If pregnancy does not occur despite regular and unprotected sexual intercourse during 12 ovulation cycles, this is called infertility. Although this 1-year period is an important criterion to talk about infertility, 12 months should be reduced to 6 months if the age of women is 35 and over. The absence of pregnancy is not the only factor in infertility, recurrent miscarriages can also be an aspect of infertility.
Infertility is extremely common. It is estimated that about 1 out of every 6 couples cannot have children. Infertility, which can be female-induced, male-induced or both female and male-induced, is a health problem that can be extremely complex, and although it is possible to diagnose it with advanced diagnostic methods, in some cases the cause cannot be determined.
Therefore, having a general knowledge about the female reproductive system makes it easier to understand what female-induced infertility is.
Women, unlike men, are born with all their egg reserves. Every 21-35 days starting from puberty, the egg cell in the ovaries matures, the follicle in which the maturing egg is located cracks, and the egg moves to the fallopian tubes. Fertilization can occur if it encounters sperm in the fallopian tubes. In the absence of fertilization, the egg continues to move towards the uterus and, together with the thickening uterine membrane, is thrown vaginally out of the body, which is what is called a menstrual period.
Female-induced infertility occurs as a result of a problem or disruption that can be experienced in this cycle. These problems lead us to the question “What are the causes of female-induced infertility?".
In a multinational study conducted by the World Health Organization, it was found that in 37% of infertile couples, infertility was caused by women. The same study also examined the most common and identifiable factors of female infertility. Ovulation disorders were diagnosed in 25% of the infertile women participated in the study, endometriosis in 15%, pelvic adhesions in 12%, tube obstructions in 11%, tube and uterus disorders other than obstruction in 11% and hyperprolactinemia (excessive prolactin hormone) in 7%.
The results of many studies have similar findings. It is possible to list the common causes of infertility in women as follows:
In the process that continues from puberty to menopause, ovulation, which usually occurs once a month, about two weeks before the next menstrual period, can last 16 – 32 hours. Ovulation, which results in the maturation of the egg cell in the ovaries, rupture of the follicle and the progression of the egg to the fallopian tubes, occurs thanks to hormones released by the hypothalamus and pituitary gland of the brain. Hormonal problems can lead to menstrual irregularities, and this condition is one of the obstacles to pregnancy.
There may be various reasons behind ovulation problems, which are encountered in as high as 40% of female infertility diagnoses. Various factors such as primary ovarian failure, Polycystic Ovary Syndrome (PCOS), decreased egg reserve and/or decreased egg quality due to aging, hormonal causes and lifestyle choices as just mentioned, can lead to ovulation problems and infertility.
Structural problems in the female reproductive system are among the causes of infertility in women. These refer to anomalies in the fallopian tubes and/or uterus.
For example, the presence of a blockage in the fallopian tubes can make it physically impossible for the egg to travel to the uterus and meet the sperm after ovulation. At the same time, structural anomalies in the uterus may prevent embryo implantation. We can list the structural problems associated with infertility in the female reproductive system as follows:
Endometriosis: Endometriosis, which affects the uterus to which the embryo attaches and the fetus grows, is a disease characterized by the growth of the tissue covering the uterus, usually in the ovaries, fallopian tubes, behind the uterus, in the intestines or in the bladder. It can lead to severe menstrual pain, severe bleeding and infertility.
Tube Obstructions: The female reproductive organs that connect the ovaries and the uterus are called the fallopian tubes. Their main task is to carry the egg released from the ovaries to the uterus. As a result of obstruction of the tubes due to scar tissue, pelvic adhesions, sexually transmitted diseases, history of ectopic pregnancy, pelvic inflammatory disease, hydrosalpinx, infections or endometriosis, it would not bee physiologically possible for sperm to meet the egg or for the egg to advance to the uterus.
Uterine Fibroids: They are the most common benign tumors found in women of reproductive age. Although the causes of these structures, which can be seen around the uterine wall or in the uterus and may consist of muscles and different tissues, are not known with certainty, being overweight or racial characteristics are among the risk factors. They may cause complications such as premature labor, recurrent miscarriages, infertility.
Polyps: These are non-cancerous growths on the inner surface of the uterus. Depending on the size and location of polyps, they can affect the function of the uterus and it is possible for them to prevent the formation of pregnancy.
Among the structural problems of the reproductive system that can cause infertility in women are anomalies in the shape of the uterus. Structural differentiation of the uterus may be an obstacle for embryo implantation and the continuity of pregnancy. At the same time, scar formations in the uterus due to injuries, infections and surgical interventions can increase the risk of miscarriage and turn into a cause of infertility by preventing implantation.
Apart from all these causes of female-induced infertility, there are many other risk factors that can increase the risk of female-induced infertility.
Many different factors may play a role in the increased risk of female-induced infertility:
As all women are born with all their egg reserves, the probability of pregnancy decreases as they age. An extremely common risk factor in female infertility, advancing age is associated with a decrease in the number of eggs, decreased egg quality and other health problems.
In a study conducted by the National Survey of Family Growth in the United States with the participation of 12 thousand women, it has been revealed that,
It has been shown that infertility rates may vary depending on environmental and socio-economic factors, and that female-induced infertility rates are higher in Eastern Europe, North Africa and the Middle East.
For a woman under 35 years of age, if pregnancy does not occur despite regular unprotected sexual intercourse for 12 months, it is necessary to undergo an examination by obstetricians and gynecologists. When you are in between 35 and 49, a 6 months of trial is necessary before consulting to a physician.
The diagnosis of infertility is not a process in which the causes are sought after only for the female part of the equation. Couples should be evaluated simultaneously and in line with the results obtained, couple-specific treatment planning should be made.
Various tests and imaging methods can be used to evaluate infertility in women.
A complete physical examination, PAP Smear test, pelvic examination, pelvic ultrasound and breast examination are performed as the first steps. In addition to all these, it may be necessary to resort to blood tests and various imaging methods.
Blood Tests: The type of laboratory tests to be performed can be selected according to medical history and physician preference. Thyroid tests, ovarian reserve tests, and hormone tests are among the blood tests that are often performed.
HSG: During hysterosalpingography, X-rays are taken by performing an injection of contrast-enhanced fluid into the uterus to investigate the presence of problems in the uterus. It is also possible to diagnose possible blockages in the fallopian tubes during this test. In addition to HSG, it may be necessary to perform a sono-hysterogram or hysteroscopy.
Ovarian Reserve Test: It is the test that helps to determine the quantity and quality of eggs for ovulation. In this context, FSH, Estradiol and AMH (Antimullerian hormone) blood tests can be performed.
After the examinations, it is also possible to resort to laparoscopy and genetic tests.
Infertility treatment in women can be planned in various ways in line with the results of the tests and imaging methods used. These are:
As a result of the evaluation of couples together, it is possible to recommend intrauterine insemination or IVF treatments. Thanks to the developing medical technologies, it is possible to obtain extremely successful results with assisted reproductive techniques which are specific for the couple. The results of the tests, the time frame in which the couple tried to have a baby, the age of the patients, the overall health of the couple and their preferences play a role in shaping the treatment process.
1 https://medlineplus.gov/femaleinfertility.html
2 https://americanpregnancy.org/getting-pregnant/female-infertility/
3 https://www.ncbi.nlm.nih.gov/books/NBK556033/
4 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/infertility-in-women
5 https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female
6 https://www.healthline.com/health/womens-health/blocked-fallopian-tubes#pregnancy
7 https://www.cdc.gov/reproductivehealth/womensrh/healthconcerns.html
8 https://www.ncbi.nlm.nih.gov/books/NBK556033/#
9 https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313
10 https://www.womenshealth.gov/a-z-topics/infertility
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