Female infertility

Infertility refers to an inability to conceive after having regular unprotected sex for one year.  The incidence of infertility has continued to rise over the last ten years and it is estimated that it affects approximately 15% of couples of reproductive age. About 40% of cases of infertility are due to female factor. About 15% of cases of infertility are due to male factor. About 30% of cases of infertility are due to problems in both the man and the woman. About 15% of cases are due to unexplained causes.

Female factor infertility

1. Iatrogenic causes - Chemotherapy and radiotherapy can result in ovarian failure.
   • Genetic disorders :- Turners Syndrome, Hypogonadism.
   • Problems with the Hypothalamus pituitary :- ovarian hormonal feedback mechanisms including PCOS (polycystic ovary syndrome).
   • Hypothyroidism
   • Premature ovarian failure, where the function of ovaries stops before the age of 40.
   • Advaced maternal age: Higher the age lesser the chances of conception because of reduced ovarian reserve. The fertility decreases after the age of 35 years.
   • Stress interferes with egg release from ovary.
2. Tubal factors – Blocked or damaged fallopian tubes prevent eggs from getting to the uterus and sperm from getting to the egg.
   • Infections (esp. genital tuberculosis) :- adhesions or surgical procedures can lead to blockage and damage of fallopian tubes. The tubal factor is one of the main indications for IVF. IVF allows for successful fertilization outside the fallopian tube, thus bypassing the problem area.
   • Previous tubal ligation :- It is possible to reverse this process, but the chances of becoming fertile again are not high.
3. Uterine factors - Egg travels from the ovary to the uterus (womb) where the fertilized egg implants and grows. If there is any problem in uterine cavity, the female may not be able to conceive naturally or abortion may occur.
   • Fibroids – It is found in the muscular wall of the uterus, occurring in 30% to 40% of women of childbearing age. They may interfere with implantation. They can also block the fallopian tube, preventing sperm from fertilizing the egg.
   • Asherman's syndrome :-  It may interfere with sperm motility.
4. Vaginal & Cervical Factors – It interfere with sperm entry and motility
   • Iatrogenic causes :- Chemotherapy and radiotherapy can result in ovarian failure.
   • Iatrogenic causes :- Chemotherapy and radiotherapy can result in ovarian failure.
5. Peritoneal factors (Endometriosis)  - It is also associated with infertility as it occurs most commonly within the fallopian tubes and on the outside of the tubes and ovaries, the outer surface of the uterus and intestines, and anywhere on the surface of the pelvic cavity leading to pelvic adhesions and tubal blockage.
6. Iatrogenic causes - Chemotherapy and radiotherapy can result in ovarian failure.