Female infertility

It affects an estimated 48 million women with the highest prevalence of infertility affecting people in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia.

Infertility is grouped into 2 categories

• Primary infertility refers to couples who have not become pregnant after at least 1 year of unprotected sex (intercourse).
• Secondary infertility refers to couples who have been pregnant at least once, but never again.

Causes of infertility

• Tubal factors: Peritoneal adhesions, endosalpingeal damage, pervious tubal surgery or sterilization, salpingitis, tubal endometriosis, polyps
• Peritoneal factors: minimal endometriosis may produce infertility
• Uterine factors: the factors which hinder the nidation are uterine hypoplasia, fibroid uterus, endometriosis
• Cervical factors: Anatomical defects congenital elongation of uterus, 2nd-degree uterine prolapse, acute retroverted uterus
• Physiological factors: presence of anti-sperm, excessive purulent discharge as in chronic cervicitis
• Vaginal factors: septate vagina, narrow introitus, atresia of vagina

Ectopic pregnancy

• The increased rate of ectopic pregnancy due to various causes.
• Sexually transmitted tubal infections
• Contraception
• Induced abortion followed by infection
• Surgery salpingotomy

Amenorrhea and anovulation

• Defect in the hypothalamic-pituitary unit
• Anorexia Nervosa
• Sustained emotional stress
• Hypothalamic Organic defect
• Lawrence – Moon-Biedl syndrome
• Olfactogenital syndrome

Sexual dysfunction

• Vaginismus: This is a condition which the muscles around the outer third of the vagina go into involuntary spasm during repeated attempts at penetration. This may lead to the woman to become fearful of the sexual act.
• Anorgasmia: The female fail to attend the orgasms, become strained they undergo depression.
• Dyspareunia
• Chromosomal anomalies
• Turners syndrome

Acquired causes

• Age
• Smoking
• Sexually Transmitted Infections
• Overweight

 
Age: A woman's fertility is affected by her age. The average age of a girl's first period is 12-13 but in postmenarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, 50% in the third and 10% in the sixth year. A woman's fertility peaks in the early and mid-20s, after which it starts to decline, with this decline being accelerated after age 35. However, the exact estimates of the chances of a woman to conceive after a certain age are not clear, with research giving differing results. The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of a woman and the fertility of the male partner.

Tobacco smoking: Tobacco smoking is harmful to the ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium. Some damage is irreversible, but stopping smoking can prevent further damage. Smokers are 60% more likely to be infertile than non-smokers. Smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%. Also, female smokers have an earlier onset of menopause by approximately 1–4 years. 12% of all infertility cases are a result of a woman either being underweight or overweight. Adipocytes produce estrogen, in addition to the primary sex organs. Too much body fat causes the production of too much estrogen and the body begins to react as if it is on birth control. Too little body fat causes insufficient production of estrogen and disruption o the menstrual cycle. Both under and overweight women have irregular cycles in which ovulation does not occur or is inadequate. Proper nutrition in early life is also a major factor for later fertility.

Chemotherapy: It poses a high risk of infertility. Chemotherapies with a high risk of infertility include procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine.  Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin. The mental and physiological impact when women cannot conceive, the blame is put on them, even when approximately 50% of infertility issues come from the man. In addition, many societies only tend to value a woman if she is capable of producing at least one child. Many infertile women tend to cope with immense stress, depression.

Prevention

• Treating or preventing existing diseases
• Not delaying parenthood
• Maintaining a healthy lifestyle