Causes of Female Infertility

 

 

Ovulatory disorders

The most common cause for female infertility is ovulatory disorders. Without ovulation, fertilization and pregnancy cannot occur. Ovulatory disorders are characterized by anovulation (complete failure to ovulate) or infrequent and/or irregular ovulation. These account for approximately 20-30% of female infertility.

Ovulatory disorders are often the result of hormone imbalances.

  • Polycystic ovarian disease (PCOD, a condition commonly characterized by hirsutism, obesity, menstrual abnormalities, infertility, and enlarged ovaries; thought to reflect excessive androgen secretion of ovarian origin)
  • Malfunction of the hypothalamus, pituitary or adrenal gland is often responsible.
  • Reasons for anovulation also include damage to the ovaries themselves (previous surgery resulting in scar tissue formation for example)
  • Premature menopause with follicle problems (the follicle fails to rupture and release the egg)
  • Hyperprolactinaemia (condition of increased levels of prolactin hormone in the blood). Hyperprolactinaemia is associated with infertility as it has an inhibitory effect on cyclical ovarian function, probably due to direct inhibition of GnRH secretion.

The WHO has adopted a treatment-orientated classification of anovulating patients:
Group I patients have hypothalamic-pituitary failure. They are amenorrheic and lack both FSH and LH;

Group II patients have hypothalamic-pituitary dysfunction and present with a variety of cycle disorders including amenorrhoea, oligomenorrhoea and luteal phase deficiencies. About 97% of anovulatory patients fall into this group, including PCOD, which is thought to be the most common cause of ovarian dysfunction.

Abnormal oocytes may be one of the reasons for infertility.

Causes of infertility

The above abnormal oocytes were obtained in patients with long standing infertility with 5 – 6 failed IUI cycles.

 

Ovarian cyst

Ovarian cyst, endometiotic cyst or polycystic ovarian diseases are other ovarian causes for anovulatory infertility


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Surgery itself can create abdominal adhesions and scar tissue that can also damage the fallopian tubes.



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Thick tubes with adhesions


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Various tubal pathologies shown above may result in infertility

 

Uterine and cervical disorders Fibroid

Abnormalities of the uterus such as fibroids, and polyps (acting like intrauterine contraceptive devices - IUCD) can contribute to infertility by causing damage to the uterine wall. Uterine abnormalities like septate or unicornuate or bicornuate uterus may also result in subfertility. Many times we come across intrauterine adhesions or sclerotic endometrium, which may be due to the involvement of endometrium by infection or tuberculosis. Likewise, abnormalities of the cervix or the cervical mucus can reduce fertility. Mechanical problems account for between 20% and 30% of female infertility.


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Cervical factor

1. Altered cervical mucus
2. Increased cell-mediated immunity


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Endometriosis

Endometriosis, is a common condition in the reproductive age group, & may be associated with a high incidence of infertility (approximately 70% of sufferers experience infertility) Endometriosis is a condition whereby endometrial tissue grows outside the uterus. Endometriotic lesions can cause blocked fallopian tubes and/or impaired ovulatory function, adhesion formation with alteration of tubo-ovarian anatomy.


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Immunological factors such as antibodies to the man's sperm within cervical mucus can cause infertility. There is much that is still not fully understood within this area making treatment difficult.

Endometriosis & hyperprolactinaemia account for approximately 10 - 20% of female infertility.

 

Pelvic inflammatory disorder

Infection of the pelvis may result in adhesion formation that can distort the tubal & ovarian anatomy thus preventing the egg pick up & transportation resulting in infertility. It could be either due to bacterial or tubercular infection.


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Pelvic Adhesions to uterus, tubes ovaries, pouch of douglas & abdominal wall

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