CAUSES OF INFERTILITY IN WOMEN

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle.


Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature
Ovulatory disorders are one of the most common reasons why women are unable to conceive, and account for 30% of women's infertility.  Fortunately, approximately 90% of these cases can be successfully treated naturally. The causes of failed ovulation can be categorized as follows:


(1) Hormonal Problems:

 
These are the most common causes of anovulation.  The process of ovulation depends upon a complex balance of  hormones and their interactions to be successful, and any disruption in this process can hinder ovulation.  

 There are three main sources causing this problem:

 Failure to produce mature eggs

In approximately 50% of the cases of anovulation, the ovaries do not produce normal follicles inwhich the eggs can mature.  Ovulation is rare if the eggs are immature and the chance of fertilization becomes almost nonexistent.  Polycystic ovary syndrome, the most common disorder responsible for this problem, includes symptoms such as amenorrhoea, hirsutism, anovulation and infertility.  This syndrome is characterized by a reduced production of FSH, and normal or increased levels of LH, oestrogen and testosterone.  The current hypothesis is that the suppression of FSH associated with this condition causes only partial development of ovarian follicles, and follicular cysts can be detected in an ultrasound scan.  The affected ovary often becomes surrounded with a smooth white capsule and is double its normal size.  The increased level of estrogen raises the risk of breast cancer.

• Malfunction of the hypothalamus
  The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation.  If the hypothalamus fails to trigger and control this process, immature eggs will result.  This is the cause of ovarian failure in 20% of cases.
   
• Malfunction of the pituitary gland
  The pituitary's responsibility lies in producing and secreting FSH and LH.  The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced.  This can occur due to physical injury, a tumor or if there is a chemical imbalance in the pituitary.

(2) Scarred Ovaries:
 

Physical damage to the ovaries may result in failed ovulation. For example, extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur.  Infection may also have this impact.

(3) Premature Menopause:
 

This presents a rare and as of yet unexplainable cause of anovulation.  Some women cease menstruation and begin menopause before normal age.  It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise.There is also a genetic possibility for this condition.

(4) Follicle Problems:
 

Although currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it, every month yet the follicle fails to rupture.  The egg, therefore, remains inside the ovary and proper ovulation does not occur.

CAUSES OF POORLY FUNCTIONING FALLOPIAN TUBE:

Tubal disease affects approximately 25% of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage.  Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30% overall,
with certain procedures having success rates up to 65%.  The main causes of tubal damage include:

(1)   Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply (usually at the expense of the host). The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss of an infected limb, and even death. The host's response to infection is inflammation.

 Colloquially, a pathogen is usually considered a microscopic organism though the definition is broader, including feces, parasites, fungi & viruses. A symbiosis between parasite and host, whereby the relationship is beneficial for the former but detrimental to the latter, is characterised as parasitism. The branch of medicine that focuses on infections and pathogens is infectious disease.A secondary infection is an infection that occurs during or following treatment of another already existing primary infection." There many caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation  resulting in scarring and damage.  A specific example is Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube.

Other  infection in women such as :


(2) Pelvic Inflammation Disease:

This is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries. It is often the result of sexually transmitted infection(STI such as syphilis, gonorrhea, chlamydia e.t.c) .PID can damage and scar the fallopian tubes making it virtually impossible for an egg to travel down into the womb

(3) Abdominal Diseases
      The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.

(4) Previous Surgeries
     This is an important cause of tubal disease and damage.  Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.

(5) Ectopic Pregnancy.

This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition.

 
(6) Congenital Defects
      In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.

ENDOMETRIOSIS

Approximately 10% of infertile couples are affected by endometriosis.  Endometriosis affects millions of women world.  In fact, 30-40% of patients with endometriosis are infertile.  This is two to three times the rate of infertility in the general population. For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36%. This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. 

Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum.  A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly. 

The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and  premenstrual spotting.  Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.  The long term cumulative pregnancy rates are normal in patients with minimal endometriosis and normal anatomy.  Current studies demonstrate that pregnancy rates are not improved by treating minimal endometriosis.


ADDITIONAL FACTORS:

(1)   Medicines and Drugs:

The side effects of some types of medication and drugs can affect your fertility.

     These medicines are outlined below:

Non-steoidal anti-inflammatory drugs(NSAIDS).Long- term use,or a high dosage of NSAIDS,such as ibuprofen or aspirin,can make it more difficult for you to conceive.

Chemotherapy:Medicines used for chemotherapy(a treatment for cancer) can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly. Ovarian failure can be permanent. Neuroleptic medicines are antipsychotic medicines often used to treat psychosis. They can sometimes cause missed periods or infertility. They can sometimes cause missed periods or infertility making ovulation(the monthly cycle where an egg is released from the ovaries) more difficult.

(2)  Behavioral Factors:
 

It is well-known that certain personal habits and lifestyle factors impact health; many of these same factors may limit a couple's ability to conceive.  Fortunately, however, many of these variables can be regulated to increase not only the chances of conceiving but also one's overall health.

• Diet and Exercise
  Optimal reproductive functioning requires both proper diet and appropriate levels of exercise.  Women who are significantly overweight or underweight may have difficulty becoming pregnant.
   
• Smoking
  Cigarette smoking has been shown to lower sperm counts in men and increases the risk of miscarriage, premature birth, and low-birth-weight babies for women.  Smoking by either partner reduces the chance of conceiving with each cycle, either naturally or by IVF, by one-third.
   
• Alcohol
  Alcohol intake greatly increases the risk of birth defects for women and, if in high enough levels in the mother’s blood, may cause Fetal Alcohol Syndrome.  Alcohol also affects sperm counts in men.
   
• Drugs
  Drugs, such as marijuana and anabolic steroids, may impact sperm counts in men.  Cocaine use in pregnant women may cause severe retardations and kidney problems in the baby and is perhaps the worst possible drug to abuse while pregnant. Recreational drug use should be avoided, both when trying to conceive and when pregnant.

(2) Other variables that may cause infertility in women:

•   At least 10% of all cases of female infertility are caused by an abnormal uterus.  Conditions such as fibroid, polyps may lead to obstruction of the uterus and Fallopian tubes.
   
•   Congenital abnormalities, such as septate uterus, may lead to recurrent miscarriages or the inability to conceive.
   
•   Approximately 3% of couples face infertility due to problems with the female’s cervical mucus.  The mucus needs to be of a certain consistency and available in adequate amounts for sperm to swim easily within it.  The most common reason for abnormal cervical mucus is a hormone imbalance, namely too little estrogen or too much progesterone.

• Infertility in women is also linked to age. The biggest decrease in fertility decrease in fertility begins during begins during the mid- thirties. Among women who are 35 years of age 95% will get pregnant after three years of having regular unprotected sex. For women who are 38 years of age,only 75% will get pregnant after three years of having regular protected sex.

(4)  Environmental and Occupational Factors:
       The ability to conceive may be affected by exposure to various toxins or chemicals in the workplace or the surrounding environment.Substances that can cause mutations, birth defects, abortions, infertility or sterility are called reproductive toxins.  Disorders of infertility, reproduction, spontaneous abortion, and teratogenesis are among the top ten work-related diseases and injuries today.  Despite the fact that considerable controversy exists regarding the impacts of toxins on fertility, four chemicals are now being regulated based on their documented infringements on conception.

• Lead
  Exposure to lead sources has been proven to negatively impact fertility in humans.  Lead can produce teratospermias (abnormal sperm) and is thought to be an abortifacient, or substance that causes artificial abortion.
   
• Medical Treatments and Materials
  Repeated exposure to radiation, ranging from simple x-rays to chemotherapy, has been shown to alter sperm production, as well as contribute to a wide array of ovarian problems.
   
• Ethylene Oxide
  A chemical used both in the sterilization of surgical instruments and in the manufacturing of certain pesticides, ethylene oxide may cause birth defects in early pregnancy and has the potential to provoke early miscarriage.
   
• Dibromochloropropane (DBCP)
  Handling the chemicals found in pesticides, such as DBCP, can cause ovarian problems, leading to a variety of health conditions, like early menopause, that may directly impact fertility.

GRAPHICAL ILLUSTRATION OF MAJOR CAUSES OF WOMEN INFERTILITY

 INFERTILITY SYMPTOMS IN WOMEN

In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Symptoms include:

• Abnormal periods. Bleeding is heavier or lighter than usual.
• Irregular periods: The number of days in between each period varies each month.
• No periods. You have never had a period, or periods suddenly stop.
• Painful periods. Back pain, pelvic pain, and cramping may happen.

Sometimes female infertility is related to a hormone problem. In this case, symptoms can also include:

• Skin changes, including more acne
• Changes in sex drive and desire
• Dark hair growth on the lips, chest, and chin
• Loss of hair or thinning hair
• Weight gain

Other symptoms include:

• Milky white discharge from nipples unrelated to breastfeeding
• Pain during sex

Many other things can lead to infertility in women, and their symptoms vary.