Female Infertility

Polycystic ovarian syndrome (PCSO) is probably the most commonest cause of failure of ovulation (when the ovaries fail to make an egg).

PCOS affects at least 30% of women of child bearing age and is probably also one of the leading causes of female inferility. PCOS means “small cyst”, were numerous small fluid filled sacs containing the egg are seen in the ovary.

Due to the hormonal imbalance seen in women with PCOS, the eggs are arrested in development and do not ovulate.

PCOS and its associated pathologies go hand in hand with weight gain and obesity.

A women is said to suffer from PCOS if she fits into the following Rotterdam’s diagnostic criteria.

A women is diagnosed with PCOS if she has two of the three following clinical symptoms

1. Irregular or absent ovulation
2. Signs of Androgen excess (male pattern of hair growth, acne, hirsutism)
3. Polycystic appearing ovaries

PCOS is usually easily managed with drugs that induce ovulation like Clomiphene citrate or gonadotrophins. Weight reduction is a must for women who are obese and when they present with PCOS.

Spontaneous pregnancies can happen in this group even if their is a 5% decrease in total body weight. 

Other Ovulation Disorders: Problems with ovulation can also occur if their is a pathology affecting either the hypothalamus or pituitary the key glands in the brain needed for producing FSH and LH.

Since both FSH and LH play a key role in stimulating follicle growth and thus egg development, deficient production of these hormones can lead to female infertility.

Irregular secretion of FSH and LH can also occur thyroid disorders namely hypothyroidism and hyperthyroidism.

 Chronic long standing diseases can also affect the secretion of FSH and LH thus leading to irregular ovulation and female infertility.

Premature onset of menopause (when a women’s cycle stops before 40) is also now a recognized cause of infertility.

The exact genetic basis of this condition remains to be studied.

Tubal Factors Leading to Infertility in women : In the Indian subcontinent, large scale studies have clearly shown that genital tuberculosis a chronic infectious disease is the leading cause of infertility in women.

Tuberculous involvement of the tubes can lead to tube blockage and female infertility consequently.

Many women commonly seen in the clinic present with frozen pelvis and tubo-ovarian masses when evaluated laparoscopically.

Interestingly though in the Western subcontinents, sexually transmitted infections like Chlamydia Trachomatis is the leading cause of tubal blockage and thus infertility.

Chlamydia is the most common sexually transmitted infection worldwide and is frequently silent in it’s manifestation.

This infection is believed to affect an estimated 6% of the world population Endometriosis : The endometrium is the tissue that lines the uterine cavity.

When this tissue deposit is found elsewhere like the uterine cavity or ovary it termed as Endometriosis Endometriosis has a strong association with female infertility and frequently women with endometriosis complaint of severe pain during menses and sometimes pain during sexual intercourse.

Approximately, 20% of women with endometriosis would have some degree of female infertility.

 Failure of Sexual Intercourse and Infertility : Domestic issues, stress and in general even a diagnosis of infertility can affect the relationship between a couple leading to decreased frequency of sexual intercourse.