The inability to conceive can be influenced by many factors, including hormonal imbalances, the failure to ovulate, the presence of uterine fibroids and structural problems in the reproductive organs. The following section will outline the various medical conditions, discussing their symptoms, diagnosis and treatment.
Hormonal Factors
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is caused by the excessive production of male hormones by the adrenal gland. This creates cysts within the ovaries which block the maturing and release of egg-containing follicles. The three classic symptoms of PCOS include: irregular or absent menstrual periods, masculinzation causing excessive facial and body hair growth and obesity. Treatment for PCOS involves the administration of compounds that stimulate ovulation, such as clomiphene citrate (Clomid,Serophene).
Hyperprolactinemia
Hyperprolactinemia occurs when prolactin levels increase beyond the concentration of 20mg/mL. The increase in prolactin decreases circulating levels of FSH and LH which then interfere with ovulation. The symptoms of this disorder include irregular or absent menses, decreased libido and galactorrhea. Treatment involves taking bromocriptine, a dopamine agonist that suppresses prolactin release.
Ovarian Factors
Premature Ovarian Failure
Known as early menopause, premature ovarian failure (POF) occurs when the ovaries fail to produce estrogen. While over half of the cases come from unknown causes, POF has been known to be caused by genetic factors, autoimmune disorders and the destruction of ovaries through radiation and chemotherapy. This syndrome is devastating to young mothers because women with POF essentially become sterile, thus preventing future pregnancy. The only options for couples involve the use of donor eggs or adoption.
Luteal Phase Defect
A luteal phase defect (LPD) occurs when the corpus luteum does not secrete enough progesterone. LPD can be caused by an insufficient LH surge, and even conditions such as psychogenic stress and inadequate nutrition. Kidney, liver or immunologic disease can also influence luteal function through directly acting upon the corpus luteum. The first line of treatment for LPD is clomiphene citrate (Clomid, Serophene).
Fallopian Tube Factors
Infection
Infection is the most common cause of tubal infertility. The fallopian tube can become obstructed by pelvic inflammatory disease (PID) caused by chlamydia or gonorrhea. The sexually transmitted diseases can cause scarring in the delicate fallopian tubes which can create either a risk of ectopic pregnancy or the inability of a fertilized egg to travel to the uterus.
Endometriosis
Endometriosis occurs when tissue that is very similar to endometrial tissue accumulates outside of the uterus. The disorder is most commonly found in women from 30-40 years of age. The most characteristic symptom is dysmenorrhea, or abnormally painful periods. As well, hypermenorrhea (prolonged, heavy and frequent menstruation) is another common symptom. The endometriosis may cause infertility by altering the anatomy of the female reproductive system. Medical treatment of this disorder has not increased pregnancy rates. Surgical treatment to remove bonds and open tubes is essential in treating advanced endometriosis.
Uterine Factors
Fibroids
Fibroids are benign muscle tumors in the uterus that can range in size from small marbles to grapefruits. Fibroids may cause infertility by interfering with the shape of the uterus and preventing implantation, or through compression of the fallopian tubes. A surgery known as a myomectomy is a simple operation that can be used to remove uterine fibroids.
Other Factors Contributing to Infertility
Vaginal Douching
Many women douche, mostly with the feeling that their vaginal area is unclean and needs to be douched as a part of personal hygiene. However, douching disturbs the normal vaginal environment and is strongly discouraged. Douching has been linked with an increased risk of pelvic inflammatory disease, chlamydia , endometriosis, ectopic pregnancy and overall reduced fertility.
Smoking
Research has shown a 50% lower pregnancy rate among women who smoked during their fertility treatments compared to non-smoking women. One study has shown that the odds of having a miscarriage increase by 46% for the first 10 cigarettes smoked per day, and by 61% for the first 20 cigarettes smoked. Overall, a widespread body of evidence suggests that habitual smoking can alter ovarian function and the viability and development of eggs.
Age and Infertility
The relationship between age and fertility is a well documented one, with the common knowledge that as one gets older it becomes harder to have children. A woman reaches her maximum potential of fertility at age 24 and its decline begins by the age of 30. Pregnancy is almost impossible after age 45, mainly due to factors relating to oocytes (eggs). The most common age-linked cause of infertility is a low number of remaining follicles in the ovary and the diminished quality of the follicles left over. In terms of treatment, many physicians agree that comprehensive infertility treatments should not be continued beyond 6 months and that the age of 42 should be set as a limit, since few pregnancies can be achieved beyond this age.
Treatments for Female Infertility
Drug Treatments
Clomiphene (Clomid/Serophene)
Clomiphene is the most popular fertility drug prescribed in the United States. While its exact mechanism of action is unknown, clomiphene causes a 50% increase in FSH levels which stimulates follicles to grow and release eggs. The conception rate per treatment cycle is about 5%, however if conception isn't accomplished within 6 cycles, couples may be advised to try an alternate method of treatment to avoid the risk of ovarian cancer.
FSH for Clomiphene-resistant Polycystic Ovarian Syndrome
This treatment is an alternate to the above treatment in those who are unresponsive to clomiphene after 6 months. FSH is given by injection with quite a high success rate; pregnancy rates of 25% after three cycles.
Pulsatile Gn-RH
The absence of the hypothalamic hormone gonadotropin-releasing hormone factor (Gn-RH) results in a deficiency in the stimulation of FSH and LH release. Women with this condition are given pulses of Gn-RH through intravenous injections which are meant to mimic the normal secretions of Gn-RH. Pregnancy rates of up to 15% can be achieved with this treatment.
Bromocriptine
In hyperprolactinemia, high prolactin levels suppress Gn-RH which results in the failure of ovulation. Bromocriptine is given to suppress prolactin production and allow for restoration of ovarian function. With bromocriptine treatment, ovulation rates can be as high as 75%. This treatment is not associated with miscarriages, premature births, fetal malformations or multiple pregnancies.
Surgical Treatments
Tuboplasty
A tuboplasty, also known as a salpingoplasty, is carried out on scarred and narrowed fallopian tubes to allow for eggs to pass through and continue on to the uterus. A tiny balloon-tipped catheter is placed in the blocked tube and inflated to open the tube and re-create the passageway.
Fimbrioplasty
The finger-like extensions of the fallopian tubes, known as fimbriae, can sometimes fuse together and block the passage of eggs to the uterus. Microsurgical techniques are used to peel back the fimbriae and restore movement of the ova.
Surgery for Polycystic Ovarian Syndrome
The methods involved in treating this syndrome involve damaging the ovary to stimulate ovulation either by cutting out or drilling holes in portions of the ovary. Surgery is restricted to those cases that are resistant to clomiphene therapy.
Surgery to Reverse Sterilization
Approximately 3/100 women sterilized through tubular clipping or such techniques regrets the operation and asks for it to be reversed. Rejoining of the severed ends of the fallopian tubes can produce pregnancy rates as high as 92%, however the success depends largely on the expertise of the physician and the hospital. Those sterilized with clips have the highest chance of successfully reversing their infertile status.
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