Fertility problems often lead to much stress and anxiety to couples. These problems also increase for both genders as we age. It might be better to start fertility screening before marriage but it can also be done at any point in time during family planning. There are several different causes for infertility in women ranging from failure of ovulation to infections to anatomical structural problems of the reproductive system to endometriosis and fibroids. Each cause would require a slightly different approach to investigation and treatment.
General risk factors for fertility issues include advanced age, diabetes, stress, smoking, excessive alcohol intake and a sedentary lifestyle. A detailed workup including a history, physical examination and investigations of both the female and male partner is required to ascertain the cause of infertility. Investigations for women would usually include blood tests for hormone levels are general health, STI screening to look for infections and imaging scans like ultrasounds or other special tests depending on the conditions suspected.
- Failure of ovulation
This is the most common cause of infertility in women (up to 40%). Without an egg being released from the ovary, pregnancy cannot occur as there is nothing for the sperm to fertilize. There are several factors that lead to failure to ovulate with age, dietary practices and lifestyle being common causes. Other reasons include ovarian issues like polycystic ovarian syndrome (PCOS) or primary ovarian failure and endocrine hormone issues like thyroid or pituitary disorders.
A review with a doctor is crucial to look for the cause for possible failure of ovulation. Treatment recommendations would then be tailored to the individual based on the findings of the review.
- Anatomical structural problems of the reproductive system
Up to 30% of women with fertility issues have a structural problem with the reproductive system. This could mean abnormalities in development of the uterus preventing implantation of the fertilised egg or blocked fallopian tubes not allowing the eggs from reaching the uterus. Detecting such problems would need tests like ultrasound scans, hysteroscopy or hysterosalphingogram which is a special x-ray test to check for blocked fallopian tubes by injecting a contrast medium into the uterus and tubes. Treatment would be targeted to the problem discovered during investigation.
Untreated STIs can lead to pelvic inflammatory disease in which the infections affect the women’s reproductive organs from the cervix to the uterus to the fallopian tubes. The inflammation can damage the reproductive organs leading to difficulty in conceiving. It is essential to screen for STIs early if there are any suspicious signs or symptoms and treat each infection urgently to prevent complications like infertility.
An estimated 20-40% of women with fertility issues are diagnosed with endometriosis. Endometriosis is a condition where uterine tissue grows outside the uterus often in the pelvis. This can often lead to severe abdominal and pelvic pain during menses and can be associated with infertility. The resulting inflammation by these excess uterine tissue has been suggested to cause abnormal ovulation and ovarian function leading to infertility. Treatment for endometriosis associated infertility can range from endometriosis surgery to assisted reproductive techniques. A detailed careful workup by a gynaecologist would be required before a treatment plan is decided upon.
- Fibroids and other pelvic growths
Fibroids and growths in the pelvis often can lead to infertility by occupying too much space in the women’s pelvis hence not allowing the fertilized egg to implant properly in the uterus or even affecting development of the embryo. Fortunately, removal of fibroids for example usually treats the infertility very effectively.