Female Causes of Infertility
There are different medical conditions in the female that may affect a woman’s fertility. Disorders and abnormalities of by her ovulation, tubes and womb could cause infertility. Some common conditions are listed below:
- Pelvic inflammatory disease (PID). This is one of the common conditions causing infertility worldwide. It is a sexually transmitted disease leading to infection of the pelvis. As a result of PID, the tubes could be scarred by the infection and be blocked causing infertility and increased risk of ectopic pregnancy.
- Polycystic ovarian syndrome (PCOS). This is also a common condition where there is an unbalanced hormones in the body. The ovaries, produces excessive male hormones (testosterone)
- Endometriosis. This refers to a condition where some patches of uterine lining implants outside the uterus i.e the pelvic cavity, tubes and ovaries. This implant would bleed every menstrual cycle causing scarring within the pelvis leading to distortion of the tubes and blockage. In addition, in could develop and grow into a cyst within ovary containing old blood (endometrioma)
- Abnormalities of the uterus e.g septum or fibroid causing difficulties with embryo implantation.
2. What are the investigations done to determine the cause of female infertility?
a. Hormone levels (including FSH, LH and Day 21 progesterone level to confirm that you are ovulating) Blood test will be done for this.
b. Assess tubal patency. This could be done either by:
i)Hysterosalpingogram (HSG) which is a x-ray done of your uterus and tube after a dye is injected through your cervix.
ii)Laparoscopy and dye test. This is an operation requiring general anaesthetic. The doctor will make one small incision at your belly button and another above your pubic bone. This operation would allow the doctor to inspect your pelvis, uterus, tubes and ovaries for any abnormalities. In addition, a dye test could be done to check the patency of your tubes.
c. Pelvic ultrasound. This would assess the uterus, ovaries and tubes. However, pelvic adhesion (scar tissue) could not be seen using the ultrasound.
3. What are the general treatment for female infertility?
This depends on the result of the investigation and the underlying problem:
i) For problems with ovulation:
You will be given drugs which will stimulate the production of your eggs e.g Clomid (Clomiphene) or injections (gonadotrophin)
ii) For blocked tubes
If both of your tubes are blocked, you will either be offered a surgery on your tubes (tuboplasty) or In-vitro Fertilization (IVF) if you can afford the high cost of the latter treatment.
iii) Endometriosis
You will either be offered a surgical operation to stage and remove the endometriotic deposits within your pelvis. Later on you will be given some medication (GnRH agonist) to suppress your menses which will also suppress the activity of your endometriosis. An example of this medication is Lucrin. For severe stages of endometriosis, IVF is usually offered.
iv) Fibroid or uterine abnormalities
If the fibroid or uterine abnormalities is thought to be the cause of infertility. You may be offered surgical treatment to remove the fibroid or correct the uterine abnormalities.
