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 endometriosis. 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.

Prolactin

Prolactin is a protein hormone and is also known as 'milk hormone', PRL and luteotropic hormone. It plays a role in lactation, metabolism and regulation of the immune system. The production of Prolactin is controlled by another hormone called as dopamine. Estrogen is also another prolactin regulator.

Normal Prolactin levels

Women: 2 to 29 ng/mL

Pregnant Women: 10 to 209 ng/mL

Men: 2 to 18 ng/mL

Prolactin levels are an indicator of a person's fertility.

Prolactin levels of between 30 ng/mL and 200 ng/mL are considered moderately high. Elevated prolactin levels or hyperprolactinaemia can be attributed to Hypothyroidism, pregnancy, prolactinoma (pituitary tumor), estrogen deficiency (females), testosterone deficiency (men), medications affecting dopamine action, anorexia, PCOS or menstrual irregularities. When prolactin levels are high, infertility might occur due to lack of ovulation. Men might suffer erectile dysfunction.

Reduced prolactin levels or hypoprolactinaemia are very rare. It can happen due to medication such as levodopa and dopamine. Hypopituitarism is also another cause for low prolactin levels. It can lead to delayed puberty and growth or premature aging.

Prolactinoma

A prolactinoma is a benign pituitary tumor that causes excess secretion of prolactin. It is more likely to occur in women than in men. Prolactinoma can lead to cessation of menstrual cycle, abnormal milk discharge, vision problems and infertility in women. In men, the symptoms are headaches and vision changes, impotence, infertility and reduced sexual interest. It also leads to lowered bone density for women and men.

To treat prolactinoma, blood tests are done to check the levels of other pituitary hormones. MRI of the brain is done to detect the tumor. Prolactinoma less than 10 mm are called microprolactinomas while the larger ones are called macroprolactinomas. Oral medications most often can reduce prolactin production and provide relief. Some medications such as dopamine agonists can shrink the tumor. Cabergoline and bromocriptine are commonly prescribed to reduce tumors and normalize prolactin levels. Surgery is resorted to based on the size and location of the tumor.