When a couple faces such a diagnosis, then both the man and the woman must go through all the stages of diagnostics to identify the possible cause of infertility.
Female infertility can be primary – when a woman has never been pregnant before, and also secondary – when a woman has already been pregnant, regardless of the outcome of the pregnancy.
The following are the most common causes of female infertility and its treatment:
1. Obstruction or functional insufficiency of the fallopian tubes
Tubal factor occupies one of the leading laces. Most often it is the presence of an adhesive process in the abdominal cavity, leading to a disorder of the patency or functioning of the fallopian tubes. Adhesions most often occur after infectious diseases of the genitourinary system, due to endometriosis, as well as after surgery in the abdominal cavity.
In addition, the cause of obstruction of the fallopian tubes can be hydrosalpinx – a condition that occurs when the abdominal end of the fallopian tube is obstructed, which leads to the accumulation of fluid in its lumen, which has an embryotoxic effect and can lead to infertility, even if the other fallopian tube is not affected.
In most cases, these pathologies are subject to treatment or surgical correction.
If there are no irreversible changes in the fimbriae and the inner lining of the tubes, for example, when the adhesive process is caused by gentle membranous adhesions, then the mechanical separation of adhesions and the restoration of normal anatomy will most likely allow the woman to become pregnant without medical assistance after such operation.
The “age” of the disease is also important – the less time has passed since the formation of adhesions/hydrosalpinx, the greater the likelihood of restoring normal functioning of a fallopian tube.
2. Infertility caused by endometriosis
Endometriosis is also one of the leading causes of infertility. According to the American Society for Reproductive Medicine (ASRM), up to half of women with endometriosis experience infertility.
Moreover, some forms of endometriosis cannot be detected by any diagnostic methods, except for diagnostic laparoscopy. The causes of infertility in endometriosis are quite diverse:
- endometrioid ovarian cysts;
- adhesive process in the small pelvis;
- violation of the receptor apparatus of the endometrium;
- changes in the peritoneal fluid, leading to disruption of the fertilization process.
Some mechanisms of infertility during endometriosis are not yet well understood. Sometimes pregnancy may not occur with even superficial mild endometriosis without significant adhesions or organ damage.
However, with the timely detection of endometriosis, correctly performed surgical treatment and timely prescribed medication, the percentage of pregnancies without medical assistance is quite high.
3. Pathology of the uterus and endometrium
Infertility associated with endometrial pathology is a case in which the endometrium does not have the necessary properties to ensure the implantation and attachment of the egg. Most often, these are endometrial polyps, hyperplasia, chronic endometritis.
On the part of the uterus, the main causes of infertility are the following:
- hysteromyomas, especially those in the submucosal layer and lead to deformation of the uterine cavity;
- adenomyosis (endometriosis in the uterus wall) which reduces the functionality of the endometrium for implantation and attachment of the egg;
- anomalies in the uterus development, such as a bicornuate uterus, duplication of the uterus, or septate uterus (although the latter is more likely to lead to miscarriage than to the absence of pregnancy);
- adhesive process inside the uterine cavity (Asherman’s syndrome) occurs as a result of inflammation or after operations in the uterine cavity.
4. Endocrinological infertility
Failure in hormonal regulation at any level can also be the cause of infertility.
Various failures of hormonal regulation can lead to impaired egg maturation, lack of ovulation, unpreparedness of the endometrium for egg implantation, and other problems that prevent a woman from becoming pregnant.
One of the most common endocrinological diseases leading to infertility is PCOS – polycystic ovary syndrome.
It occurs in 5-10% of women and is usually manifested by increased blood levels of androgens, amenorrhea/oligomenorrhea, excessive male-pattern hair growth, and acne.
A woman can be diagnosed with PCOS if she has two of the following three symptoms:
- clinically and laboratory proven hyperandrogenism (increased levels of male hormones);
- multifollicular ovaries, having more than 10 follicles in each ovary according to ultrasound;
- anovulation or oligoovulation.
Many different endocrinological diseases (insulin resistance, luteal phase deficiency, thyroid pathology, ovarian failure syndrome, hypothalamic syndrome, diabetes mellitus, adrenal gland pathologies, etc.) can lead to problems with the onset of pregnancy.
In the treatment of endocrinological infertility, consultation and treatment with an endocrinologist is necessary, because the main problem in this case lies precisely in hormonal disorders and, after their correction, pregnancy is possible.
