatomical abnormalities in the uterine canal that hinder the progression of sperm towards the uterine cavity, and obstructions following past surgeries, can also cause infertility in women. Congenital cervical anomalies are rare (1/80,000). Obstruction in the uterine canal may occur as a result of a previous surgery (e.g., in women with precursor lesions detected during cervical cancer screening and who have undergone shaving of the cervix or cone-shaped removal of the cervix).
Treatment Options
Treatment options for female infertility can vary depending on each individual’s situation and needs. Therefore, it is important to consult with a specialist to determine the most appropriate treatment option. These options include medications, surgical interventions, in vitro fertilization (IVF), and assisted reproductive techniques.
– Medications: Medications can be used to correct hormonal imbalances in the treatment of female infertility. These drugs can stimulate ovulation or help correct hormonal imbalances.
– Surgical interventions: Surgical interventions may be necessary in some infertility cases. For example, ovarian cysts or tubal blockages can be corrected surgically to increase the woman’s chances of becoming pregnant. Ovarian cysts are fluid-filled sacs that form in the ovaries. These cysts can affect the normal function of the ovaries and make the process of getting pregnant more difficult. These cysts can be removed surgically to ensure the healthy functioning of the ovaries. Tubal blockages are also a common cause of female infertility. The fallopian tubes allow the fertilized egg to reach the uterus. However, blockages in the fallopian tubes can prevent this process. Tubal blockages can be corrected surgically, allowing for the fertilized egg to reach the uterus. However, surgery may not be necessary in every case, and the treatment plan may vary depending on the individual situation. Therefore, consulting with a specialist is important.
– In vitro fertilization (IVF): IVF treatment is a commonly used method in infertility treatment. In this treatment, embryos are created in a laboratory setting and then transferred to the uterus of the prospective mother. In IVF treatment, egg cells are first collected from the prospective mother. These cells are then combined with the partner’s sperm in a laboratory setting. After fertilization, the embryos develop in a laboratory setting for several days and are then transferred to the prospective mother’s uterus on day 3 or day 5. The success rate of IVF treatment depends on many factors. Factors such as the age of the prospective mother, egg and sperm quality, and uterine health can affect the success of the treatment. However, IVF treatment is a highly advanced method today and offers successful results for many couples.
Female infertility, also known as female sterility, refers to the absence of pregnancy due to reasons originating from the woman during the process of couples trying to conceive.
There can be many causes of female infertility. Factors such as hormonal imbalances, ovarian problems, tubal blockages, and uterine anomalies can lead to infertility. Additionally, lifestyle factors such as age, stress, obesity, and smoking can increase the risk of infertility by reducing ovarian reserve and egg quality.
With age, there is a significant decrease in ovarian reserve. Chromosomal segregation errors during meiotic division become increasingly common with age, leading to the production of eggs with an incorrect number of chromosomes, resulting in impaired embryo quality and an increased risk of birth defects and miscarriages. Additionally, the likelihood of conditions that can negatively affect fertility, such as fibroids or endometriosis, increases with advancing age. This decline in fertility due to age becomes more rapid after the age of 37.
Women under the age of 35 should be evaluated after 1 year of attempting pregnancy. Women over the age of 35 should be evaluated after 6 months, and women aged 40 and above should consider urgent evaluation. However, women experiencing painful periods or with endometriosis, those with irregular menstrual cycles, or a history of pelvic inflammatory disease should be evaluated earlier.
The treatment of female infertility can vary depending on the underlying causes. Treatment options include medications, surgical interventions, intrauterine insemination, and assisted reproductive techniques such as in vitro fertilization (IVF). The treatment plan is determined by a specialist on an individual basis, aiming to utilize the most effective methods.
Hormonal imbalances are common causes of infertility, especially conditions like polycystic ovary syndrome (PCOS) and thyroid problems. Often, medication therapy can be attempted. However, if this is not sufficient, treatment with assisted reproductive techniques can increase the chances of pregnancy. The treatment process is planned based on hormonal tests and evaluations conducted by your doctor.
IVF is a commonly used method in the treatment of infertility. This treatment involves a process where, following approximately 10 days of medication, eggs are retrieved under mild anesthesia and then fertilized with the partner’s sperm using the microinjection method in a laboratory setting. After fertilization, the development of embryos is monitored in the laboratory, and at the appropriate time, they are transferred to the uterus of the female partner.
By filling out the form, you can make an appointment with Gynecology and Obstetrics Specialist Prof. Dr. Ebru Çöğendez.
IVF treatment prices usually include factors such as tests, medications, laboratory procedures, doctor examinations, etc. during the treatment process.
IVF treatment is applied to couples who are determined by taking certain factors into consideration.
Factors such as age, health status, choice of treatment center and treatment process can affect success rates.
The stages of IVF treatment usually consist of four main stages. The first stage is the preparation stage.
As with any medical intervention, IVF treatment has potential risks and possible complications.
