Infertility has always been a sensitive and straining issue for couples. With many studies conducted, they’ve shown that 15 to 20 percent of people within reproductive age have some level of infertility. It is considered that the causes of infertility can be attributed to either the male or female partner each 50% of the time. Some of the common problems which cause infertility in females are as follows.
Ovarian problems: All females are endowed with a fixed quota of eggs by birth. There are roughly 300 thousand eggs at birth, of which only 300 finally mature and are released for fertilization during the whole menstrual life span of a woman (age 12 – 50). The rest of the eggs die a pre-programmed death at the rate of 3000-5000 per month. Contrary to common misconception, the fertile life span of women (age 18 – 40) is much shorter than the menstrual life span. Even in these age groups, the rate of fertility declines to less than 50% of the younger age. Decreased ovarian reserve due to delayed child bearing has become the single most common or contributory reason for infertility and reason for poor outcome in urban societies. No matter how healthy a woman remains, one cannot stop the aging process of the ovaries. The ovaries may be absent by birth, removed or destroyed by surgery, disease or toxic treatment related to life threatening diseases like cancers.
Polycystic ovarian disease or PCOD: It is a type of dysfunction of ovaries. Almost 20 – 30% of women with infertility have this problem. This is related to genetic factors and obesity. Any gain in weight in a genetically predisposed individual can lead to abnormal hormonal function, menstrual anomalies and abnormal ovulation. A life style which is conducive to an optimal weight is the only available treatment which is likely to restore normal menstruation and ovulation. However, pregnancy can be achieved with the help of fertility hormones.
Pituitary or hypothalamic problems: Presence of tumour like conditions in the master gland – the pituitary, or in other areas of brain; tension, mental stress, anxiety all interfere with the hormonal control and menstrual cycle and may affect the normal ovulation process. Most of these problems except age can be treated with fertility medicines. However, 30% of these cases will also require in vitro fertilization procedures.
Fallopian tubes: Fallopian tubes are the connecting passages which pick up eggs from the ovaries with active suction, support them until they are fertilized with sperms, nurture the very early embryo and even move it to the uterus for implantation by wave like movements. Any blockage in the tubes is an absolute barrier to fertilization. Even with open tubes, the functions of egg pick-up, nutritional support of early embryo and embryo transport to uterus may be compromised due to infections like tuberculosis, post-abortal or post-partum infections and sexually transmitted diseases. The incidence of tuberculosis is increasing worldwide including that of genital tuberculosis. Genital tuberculosis is generally silent and asymptomatic. Even if healing occurs, either with the help of the body’s own defences or with medicine, there is a significant impact on the tubes because of scarring which is left behind. In severe cases even the ovaries or the uterus may get involved. Treatment is successful in reversing infertility only in very early cases. IVF is the only successful treatment for all cases of tubal block or dysfunction.
Uterus and endometrium: The uterus is a muscular organ which increases in size from the non-pregnant state (approximately equal to a lemon) to a one and half foot long structure during pregnancy. In addition to protection, it also supplies the baby with nutrients through maternal blood for the nine months of pregnancy. Finally, the uterus helps to deliver the baby at term. All these functions can be impaired in various disease conditions e.g. moderate to big size fibroids or infections like tuberculosis. Abnormal shape of uterus by birth, operations or abortions, may also interfere with the process of implantation, growth of the baby or full enlargement of the uterus and may lead to abortions or pre term births.
Endometriosis: Responsible for almost 10% of infertility, it is a tumour like condition which occurs due to implantation of the lining of uterus in abnormal positions. The most common sites are ovaries and the lining of the female pelvic organs. These result in abnormal chemical composition of the peritoneal fluid, severe adhesions of pelvic organs, destruction of ovarian tissue and abnormal function of both ovaries and tubes. This is a progressive disorder leading to adverse consequences on wellbeing and fertility. The women may have progressive pain during menses or throughout the menstrual cycle. She may have bleeding problems. Infertility in them is difficult to treat. Most of these women require IVF for treatment which should be done early.
Unexplained infertility: There is a large subset of nearly 20% of infertile couples where no cause can be detected in both partners despite extensive workup. Here, the defect lies at the functional or biochemical level which is neither possible to diagnose with current workup techniques nor required. The treatment remains IVF in the most of these couples. Unexplained infertility in young couples is as bad as infertility due to any other cause. If pregnancy is not occurring at the best of age, the chances decreases with the growing years. IVF is indicated after 3-5 years of unexplained infertility in young couples also.
