Infertility is defined as inability of a couple to become pregnant after one year of regular, unprotected intercourse. Regular here means at least three times a week and unprotected means no barrier methods such as condoms.  Couples are often confronted with Infertility and one way to know who among the two of them is infertile is by going for fertility tests. The rate of infertility is on the increase and is more common in women than men and about two-third of infertility cases affects women.

CAUSES OF INFERTILITY IN WOMEN

Infertility usually results from conditions that prevent ovulation, fertilization and/or implantation. These conditions are directly related to hormonal imbalance, fallopian tubes damage and problems within the uterus. More specific causes of infertility in women include:

Polycystic ovary syndrome (PCOS)

PCOS is the leading cause of infertility among women. It is characterized by hormonal imbalance in which the sex hormone are out of balance. A woman with PCOS rarely ovulates and will have problem conceiving. The defining features of PCOS are menstrual irregularities, masculine appearance and infertility.

Pelvic inflammatory disease (PID)

PID is the infection of the pelvic area most importantly the uterus including the fallopian tubes. PID is a complication of untreated and poorly treated sexually transmitted infections.  PID can affect the fallopian tubes causing adhesion and blockage.  When eggs are released they are fertilized in the fallopian and transported down to the uterus for implantation  but when the fallopian tubes is blocked,  fertilization may not occur or even the fertilized egg may be trapped down preventing implantation.

Scar and adhesion

Previous obstetrical surgeries and invasive procedures that leave scars in the uterus or that caused adhesion can prevent implantation and cause infertility.

Abnormal cervical mucus

Abnormal cervical secretions can prevent sperm from swimming to the fallopian tubes for fertilization thereby preventing conception.

Other possible causes of infertility in women are:

  • Previous ectopic pregnancy
  • Endometrosis
  • Premature ovary failure
  • Hyperprolactinaemia

 

DIAGNOSIS OF FEMALE INFERTILITY

A woman is said to be infertile is she fails to conceive after one year of regular and unprotected sexual intercourse with fertile male(s) .  The diagnosis of infertility can be as simple as that.  Other tests and investigations are to ascertain the cause of the infertility. A general physical examination may help point out the cause of the infertility and prevent the stress involved in specific fertility tests and when this doesn’t produce the desired result, then specific fertility tests may be required and they may include:

Ovulation testing: in this test, a blood sample is tested to determine whether a woman is ovulating or not and this is through the determination of the level of the hormone associated with ovulation.

Hysterosalpingography: this is a non-invasive diagnostic procedure which involves the examination of the uterus and the fallopian tubes to check for any blockage in the tubes or endometrial problems. To do this, an X-ray contrast is injected into the uterus before picture is taken.

Ovarian reserve testing: This testing helps determine the quality and quantity of the eggs available for ovulation. This approach often begins with hormone testing early in the menstrual cycle.

Imaging tests: other imaging testing may include Pelvic ultrasound scan which helps to detect any abnormality in the uterus and fallopian tubes. Hysterosonography is also used to see details inside the uterus that are not seen on a regular ultrasound.

High vagina swap test: to check for infection which may be sexually transmitted or as a result of poor hygiene.

Breast examinations: To check for milk production

Hormonal assay: to check for hormonal imbalance or other problems including thyroid functions.

 

And as the situation may warrant, other tests may include:

Hysteroscopy: Based on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease. During hysteroscopy, your doctor inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities.

Laparoscopy: This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.

Genetic testing: Genetic testing helps determine whether there’s a genetic defect causing infertility.

 

TREATMENT

In cases where spontaneous pregnancy doesn’t happen, couples can often still achieve a pregnancy through use of assisted reproductive technology. Infertility treatment may involve significant financial, physical, psychological and time commitments.

Treatment for women

Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed for her to be able to conceive.

 

Stimulating ovulation with fertility drugs: Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.

Intrauterine insemination (IUI): During IUI, healthy sperm are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.

Surgery to restore fertility: Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.

Assisted Reproductive Technology (ART) is any fertility treatment in which the egg and sperm are handled. An ART health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.

Other techniques are sometimes used in an IVF cycle, such as:

Intracytoplasmic sperm injection (ICSI): A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.

Assisted hatching: This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).

Donor eggs or sperm: Most ART is done using the woman’s own eggs and her partner’s sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.

Gestational carrier: Women with non-viable uterus or women who are prone to inevitable loss of pregnancy might choose IVF using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of the carrier for pregnancy.

REFERENCES

Infertility: An overview — A guide for patients. American Society for Reproductive Medicine. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf. Accessed May 23, 2016.

Infertility FAQs. Centers for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/Infertility. Accessed May 23, 2016.

Infertility. Merck Manual Consumer Version. https://www.merckmanuals.com/home/women-s-health-issues/infertility/overview-of-infertility. Accessed May 23, 2016.

Frequently asked questions. Gynecologic problems FAQ137. Treating infertility.

American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130521T1023327144. Accessed May 23, 2016.

Frequently asked questions. Gynecologic problems  FAQ138. Evaluating infertility. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq136.pdf?dmc=1&ts=20130521T1027034009. Accessed May 23, 2016.