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In a typical 28-day reproductive cycle for women, an egg is released from a follicle in one of the woman’s ovaries. The egg travels via the fallopian tube where it could be fertilised by a man’s sperm.
The fertilised egg, called an embryo, would then travel to the woman’s uterus. Implantation of the embryo happens in the uterus, where the embryo subsequently develops into a fetus.
The menstrual cycle repeats itself if there is no fertilisation or implantation.
Female infertility can be due to:
- Ovulation disorders, or infrequent or non-exist ovulation, which can be caused by:
- Polycystic ovary syndrome (PCOS)
- Hypothalamic dysfunction
- Premature ovarian failure
- Excess prolactin
- Blocked or damaged fallopian tubes: this prevents sperm from reaching the egg or can block the migration of the egg into the uterus
- Endometriosis: this is when tissue that should stay within the uterus instead implants and grows in other locations. The scarring from surgical removal of this tissue may block fallopian tubes and prevent fertilisation.
- Endometriosis can also be an issue inside the lining of the uterus, affecting implantation of the embryo.
- Uterine or cervical causes:
- Benign polyps or tumours in the uterus.
- Uterine abnormalities since birth
- Cervical stenosis: narrowing of the cervix
- Lastly, there’s unexplained infertility, in which the cause of infertility is never found.
Certain factors may put a woman at higher risk of infertility, including:
- Age. The quality and quantity of a woman’s eggs decline with increasing age. In the mid-30s age range, the rate of follicle loss speeds up, resulting in fewer and poorer quality eggs. This leads to greater difficulty in conceiving, and an increase in the risk of miscarriage.
- Smoking. Besides damaging your cervix and fallopian tubes, smoking increases the woman’s risk of miscarriage and ectopic pregnancy.
- Weight. Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
- Sexual history. Sexually transmitted infections can damage the fallopian tubes, which can cause fertility problems.
- Alcohol. Excessive consumption of alcohol can affect fertility. Moderate alcohol consumption of no more than one alcoholic drink per day is recommended.
Screening for Infertility
Preliminary screening would entail blood tests to investigate if there are any hormonal factors affecting fertility.
Ultrasound Scans are used to monitor the ovaries for developing follicles, as well as to detect abnormalities in the womb.
A hysterosalpingogram can be done to detect any blockage in the fallopian tubes. This
procedure, done in the hospital, involves infusing a solution through the cervical cavity. An x-ray would then be done to show if there is any flow of the solution through the tubes.
Hysteroscopy and laparoscopy are surgical procedures which are done in the hospital. Both procedures use a tiny camera which allows the doctor to observe the uterus, its surrounding and the ovaries. The doctor would be able to see if there are any polyps, fibroids or cysts.
There are various treatment options available based on the diagnosis of the cause of infertility.