Infertility is defined as the inability of a couple to conceive even after trying for more than a year. Infertility can be because of problems in either of the partner. There is 33% possibility that the problem lies purely with the female. Remaining one third is because of the male partner and the rest is because of combined causes. Almost in 20% of the cases, the cause of the infertility is not determined.
Female Infertility is of Two Types:
- Primary Infertility: If the patient has not ever conceived in her life, then it is known as primary infertility.
- Secondary Infertility: in this, the female has conceived in the past and has a child. But is unable to conceive now.
Female infertility can be caused because of the number of factors. They are summarised below:
- Advanced age: As the age of the female advances, the number of good quality eggs in her ovary decrease, this makes it difficult for her to conceive.
- Ovulation problems: in order to achieve a pregnancy a female should be able to ovulate. Problems in ovulation may lead to infertility. E.g. PCOS (polycystic ovarian syndrome).
- Tubal causes: the fallopian tubes connect the ovaries and the uterus. If they are obstructed, the pregnancy cannot occur.
- Uterine abnormalities: the uterus may have some congenital structural deformities. E.g. uterine septum. Other pathologies like fibroids, endometriosis, and polyps cause problems with implantation rendering the patient infertile.
- Cervical causes: some of the females have abnormal mucus, which might lead to the killing of the sperms in the cervix itself leading to infertility.
- Infections: females may not be able to conceive if they have infections in the pelvic region like pelvic TB.
- Unexplained: almost 20% of females experience infertility in spite of having all the normal reports.
Following investigations are conducted to determine the cause of infertility in a female:
- Detailed history taking: the treating doctor takes a detailed medical, family, past, drug history.
- Physical examination: a thorough physical examination is conducted by the treating doctor. The doctor examines the pelvic area for any abnormalities.
- Blood tests: hormonal levels are checked with blood tests.
- USG: Ultrasonography of the pelvis is done to check the reproductive organs.
- HSG: Doctors also advise hysterosalpingography to check the patency of the tubes.
- Hysteroscopy: in this procedure, the insides of the uterus are viewed with the help of a camera.
- Laparoscopy: a laparoscope allows the doctor to examine the uterus and the tubes from outside.
- Medications: various drugs can be prescribed according to the condition. E.g. clomiphene citrate, gonadotropins etc.
- Surgical: the uterine abnormalities like fibroid, polyps, and septum can be corrected surgically with the help of hysteroscopy or laparoscope or open surgeries.
- Assisted reproductive technology: if the patient is not able to conceive, then ART is the best option to help them conceive. In ART, various treatments like IUI, IVF are done which enhance the chance of the patient of conceiving.
- Egg donation: If a female doesn’t have her own eggs, she can always opt for donated eggs to conceive.