Infertility in women
Infertility in women
In women, infertility or sterility is the inability to conceive and bring a child into the world. Otherwise, we can define infertility as the inability to conceive the child with regular unprotected sexual intercourse which last for more than a year, some experts say more than two years. There are many causations of infertility, and psychological condition or risk factors which affect fertility are also not exceptional.
Female genital system consists of the ovaries, fallopian tubes, uterus, vagina and external genitals. Aside from the external genitals, the process of fertilization involves all of the mentioned parts. In the healthy fertile women, approximately once a month, is in the ovaries during the menstrual cycle created female gamete or the ovum, which is after maturation released into the fallopian tubes. This phase is called ovulation. The egg then travels through the fallopian tubes where is it fertilized by male gamete, i.e. sperm. The fertilized egg moves further into the uterus which is under the influence of hormones properly prepared for the implantation of ovum. The endometrium is widened and supplied with blood to ensure proper nourishment of the egg. Afterwards, the ovum in the uterus develops, grows and descendant is rising. If sperm does not fertilize the ovum, menstrual phase occurs and the ovum together with prepared uterine mucosa is evicted out through menstrual blood.
Maturation of the eggs is complex process that is strictly regulated by the hormones which levels vary over the cycle and so they "tell" ovaries what to do. Therefore, several individual steps are necessary for the proper development of eggs. There must be created the ideal level of hormones, the ovaries and eggs stored in them must be unimpaired, and also fallopian tubes and uterus can not be affected for the proper implantation of fertilized embryo and fetus.
Causes of infertility in women
Within the most common causes of infertility in the women we include ovarian malfunction, damaged fallopian tubes, endometriosis ,i.e. an anatomical abnormality of the uterus, uterine disorders, developmental defects of the genitals, inflammation of the vagina, low immune function and mental status. Let us describe them more precisely.
Fertility problems may develop due to the different genetic defects or pathological process in that parts of the brain which release sex hormones. Some of these problems occur during puberty when the woman's sexual characteristics are not developed properly, i.e. growth of breasts or pubic hair, or the fact that the woman is not menstruating. These disorders can also develop after the puberty, and they may be not noticed thanks to the use of hormonal contraceptives. Typical are, for example, small tumours or inflammation of the pituitary gland in which sex hormones originate.
The causations of infertility in women can be also located in the ovaries. One of the main causes is changed level of the hormones which are responsible for growth and development of the eggs. This is why it does not come to the maturation of eggs at all, or the matured egg is not able to release from the ovary. Therefore, there is no ovulation. Furthermore, for impaired function of the ovaries are responsible some medications, ovarian tumours, poor development of the ovaries, but also the polycystic ovary syndrome which is characterized by the fact that the woman has an excess of male hormones, and thus the interference in ovulation and menstruation.
Fallopian tube disorder
Another common cause of infertility in women is fallopian tube disorder. Even if the woman ovulates regularly, and mature and healthy eggs are created, she may not be fertile. The fault may be partial or complete obstruction of the fallopian tubes, and so sperm can not reach the egg or the egg is not able to get to the uterus. According to this, there is a great risk of ectopic pregnancy in which is the fertilized egg nidated in the obstructed fallopian tube. The fallopian tube is not suited for pregnancy, it may crack and endanger the woman's life with massive bleeding. Tubal obstruction usually occurs in long-term inflammation caused by STDs (gonorrhoea, chlamydia), in endometriosis or after the various operations in the lower abdomen, and even after complicated surgery of appendix. Cicatricial connections, between surfaces of the organs that are not normally associated, can also develop. These connections are called adhesions which can affect the shape, direction, and position of the organs in lower abdomen and can possibly cause the blockage of fallopian tubes.
As already mentioned, also endometriosis is often the cause of infertility in women. Endometriosis is a condition in which is uterine lining outside the uterus, most commonly on the ovaries, fallopian tubes and bladder. This mucosa, as well as mucous membrane in the uterus, is under the influence of hormones and it comes to bleeding during menstruation. Places impaired with endometriosis gradually cicatrize and adhesions are formed. Accordingly, this is from 30-50% the causation of infertility in women.
The problem causing infertility in women can also be the failure of uterus. Although the egg is fertilized but it can not nidate. This may be due to congenital malformations of the uterus, or further uterine tumours, polyps and adhesion of the uterus as result of medical intervention can develop. Another cause of infertility in women can be closure of the cervix, which gives no chance for sperms to reach the egg.
Important are also immunological disorders in which the immune system inappropriately responds to partner's sperms, the immune system considers them as foreign and destroys them. According to this, the egg can not be fertilized.
Psychological causes of infertility in women
Mental composure has the great influence on female fertility. There is often no physical causation and only psychotherapy can help the woman to conceive. Cases, when a couple can not conceive and the woman becomes naturally pregnant after an adoption of child, are not so rare. Among the psychological causes of infertility belong depression, stress, overwork or nervous exhaustion.
When we are looking for causes of infertility in women systemic diseases should not be neglected. Systemic diseases may not be associated with the genital organs but in the body are all processes connected. Therefore, it is necessary to check the function of thyroid gland, and as well as the function of pancreas that produces insulin which deficiency causes diabetes. Obesity plays also an important role. Adipose tissue is an active material which produces a lot of agents that may contribute to infertility. Accordingly, it is necessary to keep good condition and have your health regularly checked with your doctor.
Risk factors for infertility in women
Among the factors that increase probability of infertility in women include:
- age - after thirty years of life, due to the declining quantity and quality of eggs, female fertility declines
- sexual activity - it is necessary to have sexual intercourse at least 3 times a week in order to fertilize the released egg that would be otherwise lost in about 48h
- negative effects of the environment
- alcohol and drugs
- nutrition – malnutrition, or obesity vice versa inhibits ovulation
- congenital malformations or acquired diseases
- genetic factor
Treatment of infertility in women
Treatment of infertility in women depends on the underlying cause. In the case of hormonal disorder are served hormonal drugs that adjust any imbalance. Surgical intervention is performed, if is infertility caused by obstructed fallopian tubes, adhesions, tumours or endometriosis. In the case of obesity, it is necessary to reduce weight of the patient. If gynaecological inflammation and sexually transmitted diseases occur, it is necessary to treat them properly and on time. Likewise diabetes or thyroid gland disorder. If none of these treatment methods had the positive effect on female infertility, methods of assisted reproduction are performed.
Methods of assisted reproduction
The simplest method is to transfer the partner's sperms into the woman's uterus, which shortens their path and reduces the risk of death. This is called intrauterine insemination (IUI). Another method is in vitro fertilization (IVF) in which are the harvested eggs under a microscope fertilized by sperms. The created embryo is then returned into the woman's uterus. Another method is intracytoplasmic sperm injection (ICSI) in which is just single sperm injected into the harvested female egg and the created embryo is put back into the uterus, where it can develop normally.