Female Infertility

Infertility is considered to exist when a sexually active couple cannot achieve spontaneous pregnancy after at least one year of unprotected sexual intercourse. If the cause is related to the woman, it is referred to as female infertility.

Depending on the degree of this inability, infertility can be classified into several types:

• Primary infertility: it is not possible to achieve a first pregnancy.
• Secondary infertility: it is not possible to achieve another pregnancy, but there has been at least one previous conception.

In the case of women, two concepts need to be differentiated: sterility and infertility:

• Female sterility: pregnancy does not occur either because there are problems with the egg that prevent it from being fertilized by the sperm or because the embryo does not implant in the uterus once fertilization has occurred.
• Female infertility: fertilization occurs, and an embryo is obtained, but it does not develop fully, and pregnancy does not reach term, instead resulting in a miscarriage.

Depending on the specific phenomenon that causes infertility, the following classification can be made:

• Ovarian or endocrine factor infertility: variations in hormone levels affect ovulation and ovarian production.
• Uterine factor infertility: due to problems in the uterus or endometrium, the embryo cannot implant, or if it does, it does not develop, and the woman suffers from recurrent miscarriages.
• Tubal factor infertility: an abnormality in the fallopian tubes prevents sperm from reaching the egg or the fertilized egg from passing into the uterus.
• Cervical factor infertility: alterations in the cervix or cervical mucus prevent the passage of sperm.
• Immunological factor infertility: infertility is caused by the presence of antisperm antibodies or an autoimmune disease that impairs proper function of the uterus or placenta.

Symptoms

The symptom of infertility is the inability to achieve pregnancy. However, the underlying causes of infertility may manifest specific signs:

• Menstrual cycle abnormalities, such as the absence of bleeding, very heavy and painful menstruation, or irregularities in duration: these are signs of endocrine system alterations.
• Intense pain or discomfort: this can be indicative of blocked fallopian tubes or uterine fibroids.

Causes

The previously mentioned factors that lead to female infertility have different causes.

Hormonal disorders that alter or abolish ovulation are usually due to:

• Polycystic ovary syndrome (PCOS), a very common disorder that causes cysts in the ovaries and alters estrogen and androgen levels.
• Hypothalamic dysfunction, the gland responsible for secreting hormones.
• Excessive prolactin production.
• Primary ovarian insufficiency, or early menopause.
• All of these conditions can be due to genetic factors, thyroid problems, stress, obesity, anorexia, chemotherapy and radiation treatments, or certain medications.

Lesions or obstructions in the fallopian tubes that prevent conception are often due to:

• Pelvic inflammatory disease, a disorder caused by infections like chlamydia or gonorrhea.
• Endometriosis, a condition that causes the endometrial tissue to leave the uterus and implant in the fallopian tubes.
• Fluid accumulation due to infection.
• Congenital malformations or a history of pelvic surgeries: these may affect the functionality of the tubes.

The functioning of the uterus can be altered by:

• Polyps, fibroids, and myomas.
• Congenital and hereditary abnormalities such as cervical stenosis.
• Injuries or trauma.
• Uterine inflammation due to microbial agents.
• Endometrial abnormalities: systematic inflammation or altered thickness due to bacterial infections or ovarian failures can prevent embryo implantation.

Risk factors

The factors that represent a higher risk of infertility in women are:

• Age: from the age of 35, the quality and quantity of eggs begin to decline. This not only makes conception more difficult, but also increases the risk of miscarriage.
• Smoking: tobacco damages the cervix and fallopian tubes, ages the ovaries, and depletes ovarian reserve. It also increases the risk of miscarriage or ectopic pregnancy.
• Weight: both overweight and underweight can affect ovulation.
• History of sexually transmitted diseases: sexually transmitted infections can affect the entire reproductive system.
• Alcohol: excessive consumption can reduce fertility.

Stress: very high stress levels can cause hormonal changes.

Complications

The main complication of female infertility is the possibility that the underlying cause may be irreversible. Additionally, the inability to conceive can cause a high level of stress and frustration for both the woman and the couple. Furthermore, pharmacological treatments for infertility can have significant side effects:

• Multiple pregnancies.
• Thromboembolic disease.
• Potential risk of ovarian tumors.
• Digestive disorders.
• Hypotension.
• Vision problems.
• Cardiac rhythm disturbances.
• Nausea and vomiting.
• Dizziness.
• Skin alterations.
• Hair loss.

Prevention

To prevent female infertility, one can act against its risk factors by promoting a healthy lifestyle, controlling body weight, avoiding tobacco and alcohol, reducing stress, and taking prophylactic measures to avoid sexually transmitted diseases.

What doctor treats female infertility?

Female infertility is evaluated and treated by specialists in gynecology and obstetrics and in assisted reproduction units.