Female infertility

Female infertility is a term that refers to infertility in female humans.

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Causes

Factors relating only to female infertility are:

General factors

• Significant liver, kidney disease
• Thrombophilia^[1][2]

Hypothalamic-pituitary factors

• Hypothalamic dysfunction

Ovarian factors

• Polycystic ovarian syndrome

• Anovulation

• Diminished ovarian reserve, also see Poor Ovarian Reserve

• Premature menopause

• Menopause

• Luteal dysfunction^[3]

• Gonadal dysgenesis (Turner syndrome)

• Ovarian cancer

Tubal (ectopic)/peritoneal factors

• Endometriosis^[4]

• Pelvic adhesions

• Pelvic inflammatory disease (PID, usually due to chlamydia)^[5]

• Tubal occlusion^[6]

• Tubal dysfunction

Uterine factors

• Uterine malformations^[7]

• Uterine fibroids (leiomyoma)

• Asherman's Syndrome^[8]

Cervical factors

• Cervical stenosis^[9]

• Antisperm antibodies^[10]

• Non-receptive cervical mucus^[11]

Vaginal factors

• Vaginismus
• Vaginal obstruction

Genetic factors

• Various intersexed conditions, such as androgen insensitivity syndrome

Diagnosis

Diagnosis of infertility begins with a medical history and physical exam. The healthcare provider may order tests, including the following:

• an endometrial biopsy, to verify ovulation and inspect the lining of the uterus
• hormone testing, to measure levels of female hormones at certain times during a menstrual cycle
• day 2 or 3 measure of FSH and estrogen, to assess ovarian reserve
• measurements of thyroid function^[12] (a thyroid stimulating hormone (TSH) level of between 1 and 2 is considered optimal for conception)
• laparoscopy, which allows the provider to inspect the pelvic organs
• measurement of progesterone in the second half of the cycle to help confirm ovulation
• Pap smear, to check for signs of infection
• pelvic exam, to look for abnormalities or infection
• a postcoital test, which is done soon after intercourse to check for problems with sperm surviving in cervical mucous (not commonly used now because of test unreliability)
• special X-ray tests

Diagnosis and treatment of infertility should be made by physicians who are fellowship trained as reproductive endocrinologists. Reproductive Endocrinologists are usually Obstetrician-Gynecologists with advanced training in Reproductive Endocrinology & Infertility (in North America). These highly educated professionals and qualified physicians treat Reproductive Disorders affecting not only women but also men, children, and teens.

Prospective patients should note that reproductive endocrinology & infertility medical practices do not see women for general maternity care. The practice is primarily focused on helping their patients to conceive and to correct any issues related to recurring pregnancy loss.

Prevention

Some cases of female infertility may be prevented by taking the following steps:

• Avoid excessive exercise.
• Avoid smoking.
• Control diseases such as diabetes and hypothyroidism
• Eat a well balanced nutritious diet with plenty of fresh fruits and vegetables (plenty of folates).
• Follow good weight management guidelines.
• Practice safer sex to avoid sexually transmitted diseases.
• Get early treatment for sexually transmitted diseases.
• Have regular physical examinations (including pap smears) to detect early signs of infections or abnormalities.
• Limit caffeine and alcohol intake.
• Ask your mother (biological) to share any unusual or abnormal issues she had related to conceiving. For example, premature menopause in your mother can be genetic and passed on to you, which limits the years in which you will have optimal egg quality.
• Fertility starts declining after age 27 and drops at a somewhat greater rate after age 35.^[13] It should be noted, however, that fertility does not ultimately cease before menopause.

References