Infertility in women

Infertility in women is a frequent and complex issue that can deeply affect both the woman and the couple as a whole. It can be due to many different factors, such as hormonal disorders, problems with ovulation, diseases of the fallopian tubes or uterus, endometriosis, but also factors related to age, lifestyle and general health.

It is important to emphasize that infertility is not exclusively a "female problem". It concerns the couple as a whole and needs careful, systematic and individualized investigation to identify - where possible - the cause and to choose the appropriate therapeutic approach.

Although the path to motherhood can be demanding, modern reproductive medicine today offers significant potential. However, every case is different and no treatment can be accompanied by certainties or excessive promises.

Proper information, honest guidance and personalized medical care are key elements for every woman and every couple who wish to have a child.

Causes and predisposing factors

Female infertility can result from different factors that affect normal reproductive function.

One of the most common causes are ovulation disorders. These may be related to irregular menstrual cycles, polycystic ovary syndrome, or endocrinological disorders, which affect the production and release of the egg.

Also important roles are played by the Troubleshooting. Obstruction, inflammation or adhesions in the fallopian tubes can prevent the egg's meeting with the sperm, making it difficult or impossible to get natural conception.

diseases of the uterus, such as endometrial polyps, fibroids or anatomical abnormalities, They may affect the implantation of the fetus or the smooth progress of a pregnancy.

the endometriosis It is also an important factor in female infertility. It is a condition in which tissue similar to the endometrium develops outside the uterus, causing inflammation, pain, adhesions and difficulty conceiving.

Other factors that may contribute to infertility are immune disorders, genetic or chromosomal abnormalities, thrombophilia, as well as Some chronic conditions.

The age of the woman also plays a decisive role. Over the years, both the quantity and the quality of the eggs decrease. This decline becomes more pronounced after 35 years and even more so after 40.

Lifestyle Factors Affecting Fertility

In addition to organic causes, lifestyle can significantly affect a woman's reproductive health. Factors associated with reduced fertility are:

  • intense or chronic stress,
  • Smoking,
  • overconsumption of alcohol,
  • substance use,
  • Too much or too low body weight,
  • Poor nutrition,
  • the lack of sleep,
  • Exposure to environmental aggravating factors.

Adopting a more balanced lifestyle can contribute positively to a woman's general health and, in some cases, to the improvement of fertility.

Investigate of female infertility

The investigation of infertility begins with taking an analytical individual and family history. The doctor evaluates the duration and frequency of the menstrual cycle, previous pregnancies, miscarriages, methods of contraception, surgeries, infections, chronic conditions and possible symptoms that may be related to gynecological problems.

Family history can also provide useful information, such as the age of menstruation and menopause of the mother, as well as the existence of gynecological or endocrinological problems in the family.

This is followed by a complete gynecological check-up, which may include a clinical examination, a height and weight measurement, a Pap smear, a transvaginal ultrasound and an evaluation of the uterus and ovaries.

Laboratory testing usually includes hematological, biochemical, hormonal and microbiological tests. Tests such as general blood count, general urine, thyroid function, prolactin and progesterone can help diagnose ovulation disorders or other endocrinological problems.

In some cases, more specialized tests may be needed, such as hysteroscopy, colposcopy, salpingography or laparoscopy. These tests help to identify diseases such as polyps, fibroids, adhesions, endometriosis or tubal lesions.

At the same time, it is necessary to examine the fertility of the partner, as male infertility is equally common and can coexist with female factors.

Treatment of Female infertility

The treatment of female infertility depends on the cause that causes it. For this reason, the correct diagnosis is the first and most important step.

In cases of hormonal disorders or ovulation problems, medication may be administered with the aim of regulating the cycle and stimulating ovulation. Fertility drugs help produce and mature eggs, increasing the chances of natural conception.

When there are infections of the reproductive system, appropriate antibiotic treatment is necessary to treat inflammation and prevent possible complications.

In cases of anatomical problems, such as polyps, fibroids, adhesions, endometriosis or tubal lesions, surgical repair may be needed. Hysteroscopy and laparoscopy are minimally invasive techniques that are often used to diagnose and treat such conditions.

Monitoring fertility can also help some couples, particularly when there are no serious pathological findings. Identifying the fertile period through a ovulation test, cycle monitoring, ultrasound control, or other methods can contribute to the correct temporal placement of conceiving attempts.

When conservative methods are not sufficient, assisted reproduction methods may be applied. These include intrauterine insemination and IVF. These methods offer significant potential, especially in cases of more complex or demanding fertility disorders.

IVF

Bibliography

  1. World Health Organization — Who.
    Infertility.
  2. National Institute for Health and Care Excellence — Nice.
    Fertility Problems: Assessment and Treatment.
  3. National Institute for Health and Care Excellence — Nice.
    Management of Female Factor Fertility Problems.
  4. Practice Committee of the American Society for Reproductive Medicine — ASRM.
    Optimizing Natural Fertility: A Committee Opinion.
    Fertility and Sterility, 2022.
  5. American Society for Reproductive Medicine — ASRM.
    Practice Guidance and Committee Documents on Reproductive Medicine.
  1. European Society of Human Reproduction and Embryology — Eshre.
    Guidelines and recommendations.
  2. Zegers-Hochschild, F., Adamson, G. D., Dyer, S., et al.
    The International Glossary on Infertility and Fertility Care, 2017.
    Fertility and Sterility, 2017.
  3. ESHRE Guideline Group on Endometriosis.
    Eshre Guideline: Endometriosis.
  4. Royal College of Obstetricians and Gynaecologists — RCOG.
    Fertility: Assessment and Treatment for People with Fertility Problems.
  5. Centers for Disease Control and Prevention — CDC.
    Infertility and Assisted Reproductive Technology.

Ioannis A. Sklavounos MD MSC DFFP
Obstetrician Surgeon Gynecologist
Specialists & Retrained in Great Britain
T.Senior Clinical Fellow – Liverpool Woman’s Hospital UK

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