Infertility in woman
A compete medical history and physical examination is the first step undertaken to investigate the cause of infertility. Menstrual history, family history of infertility and sexual factors are examined. Blood and urine tests to determine hormonal levels, prolactin levels, hyperthyroidism and diabetes are taken to evaluate the possible causes of infertility. Hormonal imbalances are sometimes caused by pituitary gland tumors.
Blocked fallopian tubes do not allow the egg to travel to the uterus and can be a cause for infertility. One of the primary tests for detecting infertility in women is to check whether she is ovulating correctly. This can be done by monitoring body temperature and checking the texture of the cervical mucus.
Hysterosalpingogram: In this test for checking the infertility of women, an x-ray of the fallopian tubes and uterus is taken after they are injected with dye. The x-ray displays the shape of the uterus and the state of the fallopian tubes. This diagnostic test is also useful in diagnosing conditions such as endometrial polyps, fibroid tumors and structural abnormalities of the uterus or fallopian tubes.
Laparoscopy: This is a test for checking the fallopian tubes and other female reproductive organs for disease. Chromosomal tests are conducted to detect sperm abnormalities and other abnormal patterns in the man and woman.
- Age is a factor that reduces a woman's chances for fertility. Women above 35 years have decreasing fertility. The decreasing fertility can be on account of the higher rate of chromosomal damage that eggs undergo as time goes by.
- The amount of fat in a woman's body may have a bearing on her ability to conceive. Most of the estrogen in a woman's body is manufactured in her ovaries but some of it is produced in the fat cells. Too high or low weight levels can be a cause for infertility. Decreased body fat in marathon runners and those who indulge in heavy exercise may result in irregular menstrual cycles. Similarly women with eating disorders and restrictive diets can experience infertility. Disturbance in the estrogen balance can throw the reproductive cycle out of gear.
- Occupational and lifestyle factors also play no small role in the process of reproductive health. Exposure to high levels of chemicals and toxic substances, radiation and high temperatures can have a bearing on a woman's fertility. Women who smoke one or more packs a day or consume caffeine or alcohol in excess are at a risk of infertility.
- Pelvic Inflammatory Disease (PID) is a term that covers a gamut of infections affecting the reproductive organs of a woman. Infection in the fallopian tubes (salpingitis) is a common cause of infertility in women. Frequent bouts of infection can lead to tubal damage.
- Ovulation problems caused by hormonal disorders account for nearly a third of all problems of infertility in women. Resultant disorders could range from empty follicles or failure of the ovarian follicle to rupture. The hormonal rhythm is a delicate balance; a slight imbalance of which can cause ovulation disorders.
- Endometriosis is a situation when fragments of the endometrial lining are implanted in other areas of the pelvis leading to cysts that can result in infertility in women.
- Polycystic Ovarian Syndrome is a major cause of infertility in women in America. This is characterized by high levels of male hormones - androgen and testosterone. This results in inability to produce mature eggs and also manifests in symptoms such as acne and increased facial hair.
- Some women's bodies develop antibodies to sperm, which cause infertility and miscarriage. Adrenal or thyroid deficiencies can result in premature ovarian failure resulting in infertility.
Endometriosis
Endometriosis affects nearly 10% of women during their reproductive years and is a major cause for infertility. This gynecological condition occurs when the tissue lining the uterus (endometrium) grows outside the uterus. The endometrium then grows on the ovaries, fallopian tubes and outer surface of the uterus and even sometimes on the bladder, bowel, intestines, colon, vagina, cesarean and laparoscopy scars. This endometrial growth does not get regularly sloughed off with the menstrual cycle and keeps building up to form ovarian cysts. In fact endometriosis can even cause distortion of a woman's internal anatomy. While the theory of retrograde menstruation holds that some menstrual blood flows back through the fallopian tubes and grows there, it is not yet fully substantiated yet. Some women have a genetic predisposition to endoemetriosis. The role of immune system dysfunction and environmental influence on endometriosis is also being studied.
Severe pelvic pain is the characteristic symptom associated with endometriosis. This pain is felt while passing urine, during sexual intercourse and during ovulation. A woman suffering from endometriosis may notice heavy irregular bleeding and abdominal bloating. Infertility is noticed in more than 40% of women suffering from endometriosis. A pelvic examination is conducted on a woman complaining of symptoms of endometriosis. It can reveal the presence of tender nodules in the ovary regions or the posterior vaginal wall. Pelvic ultrasound is used to locate endometriosis areas. Laparoscopy can aid in checking pelvic organs for endometrial tissue. It gives a clear idea of the extent and location of endometriosis.
Hormone therapy is advocated by some as treatment against endometriosis. Birth control pills or progestins are often prescribed. This may help in tempering the estrogen production and relieving some of the signs and symptoms of endometriosis. Progesterone pills or injections can be used to treat endometriosis. The drug Danazol is also sometimes prescribed. Anti-gonodotropins produce a psedomenopausal state and can relieve some of the problems associated with endometriosis. But treatment of endometriosis with drugs is limited to about six months or so to prevent a detrimental effect on bone density. Laparoscopic surgery is yet another endometriosis treatment advocated by some doctors. The surgeon aims at removing all endometriosis lesions, cysts and adhesions. This is done is severe cases of endometriosis and infertility.
Polycystic Ovarian Syndrome
In PCOS, under-developed follicles accumulate in the ovaries. Since they fail to mature, they accumulate as cysts in the ovaries. The low levels of follicle stimulating hormone (FSH) and elevated levels of androgens may be the reasons for this condition. When there is no ovulation, the progesterone hormone is not created and the lining of the uterus is not shed in a timely fashion. This increases the chances of endometrial hyperplasia and even cancer.
Another feature associated with PCOS is hyper androgenism or increased responsiveness to testosterone. This usually shows up in oily skin and acne. Excess hair may be noticed on the face and other parts of the body. Women suffering from PCOS have a weight problem, especially around the waist. Insulin resistance is also noticed in some women. This increases the risk of developing diabetes in later years.
Polycystic Ovarian Syndrome Symptom
- Absence of menses or abnormal or scanty menstrual periods
- Weight gain
- Infertility
- Aggravated acne
- Increased hair growth in a male pattern
High levels of insulin can result in symptoms such as high androgen levels, infertility and lack of ovulation. These symptoms are usually noticed when women are in their 20s or 30s. Diagnosis of PCOS is after a physical examination and laboratory tests. Thyroid and prolactin levels in the blood are tested. Serum levels of male hormones (DHEA and testosterone) are tested for higher than normal levels. Tumors in the ovary or adrenal glands can be diagnosed with vaginal and abdominal ultrasounds. Insulin resistance is vital in the diagnosis of PCOS. Insulin is instrumental in regulating the ovarian function. An ovarian biopsy may also be done.
Treatment for Polycystic Ovarian Syndrome
Treatment for women with Polycystic Ovarian Syndrome depends on what stage of a woman's life this condition has manifested and her fertility desires. Birth control pills are prescribed to regularize the menstrual cycle and reduce the risk of uterine cancer. Other medications used in the treatment of PCOS are flutamide and spironolactone.
Clomiphene induces the pituitary gland to secrete more FSH and this stimulates release and maturity of ova. Insulin resistance is reduced with drugs such as Metformin (Glucophage) and Troglitazone. 'Ovarian drilling' is a process of using laser to place small holes in the ovaries so as to normalize the hormonal environment and allow normal ovulation.
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