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Infertility refers to being able to get pregnant after one year of trying. Women who can get pregnant but are unable to stay pregnant are also termed as infertile. Ovulatory disorders are one of the most common reasons why women are unable to conceive and is presen in 30% of women suffering from infertility.
- Hormonal problems: Ovulation is linked with a complex balance of hormones and any disruption in the process can hinder ovulation. The disruption includes the fact that the ovaries are not producing normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and there are no chances of fertilization. Polycystic ovary syndrome is the most common disorder responsible for infertility. Malfunction of the hypothalamus leading to failure in triggering hormonal stimulus to ovaries for egg maturation leading to immature eggs and ovarian failure. Malfunction of the pituitary gland leading to imbalance in hormonal secretion thus causing disturbance in ovulation. This can occur due to physical injury, a tumour or a chemical imbalance in the pituitary.
- Scarred ovaries: Ovulation failure can also be due to a physical damage to the ovaries. Invasive surgeries involving ovarian cysts leads to damaging or scarring of capsule of the ovary to become due to which follicles cannot mature leading to disruption of ovulation.
- Premature menopause: Early menopause or premature menopause before the normal age means that the natural supply of eggs has been depleted. This is most common in extremely athletic women with a history of low body weight and extensive exercise.
- Follicle problems: Infertility is also caused due to non-ruptured follicle syndrome in which women who produce a normal follicle, with an egg inside of it, every month but the follicle fails to rupture. This leads to disruption of ovulation as the egg remains inside the ovary.
- Others: Treating female infertility by chemotherapy is next to premature ovarian failure by loss of primordial follicles. Sexually transmitted infections are a leading cause of infertility. Tobacco smoking is detrimental to the ovaries and the amount of damage is dependent upon the amount and length of time of exposure of smoke in the environment. Nicotine in cigarettes interfere with the body’s ability to create oestrogen, a hormone that regulates ovulation. In addition, blocked fallopian tubes due to pelvic inflammatory disease or surgery for an ectopic pregnancy also causes infertility. Infertility can also be due to physical problems with the uterus or fibroids of uterus where non-cancerous clumps of tissue and muscle on the walls of the uterus.
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Trying to get pregnant can go either ways for most couples that is it can be a breeze, or it can be a difficult process that ends up with lots of fertility clinic visits. While in some cases, the reasons for not being able to conceive may come down to male infertility, there are many cases where the reason may be female infertility too. In many other cases, both male and female infertility may be the cause.
Let us discuss female infertility in more details here.
When can it be called Infertility?
When a couple is not being able to conceive even after trying for a period of over a year, then a case can be made in favour of infertility. Infertility can result from females in at least one third of the cases, as per various medical studies. While the actual cause may be difficult to diagnose, there are many available treatments that one can use in order to fix the underlying issues.
When to Start Worrying?
Female infertility comes with many symptoms, while the main symptom may be the inability to conceive, the other symptoms include excessively long menstrual cycles that show signs of slowing down only after 35 days or so, or even cycles that are too short where they appear within 21 days. Irregular and absent periods can point at the lack of ovulation which is the main sign of infertility. Other than that, there are no outward signs of infertility as such apart from pelvic pain and cramping or heavy bleeding during periods. If you are 30 years of age, or younger, then you may want to see a doctor regarding irregular and absent periods, or the lack of conception even after trying for a year. Also, if you are between 35 and 40 years of age, you can discuss the inability to conceive with your doctor, after efforts for six months. If you have been trying to conceive and you are over 40 years of age, then the doctor will put you through tests on an immediate basis.
The Requirements for Conception?
In order to conceive, you will need to ovulate on a normal basis and have regular menstrual cycles as well as intercourse. Also, your fallopian tubes and uterus must be in normal working condition without any infections and other conditions.
There may be many causes for female infertility including ovarian faults like polycystic ovary syndrome (PCOS), hypothalamic dysfunction, premature ovarian insufficiency and excessive prolactin in the ovaries. Also, pelvic inflammation disorders that lead to damage of the fallopian tubes and other uterus related issues like endometriosis can lead to female infertility.
In case you have a concern or query you can always consult an expert & get answers to your questions!
I am 35 and we are trying to conceive. Dr. have done some test which is as under. Tsh 0.903 Prolactin 12.06 Amh 1.32 Hsg normal Hsa normal PCT normal Now Dr. is asking to do follicular Monitoring. Medications. ovaries plus and folvite for 3 months Letroz 2.5 5 days from periods day 2. Is there any complications? To undergo so many tests and medicine Dr. now advised to do follicular Monitoring. What for? Can pregnancy not happen naturally? I had one miscarriage 1 Yr back. Sonography had shown no heartbeats at 8 weeks Am I going to correct Dr. or should change the Dr. Pls advise.
The ovaries are an important part of the female reproductive system. In a normal scenario, a woman has two ovaries that lie on either side of the uterus. Their main function is to produce eggs and release them into the fallopian tubes. These eggs then travel to the uterus where they may be fertilized. The ovaries are also responsible for the release of estrogen and progesterone. These hormones help regulate the menstrual cycle.
The functioning of the ovaries is directly related to a woman’s age. When a girl is born her ovaries have approximately 2 million eggs. These are in the form of follicles. By the time she reaches puberty, this number would have reduced to around 400,000. It is believed that a woman releases only around 450 eggs during her entire reproductive period. This is less than 1% of the eggs she was born with. During each menstrual cycle, one of the follicles will mature into an egg and be released. At the same time, some follicles may die. Thus, as a woman ages, the number of eggs available reduces. By her 30th birthday, the rate at which eggs are lost increases. By her 40th birthday, a woman’s eggs will die rapidly. Without a healthy egg being released sperm cells will have nothing to fertilize. Thus, ovarian functioning decreases as a woman grows older. This implies that the risk of infertility also increases as a woman grows older.
Along with a decrease in the number of eggs available the quality of eggs also reduces with age. Thus, though the ovaries may release an egg even when a woman is in her 40s, the chance of these eggs being fertilized is very low. Even if the egg is fertilized, women who conceive a child after the age of 40 have a high risk of miscarriage. There is no direct way to assess the quality of a woman’s eggs but some tests may help indicate the chances of getting pregnant. This includes a Basal FSH to indicate the level of follicle stimulating hormones, tests to determine the amount of Estradiol and tests to determine ovarian reserve. Ultrasounds can also help assess the number of follicles in the ovaries. This test is known as an Antral Follicle Count.
Infertility caused by decreased functioning of the ovaries is usually termed as unexplained infertility. In such cases, IVF is often the most preferred form of treatment.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Pregnancy is something, which is quite divisive. The mere prospect of it can really go a long way in scaring people. At the same time, for some others, giving birth to a baby can be the primary cause for a lot of happiness. When a couple is having trouble conceiving, infertility is usually the reason why there is a relationship strain between the two of them. Considering this, doesn’t it make sense to learn a bit about infertility and the truth to all that is said about it so as to separate the wheat from the chafe?
To start with, it is often said that when there is an infertility issue, it is probably due to the lack of fertility of the woman rather than the man. However, this is pretty untrue. It has been found that both men and women are responsible for infertility almost equally. In fact, according to a study, in about a fifth of the cases of infertility, the reason for it was that both the man and the woman were not fertile.
Many people say that, if a woman wishes to have a baby, she should do so before she crosses the age of 35. This is true to some extent as the chances of a woman conceiving do fall to a significant extent after the age of 35. As a matter of fact, a woman can expect to reach the peak of her fertility while she is in her twenties, itself!
Without a shadow of doubt, having sex around the time of ovulation is the key to getting pregnant. However, it is believed by a large number of people that there is no chance of getting pregnant if sex is had too soon or too late after ovulation as sperms only live for a few hours after an intercourse. The truth is that the sperms have the ability to live for several days.
When planning to conceive, many women believe that for about a quarter of a year or three months after they stop making use of the birth control pill, they will not be able to get pregnant. The good news for them is that as soon as the pill is stopped, the levels of a woman’s hormones return back to their pre-pill levels almost immediately and ovulation can be expected to occur at the time of their following cycle.
There can be a number of reasons that lead to infertility in women. Endometriosis is one of them. It is a benign condition where the endometrium, which includes the tissues that form the lining inside the uterus, grows outside the uterus. Apart from infertility, it may also cause pelvic pain in women.
There are no such symptoms of endometriosis apart from pelvic pain and it cannot be detected without surgery. Thus, it is very difficult to diagnose this disease and state how common it is. However, research says that the prevalence of this disease in women in their reproductive age is between 3 to 10 per cent.
It is found that endometriosis sometimes leads to infertility. Here is how:
Abdominal Adhesions and Infertility
Normally, the endometriosis implants develop in the abdomen. Then the body surrounds them with connective tissues. The reason for doing so is isolating the implants, so that they cannot harm your body.
Now, sometimes these adhesions can create a blockage in the opening of the fallopian tube or may also pinch off the fallopian tube. This will result in obstruction in the fertilisation of egg and the sperm and thus fertilization will not take place; so there are no chances of conceiving. These obstructions when diagnosed can be treated with surgery.
Secretions from implants
Endometrium plays a vital role in conception where the tissues secrete a wide variety of hormones and nutrients. Now, the endometrial implant also functions in the same way and secretes those hormones. The difference is that it does not deposit them in the lumen of the womb, and it is released in the abdominal cavity. In these substances, there may be some hormones that are responsible for infertility.
Prostaglandins are other hormones that are secreted by the endometrium normally. It helps in a lot of body processes that include various stages of menstrual cycle and pregnancy.
This hormone is required for a lot of functions such as ovulation, sperm mobility, and regression of corpus luteum, immune interaction, menstrual cramps and contraction of the uterus at birth.
Just like the endometrium, the implants also secrete these hormones. And the problem that is caused by the implant secreted prostaglandin hormone is that they are released in the abdomen and not in the womb. Moreover, they are not secreted at the right time, thus sending a wrong message to the brain.
A woman with a few days of pregnancy may face a miscarriage because the ovary will get a signal to start the menstrual cycle, and the womb lining where the egg is implanted will be expelled.
Infertility can be defined as the inability to get pregnant despite having unprotected sex for more than a year. Infertility can affect both men and women. There are many causes for this. Tubal infertility or infertility caused by blocked or scarred fallopian tubes accounts for around 25% of female infertility. Blockage in the fallopian tubes could also increase the risk of ectopic pregnancies.
The fallopian tubes connect the ovaries to the uterus. When an egg is released by the ovaries, it must travel through the fallopian tubes to reach the uterus. If the egg does not reach the uterus, it cannot be fertilized. There may be many causes for scarring of the fallopian tubes or blockage of the same. Some of the common causes are:
Infertility may be said to be caused by irregularities in the fallopian tubes if no other cause of infertility is found in standard infertility tests. To confirm this diagnosis, a hysterosalpingogram may be conducted. For this test, a dye is injected into the uterine cavity through the cervix. An X-ray is then used to follow the flow of this dye through the fallopian tubes into the abdominal cavity. However, this test does not indicate if the fallopian tubes are scarred. A laparoscopy may also be performed to detect the extent of scarring and damage within the fallopian tubes. In extremely rare cases, tubal catheterization may also be performed to assess the states of the mucus lining the fallopian tubes.
Tubal infertility can be treated in two ways; surgery to treat the fallopian tube scarring or clear blockage and IVF or In Vitro Fertilization. Surgical treatment for tubal infertility depends on the extent of the damage. In the case of scarred fallopian tubes, the scar tissue may be resectioned with lysis of adhesions. In case of blocked fallopian tubes, surgery aims at clearing the blockage so as to reopen the tubes. In some cases, reconstruction of the tubes may also be required.
IVF involves harvesting the eggs from the woman and introducing them to sperm cells in a laboratory. 3-5 fertilized zygotes will then be reintroduced to the woman’s womb. IVF has a much higher success rate as compared to tubal surgery. However, it involves the use of hormone medications and hence is usually considered a last resort. The IVF process can be repeated multiple times in case the pregnancy does not reach full term.
INVO (intravaginal culture of oocytes), also called IVC (Intravaginal culture) is an abetted procedure of reproduction where early embryo development and oocyte fertilization are carried out inside a gas penetrable, air-free plastic tool or device that is placed into the maternal vaginal chamber for incubation. It is a device that helps the future mothers to participate in the evolution and growth of their own embryos present inside their body. The device is composed of an inner cavity with a protective outer rigid shell and a rotating valve.
It can be used for IVF (In Vitro Fertilization) cycles; whether with the mother's own eggs or any donor's eggs. It provides the same successful results as conventional treatments. It works in a very simple way:- when the requisite samples to produce embryos have been acquired or when the eggs have been impregnated in the laboratory, they together with culture medium are placed into the INVOcell device and then the device is inserted into the vagina of the mother and there it is kept for two to three days (for 72 hours culture period). Throughout this time, the mother can lead a practically normal life but she needs to elude taking bath, having intercourse or flying during those days on which she is wearing it.
When fertilisation takes place, it will be the mother's own heat which will supply the best conditions for the proper development of the embryos. Once they are set and ready, the doctor will remove the INVO from the mother's vagina to recover the embryos. The embryos are then evaluated under the microscope to choose the healthiest-looking ones to transfer them into the uterus. Within the uterus they will be embedded in order to begin developing.
Advantages of INVO are:
- It is one of the most cost-effective assisted conception treatments.
- In this method, the embryo incubation is more natural.
- Since in this whole process embryo incubation in the laboratory isn’t required, the possibility of stumbling at the laboratory is diminished.
- In this method, the couple experiencing the treatment is involved more.
- This method has similar efficacy as the IVF treatments.
Disadvantages of INVO are:
- Since the device has to remain for three days in the mother's vagina, it causes some discomfort.
- The patient has to spend much time in the assisted reproduction clinic and visit it more often.
The studies suggest that it could be a usable alternative choice for assisted reproduction.
Almost every man and woman craves to have a child they can call their own. This makes an inability to procreate one of the most dreaded situations. Infertility can be defined as the inability to conceive a child within 12 months of biologically appropriately timed intercourse. Infertility exacts a huge psychological toll on the person.
Infertility often triggers depression in a person. This may be acute and result from specific events such as the holidays, family celebrations of the news of a someone else having conceived a child or could be cyclic and coincide with phases of their fertility cycle. This depression could lead to problems at work and communication with the spouse.
Infertility can also make a person feel helpless and affect their self esteem. Infertility accompanied by depression can trigger the feeling of having lost control over one’s life and can make people withdraw into themselves.
An infertile person may also often feel guilty and make them blame themselves and their prior actions for the condition. This leads them to question their worthiness of being a good spouse and potential parent. A woman who has suffered from an STD earlier or has undergone an abortion earlier can become obsessed with blaming herself for being infertile.
This affects their daily lives and ability to work. An infertile person may also feel guilty for having robbed their partner of the chance to become a parent. This can put a strain on their relationship and in many cases lead to a broken marriage.
When they find themselves unable to conceive a child, a couple may try to time their intercourse with ovulation tools, such as an ovulation thermometer etc. and may try different positions, some of which may be fairly uncomfortable. They may also end up having intercourse more often than desired. In order to prevent sperm from leaking out of the vagina, a woman may also find herself lying in an awkward supine position after intercourse. A combination of all these factors makes the act a chore and with time can lead to a loss of libido.
Infertility can also trigger anger against life for having been treated unfairly or towards other parents. This may also be displaced towards their family and friends leading to situations where they feel ostracized and unsupported.
When dealing with infertility, it is important to understand that neither partner is to blame. Infertility is a physiological condition and can be treated in most cases.
Almost all women with the ability to reproduce develop ovarian cysts at some point or the other but not all of them suffer from PCOS or have infertility issues. PCOS affects only around 10% of women of reproductive age. It is important to note the PCOS or Polycystic Ovarian Syndrome does not cause cysts but leads to the development of follicles. This causes a hormonal imbalance. The results of this hormonal imbalance can be noted in many ways including infertility.
- Infertility can be described as the inability to conceive and reach full term despite having unprotected intercourse at the right time of a woman’s menstrual cycle for over a year. One of the main ways in which PCOS interferes with fertility is by disturbing the natural ovulation cycle. Normally, a woman ovulates once a month. At this time an egg is released by either one of the ovaries. As a result of PCOS, these eggs are not released. This is because the ovaries of a woman suffering from PCOS are much larger than normal and have a number of small antral follicles that do not allow the egg to mature. Without an egg, sperm cells have nothing to fertilize and hence a woman cannot conceive. PCOS also causes irregular menstrual cycles. This makes it difficult to determine the period of ovulation.
- PCOS can be managed with medication but there is no cure for this condition. Thankfully, infertility caused by PCOS can be treated and these women can have healthy pregnancies. For this, you will need to consult a fertility specialist. There are two forms of medication to treat infertility caused by PCOS. Birth control pills, with a combination of synthetic estrogen and progestin, can help regulate the menstrual cycle. In some cases, a doctor may prescribe progestin-only pills. These pills need to be taken daily for two weeks for up to 2 months. Medication may also be prescribed to stimulate ovulation. This medication may be the form of pills or injections.
- Lifestyle changes can also help improve your fertility. For example, being overweight or obese can aggravate hormonal imbalances. With a healthy diet and regular exercise, you should be able to reduce your weight. This, in turn, can make menstrual cycles more regular. In addition, you should quit smoking, meditate and reduce your exposure to stress and pollution. This makes your body healthier and increases your chances of conceiving a baby.