Infertility is broadly described as trying to get pregnant with frequent intercourse for at least a year with no success. Female infertility, male infertility or a combination of the two affects many couples. An estimated 15 to 20 percent of couples have trouble getting pregnant or having a successful delivery.
Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
This week, the discourse shifts to female factor infertility. Female infertility causes can be as difficult to diagnose as male infertility and there are as many available treatments – depending on the cause of the infertility.
Women are the vessels that bring forth children. It is women that conceive and give birth, but there are a number of things that may be keeping a woman from getting pregnant and giving birth normally.
In women, a number of factors can disrupt conception at any step and infertility is caused by variety of factors, however, the primary symptom of infertility is the inability to get pregnant. The most common cause of female infertility is tubal blockage.
Damage to the Fallopian tubes is one of the major causes of female infertility. The Fallopian tubes carry eggs from the ovaries, which produce eggs, to the uterus, where the baby develops. They can get damaged when scars form after pelvic infections, endometriosis, and pelvic surgery. That can prevent sperm from reaching an egg.
Today, will be examining the Fallopian tubes in detail but first let’s look at the ovulation process.
A woman maynot be getting pregnant because her body isn’t going through the usual hormone changes that lead to the release of an egg from the ovary and the thickening of the lining of the uterus.
To get pregnant, the woman’s ovaries must produce and release an egg – a process known as ovulation. Ovulation occurs in menstrual cycles or monthly periods described as the “menses”. Various causes of infertility may result in additional symptoms including infrequent ovulation (when the periods do not come every month).
A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can mean that there is no ovulation. There may be no other outward signs or symptoms.
The general doctor can help evaluate the menstrual cycles and confirm ovulation. The woman must have open Fallopian tubes and a normal uterus.
Normal aging reduces a woman’s ability to become pregnant. As a woman grows older, ovulation becomes slower and less effective. Aging begins to reduce fertility as early as age 30 and pregnancy rates are very low after age 44. This is true even when fertility medications are used. More about the role of ageing will be discussed in the next write up.
The first step in diagnosing female infertility is determining whether ovulation is occurring at predictable intervals. When an egg is released, it causes a shift in the body’s sex hormones. This shift in sex hormones can be detected with specific test.
Diagnosing an issue relating to female fertility starts with a comprehensive appointment with a fertility physician. During this appointment, medical history and lifestyle will be discussed extensively. Topics such as birth control use, menstrual and pregnancy history, current and past sexual practices, medications used, surgical history, other health issues and lifestyle as well as work/living environment will all be discussed.
A thorough physical exam will also be done. Areas such as the thyroid, breasts, and hair growth will be looked at. A pelvic exam is also an important part of evaluating female fertility, along with a pap smear.
Now let’s talk about problems with the Fallopian tubes. Blocked Fallopian tubes are among the commonest causes of female infertility. The Fallopian tubes are two thin tubes, one on each side of the uterus, which help lead the mature egg from the ovaries to the uterus.If they become blocked or infected, infertility may result.Blocked fallopian tubes are a common cause of infertility. The egg and sperm meet in the Fallopian tubes, and the embryo needs a healthy uterus in which to grow.
When an obstruction prevents the egg from traveling down the tube, the woman has a blocked Fallopian tube. The blockage can occur on one or both sides. Blocked Fallopian tube is also known as tubal factor infertility.
In a healthy reproductive system, the Fallopian tube serves as both the pathway for an ovulated egg to reach the uterus.Each month, when ovulation occurs, an egg is released from one of the ovaries. The egg travels from the ovary, through the tubes, and into the uterus. The sperm also need to swim their way from the cervix, through the uterus, and through the fallopian tubes to get the egg.
After an egg is released from the ovary, finger like projections from the Fallopian tube draw the egg in.Assuming sex has taken place close to ovulation, the egg will meet with sperm inside the tube. Fertilization usually takes place while the egg is traveling through the tube and not inside the uterus, which is a common misconception.
The fertilized egg, or embryo, will make its way down the tube, into the uterus, and implant itself into the uterine wall. If this pathway is blocked, infertility may result.Normally, finger-like projections called fimbriae extend from the end of the fallopian tube close to the ovary. They help draw in the ovulated egg from the ovary into the fallopian tube.
If one or both Fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg, preventing fertilization and pregnancy. It’s also possible for the tubes to be blocked only partially. If only one tube is blocked and the other is healthy, technically speaking, it’s possible to conceive with just one open tube.
However, because the delicate environment of the uterus may be affected, pregnancy rates may be affected.Surgery is the most common treatment for blocked tubes with IVF treatment after to aid in conception.
A specific kind of blocked Fallopian tube, called Hydrosalpinx, may cause lower abdominal pain and unusual vaginal discharge, but not every woman will have these symptoms. Blockage could cause the tube to dilate (increase in diameter) and fill with fluid. The fluid blocks the egg and sperm, preventing fertilization and pregnancy.
However, some of the causes of blocked fallopian tubes can lead to other problems as well. For instance, endometriosis and pelvic inflammatory disease may cause painful menstruation and painful sexual intercourse.
The most common cause of blocked fallopian tubes is from infection, notably pelvic inflammatory disease (PID). PID is the result of a sexually transmitting infection, but not all pelvic infections are related to STDs. Also, even if PID is no longer present, a history of PID or pelvic infection increases the risk of blocked tubes.
Other potential causes of blocked Fallopian tubes include current or history of an STI infection, specifically Chlamydia or Gonorrhea; history of uterine infection caused by an abortion or miscarriage; history of a ruptured appendix or abdominal surgery; previous ectopic pregnancy; prior surgery involving the fallopian tubes and endometriosis
Blocked tubes are usually diagnosed with a specialized x-ray, called a Hysterosalpingogram, or HSG. This test involves placing a dye through the cervix, using a tiny tube. Once the dye has been given, the doctor will take x-rays of your pelvic area. If all is normal, the dye will go through the uterus, through the tubes, and spill out around the ovaries and into the pelvic cavity. If the dye doesn’t get through the tubes, then there may be a blocked fallopian tube.
It’s important to know that some women have a “false positive,” where the dye doesn’t get past the uterus and into the tube. The blockage appears to be right where the fallopian tube and uterus meet. If this happens, the doctor may repeat the test another time, or order a different test to confirm.
Other tests that may be ordered include ultrasound, exploratory laparoscopic surgery, or hysteroscopy (where they take a thin camera and place it through the cervix, to look at the uterus). Blood work to check for the presence of Chlamydia antibodies (which would imply previous or current infection) may also be ordered.
It’s often been debated is a woman can get pregnant with blocked Fallopian tubes. If she has one open tube, and is otherwise healthy, a woman might be able to get pregnant without too much help. Fertility drugs help to increase the chances of ovulating on the side with the open tube. But this is not an option if both tubes are blocked.
In some cases, laparoscopic surgery can open blocked tubes or remove scar tissue that is causing problems. Unfortunately, this treatment doesn’t always work. The chance of success depends on how old the woman is (the younger, the better), how bad and where the blockage is, and the cause of blockage.
If just a few adhesions are between the tubes and ovaries, then chances of getting pregnant after surgery are good. If there is a blocked tube and the woman is otherwise healthy, there is a 20 percent to 40 percent chance of getting pregnant after surgery.
But if thick, multiple adhesions and scarring are between the tubes and ovaries, or if there is a diagnosis of hydrosalpinx, surgery may not be a good option. Also, if there are any male infertility issues,surgery may not help. In these cases, IVF treatment is often the best bet.