Female Infertility

February 8, 2017

Childbearing and raising of children are extremely important events in every human’s life and are strongly associated with the ultimate goals of completeness, happiness and family integration. It is widely accepted that human existence reaches completeness through a child and fulfils the individual’s need for reproduction. Human fertility, compared with other species of animal kingdom, is unfortunately low.

Female Infertility is defined as the inability of getting pregnant after trying for at least 6 months or one year, for women over 35 years old, without use of birth control means and while having normal sexual intercourse. Infertility may also be referred to as the inability to carry a pregnancy to the delivery of a live baby.

More than 1 out of 10 couples experience infertility. Infertility isn’t just a woman’s problem. Men can have fertility problems, too. When a couple is having a hard time getting pregnant, it is just as likely to be caused by a problem with a man’s fertility as it is with a woman’s fertility.

Natural conception occurs when sperm cells, after sexual intercourse, migrate up through the cervix and uterus and into the fallopian tubes. Somewhere along the fallopian tube the sperm will meet the egg and a single sperm will penetrate the egg and fertilize it. The fertilized egg (called a zygote) continuously divides to form a ball of cells as it travels down the fallopian tube. By the time the fertilised egg has reached the uterus it has developed into a blastocyst.

A blastocyte has an inner group of cells that will become the embryo, and an outer group of cells that will attach the blastocyst to the uterus wall to form the placenta. The placenta carries oxygen and nutrients from the mother to the foetus and waste materials from the foetus to the mother. The blastocyst attaches to the lining of the uterus, where is starts to receive nourishment from the mother’s bloodstream. The implantation of the blastocyst to the uterus lining usually occurs about 10 days after the sperm first penetrated the egg in the fallopian tube. Natural conception is a complex process that relies on a number of factors in order to be successful. These factors include:

The production of healthy sperm by the man
The production of healthy eggs by the woman
Unblocked fallopian tubes to allow the sperm to reach the egg
The ability of the sperm to fertilise the egg when they meet in the fallopian tube
The ability of the egg to move into the woman’s uterus and become implanted in the uterus wall
A good quality embryo
Suitable hormonal environment in the woman

When a couple has a problem achieving pregnancy, it’s estimated that about –

1 out of 3 times it’s due to a problem with the man’s fertility
1 out of 3 times it’s due to a problem with the woman’s fertility
1 out of 3 times it’s due to a problem with both the woman’s and the man’s fertility, or a cause cannot be found for the problem

That’s why both the woman and the man usually get tested for fertility problems when a couple is having infertility problems.

Causes

Ovulation disorders

Problems with ovulation are the most common cause of infertility in women, experts say. Ovulation is the monthly release of an egg. In some cases the woman never releases eggs, while in others the woman does not release eggs during come cycles.

Ovulation disorders can be due to:

Premature ovarian failure – the woman’s ovaries stop working before she is 40.
PCOS (polycystic ovary syndrome) – the woman’s ovaries function abnormally. She also has abnormally high levels of androgen. About 5% to 10% of women of reproductive age are affected to some degree. Also called Stein-Leventhal syndrome.
Hyperprolactinemia – if prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
Poor egg quality – eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is the higher the risk.
Overactive thyroid gland
Underactive thyroid gland
Some chronic conditions, such as AIDS or cancer.

Poorly Functioning Fallopian Tubes

Tubal disease affects approximately 25% of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30% overall, with certain procedures having success rates up to 65%. The main causes of tubal damage include –

Infection – Caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation resulting in scarring and damage. A specific example is Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube.
Abdominal Diseases – The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.
Previous Surgeries -This is an important cause of tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.
Ectopic Pregnancy – This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition.
Congenital Defects – In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.

Problems in the uterus or fallopian tubes

The egg travels from the ovary to the uterus (womb) where the fertilized egg grows. If there is something wrong in the uterus or the fallopian tubes the woman may not be able to conceive naturally. This may be due to –

Surgery – pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
Submucosal fibroids – benign or non-cancerous tumors 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. Large submucosal uterine fibroids may make the uterus’ cavity bigger, increasing the distance the sperm has to travel.
Endometriosis – cells that are normally found within the lining of the uterus start growing elsewhere in the body.
Previous sterilization treatment – if a woman chose to have her fallopian tubes blocked. It is possible to reverse this process, but the chances of becoming fertile again are not high. However, an eight-year study showed tubal reversal surgery results in higher pregnancy and live birth rates and is less costly than IVF.

Medications

Some drugs can affect the fertility of a woman. These include:

NSAIDs (non-steroidal anti-inflammatory drugs) – women who take aspirin or ibuprofen long-term may find it harder to conceive.
Chemotherapy – some medications used in chemotherapy can result in ovarian failure. In some cases, this side effect of chemotherapy may be permanent.

Behavioral Factors

It is well-known that certain personal habits and lifestyle factors impact health; many of these same factors may limit a couple’s ability to conceive. Fortunately, however, many of these variables can be regulated to increase not only the chances of conceiving but also one’s overall health.

Diet and Exercise – Optimal reproductive functioning requires both proper diet and appropriate levels of exercise. Women who are significantly overweight or underweight may have difficulty becoming pregnant.
Smoking – Cigarette smoking has been shown to lower sperm counts in men and increases the risk of miscarriage, premature birth, and low-birth-weight babies for women. Smoking by either partner reduces the chance of conceiving with each cycle, either naturally or by IVF, by one-third.
Alcohol – Alcohol intake greatly increases the risk of birth defects for women and, if in high enough levels in the motherís blood, may cause Fetal Alcohol Syndrome. Alcohol also affects sperm counts in men.
Drugs – Drugs, such as marijuana and anabolic steroids, may impact sperm counts in men. Cocaine use in pregnant women may cause severe retardations and kidney problems in the baby and is perhaps the worst possible drug to abuse while pregnant. Recreational drug use should be avoided, both when trying to conceive and when pregnant.
Stress – Excessive physical or emotional stress that results in amenorrhea (absent periods).

Environmental Factors

The ability to conceive may be affected by exposure to various toxins or chemicals in the workplace or the surrounding environment. Substances that can cause mutations, birth defects, abortions, infertility or sterility are called reproductive toxins. Disorders of infertility, reproduction, spontaneous abortion, and teratogenesis are among the top ten work-related diseases and injuries in the U.S. today. Despite the fact that considerable controversy exists regarding the impacts of toxins on fertility, four chemicals are now being regulated based on their documented infringements on conception.

Lead – Exposure to lead sources has been proven to negatively impact fertility in humans. Lead can produce teratospermias (abnormal sperm) and is thought to be an abortifacient, or substance that causes artificial abortion.
Medical Treatments and Materials – Repeated exposure to radiation, ranging from simple x-rays to chemotherapy, has been shown to alter sperm production, as well as contribute to a wide array of ovarian problems.
Ethylene Oxide – A chemical used both in the sterilization of surgical instruments and in the manufacturing of certain pesticides, ethylene oxide may cause birth defects in early pregnancy and has the potential to provoke early miscarriage.
Dibromochloropropane (DBCP) – Handling the chemicals found in pesticides, such as DBCP, can cause ovarian problems, leading to a variety of health conditions, like early menopause, that may directly impact fertility.

Risk Factors

Age – With increasing age, the quality and quantity of a woman’s eggs begin to decline. In the mid-30s, the rate of follicle loss accelerates, resulting in fewer and poorer quality eggs, making conception more challenging and increasing the risk of miscarriage.
Weight – If a women is overweight or significantly underweight, it may hinder normal ovulation. Getting to a healthy body mass index (BMI) has been shown to increase the frequency of ovulation and likelihood of pregnancy.
Sexual history – Sexually transmitted infections such as chlamydia and gonorrhea can cause fallopian tube damage. Having unprotected intercourse with multiple partners increases the chances of contracting a sexually transmitted disease (STD) that may cause fertility problems later.

Symptoms

The signs and symptoms of infertility in women depend on the underlying condition causing the infertility. In women with regular menstrual cycles (periods), 95% of the time one egg is released in each cycle (each month). Women who have problems in releasing eggs are likely to experience infrequent or absent periods (amenorrhea).

Polycystic ovary syndrome is the most common hormone disturbance for women with infertility which results in irregular periods. With this condition some women will experience unwanted hair growth on the face and body, patchy hair loss from the scalp (alopecia) and too much weight gain.

Women with endometriosis are likely to have painful and heavy periods, lower abdominal pain, painful sexual intercourse or a combination of these symptoms.

Treatment

Medications for Ovulation disorders – If the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include –

Clomifene (Clomid, Serophene)
Metformin (Glucophage)
Human menopausal gonadotropin, or hMG, (Repronex)
Follicle-stimulating hormone (Gonal-F, Bravelle)
Human chorionic gonadotropin (Ovidrel, Pregnyl)
Gn-RH (gonadotropin-releasing hormone) analogs
Bromocriptine (Parlodel)

Surgery

Fallopian tube surgery – if the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them.
Laparoscopic surgery – a small incision is made in the woman’s abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.

IVF (in vitro fertilization) – Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).

Intrauterine Insemination (IUI) — Semen is collected from a man. A procedure called “sperm washing” is done to separate the healthy sperm from the rest of the semen. A health care provider puts the sperm directly into the uterus. This puts the sperm closer to the egg. It cuts down the time and distance sperm have to travel to reach an egg. IUI is often referred to as donor insemination, alternative insemination, or artificial insemination.

Assisted hatching -This improves the chances of the embryo’s implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant.

Embryo Transfer – One to three days after the eggs are retrieved, up to four healthy embryos are inserted into the uterus with a thin plastic tube that is passed through the cervix.

Gamete Intrafallopian Transfer (GIFT) is a more sophisticated variation of the basic IVF procedure and usually produces a slightly higher pregnancy rate.
Zygote Intrafallopian Transfer (ZIFT) is the latest variation on the IVF-GIFT technique. The freshly fertilized eggs (zygotes) are placed into the fallopian tubes during a laparoscopy after they have reached the embryo stage.

Lifestyle Changes – Although there are no dietary or nutritional cures for infertility, a healthy lifestyle is important. Some ovulatory problems may be reversible by changing behavioral patterns. Some tips include –

Maintain a healthy weight. Women who are either over- or underweight are at risk for fertility failure, including a lower chance for achieving success with fertility procedures.
Stop smoking. Smoking may increase the risk for infertility in both men and women. Everyone should quit.
Avoid excessive exercise if it causes menstrual irregularity. However, moderate and regular exercise is essential for good health.
Avoid or limit caffeine and alcohol.
Avoid any unnecessary medications.

Alternative Treatment

Supplements

Vitamin D- Vitamin D deficiency is very common in America, especially during the winter, and can be very detrimental to overall health. Recent studies link inadequate vitamin D with infertility and miscarriage.

Vitamin C– A potent antioxidant, vitamin C is good for both male and female infertility.

Folic Acid– Folic acid is well known as a necessary vitamin in early pregnancy to prevent complications, but it is most beneficial when taken for several month before the pregnancy as well as during. It helps cell division and promotes ovulation.

Zinc– It is very important for cell division including sperm production and ovulation.

Selenium– Helps protect the body from free radicals and protects sperm and egg.

B-Vitamins– Deficiency of b-vitamins is common in anyone who consumes large amounts of processed foods, grains or sugars. Optimizing b vitamin levels can increase lutenizing hormone and follicle stimulating hormone to improve fertility.

Bioflavonoids – Helps strengthen the uterus by promoting healthy blood vessels.

Flaxseed oil – A healthy fat that can help normalize hormones and is essential to health.

Herbs

Black cohosh (Cimicifuga racemosa)—Balances hormones.

Chaste tree (Vitex castus)—Raises progesterone levels, lowers estrogen levels, and helps correct ovarian dysfunction.

Dong quai (Angelica sinensis)—Nourishes and balances the female reproductive system.

False unicorn (Helonias dioica)—Has a reputation for promoting fertility, is recommended for ovarian dysfunction and as a uterine tonic.

Licorice (Glycyrrhiza glabra)—Balances hormones and is anti-inflammatory and sweet tasting (good flavoring for teas).

Red raspberry (Rubus strigosus)—Nourishes and strengthens the female reproductive system.

Squaw vine (Mitchella repens)—Also known as partridge berry. Recommended for fertility as a uterine tonic.

Wild yam (Dioscorea villosa)—Has a reputation for promoting fertility.

To Avoid –

Avoid Estrogen – Estrogen can have a negative effect on the development of the female reproductive tract. Therefore, it is important to reduce or eliminate excess estrogen or estrogen-like chemicals in your body. Avoid all dairy products where cows have been fed hormones. The drop in sperm counts since the 1940s parallels a rise in the consumption of dairy products.

Chemicals, such as PCBs, dioxin, etc. are weakly estrogenic and degenerate very slowly, they hang around for years in our environment. Avoid the use of toxic substances such as fertilizers, cleaners. Also avoid all fatty animal products where chemicals may be stored up without being degraded.

Avoid Heavy Metals – Sperm are affected by lead, cadmium, arsenic, and mercury. There are many sources of exposure to these heavy metals such as deep-sea fish, cigarette smoke, and water from old pipes. Just as with men, lead, cadmium, or mercury can impair fertility by affecting sex hormones.

Avoid free radicals – We have all heard that free radicals (the hungry and unstable oxygen in our bodies) can cause cancer, heart disease, and increase the aging process. Like –

Cigarette smoke
Sunlight
Unsaturated oils (corn oil may be the worst)
Heating oils to too high a temperature when cooking
Foods left out of the refrigerator (oxidation causes butter to turn a slight yellow and cut apples to turn brown)

Caffeine and Alcohol – Both can impair female fertility. Excessive alcohol causes prolactin to rise and too much or too little prolactin is associated with infertility. Caffeine causes a decrease in serum prolactin. Caffeinated soft drinks may also reduce the chance of conception.

Others

Flower Essences – The flowers of plants may be prepared in a similar way to homeopathic remedies so that the “essence” of the plant is harnessed in a medicinal way. An example is Pomegranate. Its use is described as a treatment for imbalance, i.e., women who are ambivalent or confused about the focus of feminine creativity, home or career, creative or procreative, those who attempt to balance both possibilities may feel drained and the psychological tension may be profound resulting in physical illness especially in the female organs.
Stress Reduction/Relaxation Therapies
Diaphragmatic Breathing Exercise

Reference –

http://www.mayoclinic.org/diseases-conditions/female-infertility/basics/risk-factors/con-20033618

http://www.yourhormones.info/endocrine_conditions/female_infertility.aspx

http://www.drugs.com/health-guide/female-infertility.html

http://www.health.harvard.edu/womens-health/female-infertility

https://www.mivf.com.au/fertility-treatment/female-infertility-tests

http://www.healthcentral.com/encyclopedia/hc/female-infertility-3168698/

http://www.advancedfertility.com/age.htm

http://www.nytimes.com/health/guides/disease/infertility-in-women/overview.html

http://www.babycenter.com/0_common-causes-of-fertility-problems-in-women_1228906.bc

http://www.ivf.com.au/fertility-treatment/female-infertility-tests

https://www.plannedparenthood.org/learn/womens-health/female-infertility