Female infertility

The main symptom of infertility is the inability to conceive. Symptoms may vary based on underlying health conditions that can affect fertility. Common symptoms include:

• Abnormal, irregular, or absent menstrual periods
• Menstrual bleeding that is heavier or lighter than usual
• Painful periods accompanied by back pain, pelvic pain, and cramping
• Pain during intercourse

Additional symptoms indicating a hormonal imbalance may include:

• Acne and skin issues
• Changes in sex drive and desire
• Excessive hair growth on the face
• Thinning or loss of hair
• Weight gain

Confused about irregular periods? What is a normal period? Read this article to answer your questions. Tap here.

To understand the cause of infertility, we should first comprehend the steps in conception and how any issues in each step can hinder the chances of getting pregnant. These include:

1. Sperm transport: The sperm must travel through the female vagina and cervix to reach the site of fertilization. Any changes in the female environment due to hormonal imbalances can destroy the sperm, inhibiting fertilization.
2. Egg transport: This process begins during ovulation, when an egg is released from one of the ovaries and picked up by the fallopian tube, where it travels to the uterus. Conditions such as pelvic infections and endometriosis can permanently impair the function of the fallopian tubes, leading to infertility.
3. Fertilization and embryo development: This crucial step involves the union between the sperm and egg for pregnancy to occur. Impairments in the fallopian tube can result in fertilization occurring in the tube itself, leading to ectopic pregnancy.
4. Implantation: This process involves the embryo attaching to the surface of the uterus and beginning to develop into a baby. Abnormalities in the uterus, hormonal or metabolic imbalances, infections, or immunological factors can lead to defective implantation, resulting in miscarriages.

The various factors that can cause infertility in females include:

1. Ovarian causes:
   • Polycystic ovary syndrome (PCOS): A hormonal disorder in which the ovaries produce large amounts of male sex hormones or androgens, interfering with the development and release of eggs. Some eggs develop into cysts, hence the name polycystic ovary syndrome. PCOS has been linked to infertility in women.
   • Premature ovarian failure (POF): Refers to the loss of function of the ovaries before the age of 40, characterized by a decrease in the hormone estrogen, loss of female egg cells, and infertility.
   • Hyperprolactinemia: High levels of the hormone prolactin interfere with the normal production of other female hormones, such as estrogen and progesterone. This can alter or halt ovulation and may lead to irregular or missed periods.
2. Tubal and peritoneal causes:
   • Inflammatory diseases: Infections of one or more of the upper reproductive organs, including the uterus, fallopian tubes, and ovaries, can cause inflammation and predispose individuals to infertility issues.
   • Endometriosis: A condition characterized by the growth of tissue resembling the uterine lining outside the uterus. This extra tissue and its surgical removal can cause scarring, blocking the fallopian tubes and making it difficult for the egg and sperm to meet.
3. Structural abnormalities:
   • Uterine anomalies: Uterine malformations characterized by adhesions and/or fibrosis within the uterine cavity can lead to infertility.
   • Fallopian tube anomalies: Any obstruction in the tubes prevents the ovum and sperm from converging, making fertilization unfeasible.
   • Cervical anomalies: Cervical stenosis (narrowing or closing of the passageway through the cervix) may affect natural fertility by impeding the passage of semen into the uterus.

• Age: Fertility declines with advancing age. The 20s and early 30s are usually the best time to conceive. It becomes difficult to conceive after the age of 35.
• Being underweight or overweight: BMI (body mass index) plays an important role in fertility. Being significantly overweight or underweight can cause hormonal changes that affect fertility rates.
• Stress: Stress alone cannot cause infertility, but it can interfere with your ability to get pregnant. Research has shown that anxiety can prolong the time needed to achieve pregnancy.
• Genetic factors: Gene mutations can cause female infertility and pregnancy disorders.
• Environmental factors: Exposure to pesticides, radiation, air pollution, heavy metals, and other chemicals can disrupt hormones leading to infertility.
• Hormonal disorders:
  • Thyroid conditions: Thyroid diseases are associated with an increased risk of prematurity or stillbirth and can affect fertility.
  • Diabetes: Studies show that diabetic women are at increased risk of infertility, delayed puberty, absence of periods, menstrual irregularities, and possibly earlier menopause.
  • Others: Excess growth hormone and testosterone also increase the risk of female infertility.
• Lifestyle:
  • Diet: Food items with a high glycemic index can cause infertility among women. Packaged, processed, and fried foods predispose to obesity and diabetes, both known risk factors for female infertility.
  • Smoking: In women, smoking can increase the risk of miscarriage and ectopic pregnancy (when a fertilized egg implants and grows outside the uterus).
  • Excessive alcohol: Excessive alcohol intake can lower fertility rates in women. According to the American Cancer Society, it is best not to drink alcohol. Women who choose to drink should limit their intake to no more than 1 drink a day.
  • Caffeine: Studies have found that women who drink large amounts of caffeine may take longer to become pregnant. High concentrations of caffeine are also found in energy drinks.
• Sexually transmitted diseases (STDs): STDs are often associated with a decreased risk of fertility. Some identified STDs include syphilis, Chlamydia, gonorrhea, herpes simplex virus, human papillomavirus, and HIV.
• Chemotherapy: Studies have shown that ovarian function decreases with chemotherapy, increasing the risk of infertility in women.

Infertility can be caused by multiple factors. Arriving at a correct diagnosis can help plan the treatment accurately, focusing on treating the problem. The diagnosis mainly consists of the following:

1. History
   A detailed history must include the duration of infertility, menstrual history, gynecological history (including a history of sexually transmitted infections), and sexual history (including frequency and timing of intercourse). Social and lifestyle history along with family history are also taken into account.
2. Physical examination
   The physical exam includes vital signs and BMI, thyroid evaluation, examination for abnormalities of the vagina, pelvic masses or tenderness, and uterine enlargement or irregularity.
3. Laboratory tests
   Hormone testing: A hormonal imbalance may be one of the indicators of infertility. Various hormone levels are analyzed for the diagnosis and treatment of infertility, including:
   • Progesterone
   • Luteinizing hormone (LH)
   • Follicle-stimulating hormone (FSH)
   • Inhibin-B
   • Anti-mullerian hormone
   • Prolactin
   • Thyroid Stimulating Hormone (TSH)
   • Dehydroepiandrosterone Sulphate (DHEAS)
   • Estradiol (E2)
   • Testosterone
   • Insulin-like growth factor-1 (IGF-1)
   Post-coital test: This test analyzes cervical mucus within a few hours of sexual intercourse to examine the interaction between sperm and cervical mucus. Antisperm antibody tests: This test detects if a woman’s immune system may produce proteins that attack sperm (anti-sperm antibodies). Clomiphene citrate challenge test (CCCT): This sensitive test identifies a decreased ovarian reserve by checking both FSH and estradiol levels between days 2 and 4 of the menstrual cycle.
4. Imaging tests
   Hysteroscopy: This test is the gold standard for assessing the uterine cavity, allowing direct visualization of intrauterine pathology and providing an opportunity for immediate surgical correction. Hysterosalpingography: This common test examines the fallopian tubes and helps in detecting any blockage or damage to the fallopian tubes and uterine cavity. Laparoscopy: Similar to the hysterosalpingogram, this test detects abnormalities in the fallopian tubes. A small instrument known as a laparoscope is inserted into the body through a cut in the abdomen to view and examine the female reproductive organs. In some cases, it can be used to remove any blockages found. Lower abdomen ultrasound: This procedure uses high-frequency sound waves to scan the internal organs located in the lower abdomen, including the pelvic cavity and reproductive system. Transvaginal ultrasound: This ultrasound test helps the doctor examine the uterus for abnormalities such as scarring, fibroids, or polyps. A wand is inserted into the vagina to produce sound waves, providing a clear picture of the reproductive organs, including the ovaries and uterus. Sonohysterograms: This special ultrasound uses sterile saline and air to observe the inner lining of the uterus. The pelvic organs are visualized through a transvaginal ultrasound. Magnetic resonance imaging (MRI): MRIs can be helpful in detecting lesions or rare abnormalities inside the pelvis and uterus.
5. Endometrial biopsy
   A sample of the cells lining the uterus (endometrium) after ovulation is evaluated for signs of inflammation and changes in the endometrium (due to ovulation). It is generally performed about 7 to 12 days after ovulation.

Book your tests now from the comfort of your home. Tap here.

Harmful lifestyle choices have a lasting impact on health and are a major contributing factor to female infertility. Here are a few things you can do to prevent and manage infertility:

• Maintain a healthy weight: Maintaining a healthy weight lowers the chances of ovulation disorders. To achieve this, exercise regularly and eat a well-balanced, wholesome diet.
• Say No to smoking: Tobacco harms your overall health and adversely affects fertility. If you are planning to get pregnant, consider quitting smoking.
• Avoid or limit the consumption of alcohol: Heavy drinking can increase the risk of ovulation disorders. While it is best not to drink alcohol, women who choose to do so should limit their intake to no more than one drink a day.
• Manage stress: Everyone experiences stress from time to time, but prolonged stress can disrupt ovulation. Additionally, infertility can cause stress, creating a vicious cycle. Manage stress effectively through exercise, reading, and meditation, among other techniques.
• Practice safe sex: Sexually transmitted infections can lead to infertility in both sexes. These infections can damage, scar, and inflame reproductive organs, resulting in infertility. Use protection to safeguard yourself and your partner from sexually transmitted infections.
• Treat existing conditions: Identifying and controlling chronic diseases increases your chances of conception. Regular physical examinations, including Pap smears, help detect early signs of infections or abnormalities.

Treatment of fertility problems needs an accurate diagnosis of the condition and a comprehensive and holistic approach. It consists of the following:

Medications

Fertility treatments are most commonly focused on infertility due to problems with ovulation. The most common medications used to treat infertility help stimulate ovulation. Some of them are:

• Clomiphene
• Gonadotropins
• Letrozole
• Bromocriptine
• Metformin

Hormonal therapy

Hormone treatment is particularly suitable for women with impaired egg maturation or no ovulation at all. It includes:

• Gonadotropins
• Human menopausal gonadotropin (HMG)
• Follicle-stimulating hormone (FSH)
• Luteinising hormone (LH)
• Pergonal
• Clomiphene citrate-human menopausal gonadotropin (CC-HMG) combination

Surgery

If infertility is due to anomalies in the reproductive organs like the uterus or fallopian tubes, the following surgeries might be advised:

• Laparoscopic surgery: It helps with problems with the uterus (womb) by removing endometrial polyps and fibroids (growths made of the uterine muscle).
• Tubal surgery: If the fallopian tubes are found to be blocked, scarred, or damaged, they can be repaired surgically.

Assisted reproduction

• Intrauterine insemination: In this procedure, many sperms that are washed and concentrated are placed in your uterus around the time of ovulation. It can help if you or your partner have a low sperm count, mild endometriosis, unexplained infertility, or issues with ejaculation or erection.
• IVF (in-vitro fertilization): During this process, mature eggs are taken and fertilized by sperm in a lab. The fertilized egg/eggs are then transferred to the uterus. This procedure is suggested if you have endometriosis, blockage in fallopian tubes, genetic disorder, or unexplained infertility.
• GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer): In these procedures, the sperm and egg are collected and placed in the fallopian tube. In GIFT, both the sperm and egg are placed without fertilization. In ZIFT, the sperm and egg are fertilized, and the embryo is placed in the fallopian tube.

An effective way to manage infertility is to maintain a healthy lifestyle. Here are a few home remedies that can help:

1. Tweak your diet: The importance of food and diet in fertility cannot be overstated. Incorporating the following foods can be very beneficial while trying to conceive:
• Pomegranate (Anaar): This fruit is very useful in treating female infertility. Consume at least one fresh pomegranate daily to support ovarian health.
• Indian ginseng (Ashwagandha): This herb powder, when mixed with milk, helps balance hormones and supports reproductive organs.
• Cinnamon (Dalchini): Studies suggest that cinnamon positively affects hormones and improves menstrual regularity in women with PCOS.
• Dates (Khajoor): Including dates in your diet may help reduce the risks of infertility.
2. Cut down on caffeine: While small quantities of caffeine do not significantly affect female infertility, consider reducing your intake if you are trying to conceive. If you are already pregnant, it is advisable to avoid caffeine altogether.
3. Make no excuse to skip exercise: Regular moderate exercise can positively influence fertility in women. Those who engage in consistent exercise may conceive more quickly than those who do not.
4. Take time to relax: The stress associated with infertility, including numerous tests and doctor visits, can disrupt hormonal balance. It is important to take time to relax and unwind regularly.
5. Add supplements: Micronutrients play essential roles in fertility, and inadequate levels can negatively impact the ability to conceive. Taking folic acid, vitamin D, and omega-3 fatty acids may enhance fertility.

Infertility and infertility treatments can lead to several complications. Here are some of them:

• Multiple pregnancies: One of the most common complications of infertility treatment is the chance of multiple pregnancies. Having twins, triplets, or more can increase the risk of premature labor and delivery.
• Ovarian hyperstimulation syndrome (OHSS): This condition is an exaggerated response to hormones. Some fertility medications can cause OHSS, resulting in swollen and painful ovaries.
• Infections: Although rare, there is a risk of infection associated with reproductive surgery.
• Psychological stress: Infertility procedures can elevate stress levels, leading to depression and anxiety throughout the treatment process, often due to a lack of emotional and educational support. Additionally, infertility can create challenges in marital relationships.

Alternative options can act as an adjunct to conventional treatment for infertility and assist in your journey to conception. Some of these therapies include:

• Relaxation techniques: Multiple relaxation techniques such as meditation, deep breathing, guided imagery, and yoga have been shown to reduce anxiety scores in women undergoing infertility treatment. Yoga, in particular, enhances quality of life and diminishes negative feelings and thoughts associated with infertility.
• Acupuncture: This therapy involves inserting tiny, delicate needles into specific body locations. Acupuncture may help increase blood flow to the reproductive organs, stimulate hormones, regulate ovulation, and reduce stress, all of which can aid in conception. However, it is advisable to consult your doctor before starting acupuncture therapy.

Infertility treatment can take a physical and emotional toll on you. Living with it can be difficult as it can cause feelings of hopelessness and frustration in you and your partner. Here are a few aspects of infertility and infertility treatment that can help you.

Psychological Impact

Infertility can cause anger, depression, and anxiety. Women with infertility often experience common psychological issues such as fear of complications during pregnancy, delivery, or maternity. Additionally, negative thoughts about the possibility of losing your life or the child during delivery, or fears of failing as a mother can contribute to stress that hampers your chances of becoming pregnant.

Addressing these psychological problems is essential for overall health and can increase the chances of conception. The following points can help:

• Learn stress-coping techniques
• Have realistic expectations from every phase of treatment
• Talk to your partner about every aspect of your physical and mental health
• Opt for infertility counseling by a qualified medical health practitioner
• Seek professional help for psychological issues

Psycho-Social Impact

This includes low self-esteem, poor quality of life, and social isolation associated with infertility treatment. Comparisons between women undergoing repeated IVF cycles and first-time participants may lead to increased depressive symptoms. As you navigate through this journey, ensure that you:

• Do not rely on only one option
• Know the other alternatives
• Learn ways to manage stress and anxiety
• Communicate your fears and apprehensions with your partner
• Keep your doctors updated about your mental and physical conditions

Psycho-Economic Impact

Treatment of infertility can have a significant economic impact on a couple's lives. It is important to consider the financial aspects as well. The following tips can help:

• Discuss all expenses with your partner and create a proper financial plan
• Select a treatment that fits your budget and expectations
• Determine if there is any insurance coverage

Are you tired of hearing all that you need to do to get pregnant? Here are all the myths debunked for you. Enlighten yourself now.