Female Infertility: Whats all the fuss about?

 

Female infertility is rampantly rising throughout the globe.

Scientific Data indicates that female infertility also called female factor or simply infertility in women and its associated issues could affect an estimated 40% of couples actively trying for a child and that’s scary as hell!.

 

 

Female infertility is a major contributory cause of infertility affecting couples.

 

 

Hey guys!. This is Dr. Shah, Founder of the Andrology Corner.

 

Today I am gonna tell you everything you need to know about female infertility

 

Infertility is rampantly rising around the globe, and affects at least one in six couples actively trying for a child.

 

….and interestingly female infertility as a cause is ever present in at least 40% to 50% of couples as a major contributing cause leading to fertility problems.

 

However, the more interesting fact is that….

 

Male Fertility Problems leading to childlessness rises notoriously as high as 70%…and we do not have much data from other countries thereby actually underestimating the real threat. We are looking at just the tip of the iceberg!

 

No benefits in blaming your wives or partners guys!. Get yourself checked first!

 


male infertility | female infertility | The Andrology Corner
Their is much we do not know about male fertility and male infertility!

Surprised?…Read on

 

now infertility is described by some BIG HEALTH AUTHORITIES as follows…

 

“Infertility is defined as the inability to achieve a pregnancy after one year of unprotected sexual intercourse”

 

But in principle this definition is actually flawed!. Why??!

 

Who defines what is normal frequency of sexual intercourse?. Is it once a day or once a month?

 

….and more importantly this definition definitely does not take into account the pregnancies that could have happened in the second or third year of marriage.

 

 

In principle it is important to understand that natural conception is possible at any time at least upto a certain age.

 

 

To get a better perspective just take a look at the data table below

 


female infertility | male infertility | The Andrology Corner


But here is the catch….

 

Even though this data suggests that a pregnancy is possible 85% of the time within the first year of marriage when the couple engages in sexual intercourse 2 to 3 times a week, their is a certain upper age limit.

 

… the data mentioned above definitely does not apply to couples where the female age is beyond 35 years of age or if a male factor is present.

 

The reason is simple, their is ample evidence in the scientific literature that suggests that when women cross 35 years of age, a sharp decline in egg production takes place. Its not just the egg production though..

 

It is also the quality of eggs…that really matter. Look below!!!


female infertility | The Andrology Corner


What are the cardinal causes of infertility in women?

 

The main reason women postpone starting a family nowadays…

 

A. Extended time spent studying and progressing from a career viewpoint

 

B. Use of contraception

 

C. Meeting a desired life partner late

 

D. Obesity – a crappy pandemic that eventually leads to PCOS and then finally irregular cycles and infertility!

 

E. Desiring a second child after a late first pregnancy

 

F. Divorces and remarriages

 

G. Increasing incidence of Sexually transmitted infections

 

Now lets go into the biology of Natural Conception

 

 

For a pregnancy to take place their are 5 important cardinal events that have to occur as mentioned below

 

 

The male should produce an adequate number of sperm, these sperms should good progressive motility and at least a few of them should have a normal shape.
The female should ovulate normally once a month. If the female has irregular cycles, conception is going to be difficult. Female age is the key determining factor of the quality of egg produced. The younger the female the better the egg!
The fallopian tubes are the key conduits that allow the sperm to reach the egg. Any blocks here will prevent a natural conception from occuring.
The one sperm that reaches egg, should have the fertilizing ability to attach to the egg, penetrate it, fertilize it and allow embryo development. A complex series of molecular event signals and coordinates the sperm attachment, penetration and fertilization
If the egg fertilizes, it forms an embryo that then develops and divides sequentially from a single cell to two cell, four cell, eight cell, sixteen cells and finally a Blastocyst. This process takes about 5 days. The blast formed should migrate and attempt to implant in the endometrium (The lining of the uterus that nourishes the embryo)
If the embryo is of good quality (it has no genetic/chromosomal anomalies) and if the endometrium is sufficiently well prepped, the embryo will implant and this would result in a pregnancy.

Just look at the image below to better your understanding


Fertilization and reproduction and fertility


 

Thus to summarize…

 

A. The man should produce a healthy sperm

 

B. The women should produce a healthy egg

 

C. The birth tube or Fallopian tube should be free of blocks only then will the sperm meet the egg

 

D. If the sperm does meet the egg, the embryo produced should also be of good quality

 

E. The embryo will implant if the uterus lining is adequately prepared by the women’s natural hormones i.e estrogen and progesterone


Female Infertility Causes

 

Causes of infertility in women is summarized below..

 

Unexplained Infertility:

 

Interestingly in about 30% of women a cause of infertility is never found. As per the ASRM guidelines, a women is said to be diagnosed with unexplained infertility when tests for standard infertility assessment turn out to be normal. These tests normally include

 

A. Ovarian reserve assessment to estimate follicle count (the sac that contains the egg)

 

B. Tube patency assessment

 

C. X-ray and/or sonographic imaging of the uterus to see it and its associated structures

 

A key point you should remember though is that in women over 35 years of age the cause of female infertility is more likely to be unexplained in nature.

 

Polycystic ovarian syndrome and Infertility:


Female infertility causes | PCOS


Polycystic ovarian syndrome (PCSO) is probably the most commonest cause of failure of ovulation (when the ovaries fail to make an egg). PCOS affects at least 30% of women of child bearing age and is probably also one of the leading causes of female inferility.

 

PCOS means “small cyst”, were numerous small fluid filled sacs containing the egg are seen in the ovary. Due to the hormonal imbalance seen in women with PCOS, the eggs are arrested in development and do not ovulate. PCOS and its associated pathologies go hand in hand with weight gain and obesity.

 

A women is said to suffer from PCOS if she fits into the following Rotterdam’s diagnostic criteria. A women is diagnosed with PCOS if she has two of the three following clinical symptoms

 

A. Irregular or absent ovulation

 

B. Signs of Androgen excess (male pattern of hair growth, acne, hirsutism)

 

C. Polycystic appearing ovaries

 

PCOS is usually easily managed with drugs that induce ovulation like Clomiphene citrate or gonadotrophins. Weight reduction is a must for women who are obese and when they present with PCOS. Spontaneous pregnancies can happen in this group even if their is a 5% decrease in total body weight.

 

 

Other Ovulation Disorders:

 

Problems with ovulation can also occur if their is a pathology affecting either the hypothalamus or pituitary the key glands in the brain needed for producing FSH and LH. Since both FSH and LH play a key role in stimulating follicle growth and thus egg development, deficient production of these hormones can lead to female infertility.

 

Irregular secretion of FSH and LH can also occur thyroid disorders namely hypothyroidism and hyperthyroidism. Chronic long standing diseases can also affect the secretion of FSH and LH thus leading to irregular ovulation and female infertility. Premature onset of menopause (when a women’s cycle stops before 40) is also now a recognized cause of infertility. The exact genetic basis of this condition remains to be studied.

 

Tubal Factors Leading to Infertility in women :

 

In the Indian subcontinent, large scale studies have clearly shown that genital tuberculosis a chronic infectious disease is the leading cause of infertility in women. Tuberculous involvement of the tubes can lead to tube blockage and female infertility consequently. Many women commonly seen in the clinic present with frozen pelvis and tubo-ovarian masses when evaluated laparoscopically.

 

Interestingly though in the Western subcontinents, sexually transmitted infections like Chlamydia Trachomatis is the leading cause of tubal blockage and thus infertility.  Chlamydia is the most common sexually transmitted infection worldwide and is frequently silent in it’s manifestation. This infection is believed to affect an estimated 6% of the world population

 

Endometriosis :

 

The endometrium is the tissue that lines the uterine cavity. When this tissue deposit is found elsewhere like the uterine cavity or ovary it termed as Endometriosis

 

Endometriosis has a strong association with female infertility and frequently women with endometriosis complaint of severe pain during menses and sometimes pain during sexual intercourse. Approximately, 20% of women with endometriosis would have some degree of female infertility.

 

Failure of Sexual Intercourse and Infertility :

 

Domestic issues, stress and in general even a diagnosis of infertility can affect the relationship between a couple leading to decreased frequency of sexual intercourse. Additional factors that can affect sexual relationships would be…

 

A. Male erectile dysfunction

B. Pain during intercourse

C. Obesity

D. Alcohol dependency

E. Other psychological factors

 

Uterine Anomalies leading to Female Infertility :

 

Uterine scars, uterine polyps (overgrown tissue in the uterus) and sub mucous fibroid (non cancerous tissue growth in the uterus) have also been associated with infertility.

 

Lifestyle factors leading to Female Infertility

 

Numerous lifestyle factors like smoking, alcohol, drug abuse, stress, junk food intake have been associated with female infertility.

Smoking :

 

Smoking both active and passive smoking definitely impairs female fertility. If you are planning for a child stop smoking today!

 

Stress :

 

Strong scientific evidence linking stress to female infertility is still debated. But doing some meditation goes in a long way keeping you focused on your fertility journey

 

Drug Abuse :

 

Drug abuse in any form impairs your ability to get pregnant, not worth it!

 

Junk food intake :

 

Regularly taking food that has a low glycemic index value goes a long way in helping you attain fertility goals. Their is definitely some link between your egg release and insulin sensitivity pathways.

 

I hope you enjoyed reading this post!. Visit this page in a week for more updates!

 

References

  1. http://americanpregnancy.org/infertility/female-infertility/
  2. http://link.springer.com/article/10.1007/s10815-016-0836-8