Female Infertility

Causes of Female Infertility

• Tubal Factor

Disorders of tubes constitute 35% of the causes of infertility. The most common cause of tubal factor infertility is pelvic inflammatory disease usually caused by chlamydia and gonorrhea.  Hysterosalpingography (HSG) and laparoscopy are the main exams for the diagnosis. If the tubes are bilaterally obstructed, closed, or removed after previous surgeries or infections, treatment with IVF is recommended.

• Ovulation Problems

Irregular or abnormal ovulation corresponds to about 5-25% of the causes of infertility. The main cause of infertility due to menstrual irregularities is anovulation (lack of ovulation). Polycystic ovary syndrome (PCOS), hypogonadotropic hypogonadism or endocrine disorders are the principal causes. There are several ways to detect ovulation, including urine test kits to measure LH levels, transvaginal ultrasound, endometrial biopsy, blood tests to measure hormone levels, and the basal body temperature (BBT) chart

• Age Factor

The female age is one of the most important factors affecting the success of infertility treatment. Advanced age lowers ovarian reserve and can also alter egg quality and chromosomes. Over 65-70% of chromosomal abnormalities are observed in women’s eggs, that are over 40 years of age. This prevents attachment of the embryos or leads to termination of the pregnancies with miscarriage, thus leading to a decrease in the pregnancy rates ending up with live birth.

• Uterus-Originated Problems

Congenital anomalies such as partial development or underdevelopment of the uterus, presence of a septum (curtain) cervical stenosis, double uterus, and unicorn uterus may prevent the embryo to implant or lead to recurrent miscarriages. Myomas and polyps that may occur in the uterus may also be the cause of infertility. In addition, previous uterine surgeries, abortions, or infections may cause infertility. Uterine problems can easily be identified by transvaginal ultrasonography examination. Polyp, synechiae (adhesion), and congenital shape anomalies can be described in detail by performing HSG and 3D ultrasound today.

• Genetic Causes

Numerical or structural anomalies of both male and female chromosomes such as gender chromosome anomalies, translocations, and inversions may cause miscarriages or infertility. In addition, people with consanguineous marriages, people with inherited diseases or people at risk of carrying them and their relatives should be informed about the course of the disease and treatment methods, the risks of recurrence and treatment options, as well as what tests should be performed and the results thereof.

• Unexplained Infertility

Although all known advanced tests have been performed to reveal the cause of infertility, the cause of infertility may not have been determined in approximately 10-15% of couples. This condition is called inexplicable infertility.

• Endometriosis

Endometriosis is the presence of intrauterine tissue in any organ or tissue outside the uterus. Endometriosis is detected in approximately 35% of women presenting infertility. Endometriosis causes infertility by causing adhesions in the pelvic region or tubes. Detailed history, ultrasonographic and gynecological examination and, if necessary, laparoscopic examination are required for the diagnosis of endometriosis.

• Laboratory Tests

Thyroid function is assessed by measuring serum TSH and T4 values. Prolactin, the hormone of lactation, is also measured. In addition, analysis of hormones such as DHEA, androstenedione, l7-hydroxyprogesterone, and testosterone, which have an effect on the reproductive system, can be necessary according to the history and examination findings. In order to identify some viral infections that may adversely affect pregnancy, B and C type hepatitis virus, HIV, and rubella virus examinations are routinely carried out In addition, anemia is investigated by blood count for the woman getting pregnant and blood group is determined for both of the spouses. Apart from these, additional examinations can be carried out to resolve other possible complaints of the woman.

The most important reason why the examinations and tests are detailed in the evaluation of the couple is that there are many factors affecting the functioning of the reproductive organs. Knowing the characteristics of the couple will ensure that the most appropriate treatment is planned for them and the chance of success will be higher at this rate.

Hysterosalpingography and endoscopic examinations are other examination methods performed to evaluate the uterus and tubes of the woman.

• HSG is frequently used to determine whether the uterine cavity is normal and the tubes are patent (opened). HSG can identify congenital shape anomalies of the uterus, intrauterine polyps, adenomyosis, myoma nodules, and tuberculosis sequelae. It should be performed by experienced surgeons.
• Laparoscopy is a process that inspects the intra-abdominal organs by inserting a fiberoptic system illuminated with the light source, into the abdominal cavity and simultaneously performs an operation if necessary. It is frequently used for the removal and closure of laparoscopic surgical tubes, removal of ovarian cysts, and endometriosis cysts or myomas in infertility.
• Hysteroscopy is an endoscopic examination of the uterus, with a fiber optic light-induced device. It is performed when HSG shows irregularities or filling defects in the edges of the uterine cavity. Also indicated if intrauterine adhesions need to be evaluated and treated and if myoma or intrauterine polyps are to be diagnosed and treated.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.