Female Infertility

Ovulation and the menstrual cycle

Ovulation is the development and release of an ovum (egg) from a woman’s ovaries. Ovulation is the fertile period of a woman’s menstrual cycle. The menstrual cycle refers to the maturing and release of an egg and to the preparation of the uterus to receive and nurture and embryo. A typical cycle takes approximately 28 to 32 days and is divided into three phases.

Problems With Ovulation

As we have discussed, becoming pregnant is dependent on the release of a healthy egg capable of being fertilised by a healthy sperm. However, if your period is irregular or absent then your production and release may be affected. About 25% of women who are infertile will suffer from ovulatory problems. Infrequent periods (oligornenorrhoea) or the absense of periods (amenorrhoea) are most often caused by deficiency in one of the controlling hormones. These can be successfully treated with medications. Problems are also associated with extremely low body weight, being overweight, or a significant change in weight. In addition, ovulation problems can arise if the ovaries themselves are resistant to normal levels of hormones. Absent, damaged or diseased ovaries will also prevent ovulation.

Blocked Fallopian Tubes

The fallopian tubes are delicate structures of only about the same thickness as the lead of a pencil. Because of this, they can easily become blocked or damaged. This can interfere with the sperm reaching the egg, proper embryo development, and implantation in the uterus. Blockages may arise as a result of scarring due to Infection or previous abdominal surgery. Pelvic Inflammatory Disease (PID) due to sexually transmitted diseases such as chlamydia or gonorrhoea, is the main cause of tubal infertility. In addition, PID is associated with an increased risk of subsequent ectopic pregnancy – when the fertilised egg implants in the fallopian tube. ovary or abdominal cavity (Instead of the uterus). Tubal infertility can sometimes be treated by surgery, but if this is not possible, or if surgery is unsuccessful, in vitro fertilisation (IVF)- may be the solution.

Endometriosis

This is a major cause of infertility and occurs when tissue that normally lines the Inside of the uterus grows in other places of your body where It doesn’t belong, such as on the ovaries, fallopian tubes, outside surface of the uterus, bowel, bladder and rectum. The symptoms of endometriosis may include heavy, painful and long menstrual periods. Because this tissue still acts the same as that found in your uterus and responds to changes in your hormones during your menstrual period, the tissue breaks down and bleeds causing pain before and after your period, scarring and adhesions (organs sticking together). A laparoscopy is used to identify endometriosis and there are several forms of treatment available, Involving both medications and surgery.

Polycystic Ovary Syndrome

Polycystic ovary (ovarian) syndrome (PCOS) is a condition in which the ovaries are enlarged, with a smooth but thicker than normal outer cover. Many small cysts cover this surface, which are themselves harmless, but may cause infrequent or absent periods, resulting in infertility. Polycystic ovaries are most easily seen by an ultrasound scan. The condition may be treated with medication or larger cysts may need to be surgically removed.

Cervical Problems

Cervical problems may be related to the consistency or not having enough cervical mucus. ‘Mucus hostility’ may arise as a result of a vaginal infection or the presence of antisperm antibodies in the mucus.