Female Infertility Symptoms and Diagnosis
Female Infertility Symptoms and Diagnosis
Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
What are causes for Female Infertility?
The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
1. Ovulation disorders
Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.
- Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
- Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
- Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.
- Too much prolactin. The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you’re taking for another disease.
2. Damage to fallopian tubes (tubal infertility)
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
- Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
- Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus
- Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States
Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.
Endometriosis can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
4. Uterine or cervical causes
Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:
- Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
- Endometriosis scarring or inflammation within the uterus can disrupt implantation.
- Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
- Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
- Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.
5. Unexplained infertility
Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem may correct itself with time. But, you shouldn’t delay treatment for infertility.
What are tests conducted for identifying Female Infertility?
1. Complete blood count (CBC):
A CBC medical test gives the measure of red blood cells (RBCs), white blood cells (WBCs) and platelets in your blood to identify the health. CBC helps in diagnosing several conditions like infections, blood disorders, and anemia. In Vitro procedure is the procedure that is done via a surgical procedure to retrieve eggs and it’s important for the doctor to know if you’re anemic or have any other medical condition. It is one of the important Infertility Profiling Tests that need to be done.
2. Erythrocyte sedimentation rate (ESR):
This is the rate at which your red blood cells RBC settle down. This rate is increased in case there is any kind of inflammation in the body. This test is done when an inflammatory condition is suspected. In testing infertility, ESR is done before going on with hysterosalpingogram (HSG), a procedure to judge the uterus and fallopian tubes condition.
3. Blood Sugar:
Fasting and PP blood sugar levels might affect your chances of becoming pregnant or conceive. Hence, checking of blood sugar levels and insulin levels is very important in infertility testing. It is one of the important Infertility Profiling Tests that need to be done.
4. VDRL (syphilis testing):
Syphilis directly does not affect fertility but untreated syphilis can affect both the mother and the fetus. Before planning the baby this test is important and included in infertility testing. It is one of the important Infertility Profiling Tests that need to be done.
5. Rubella IgG:
Rubella identifies if you’re immune to Rubella virus. This test is not required to diagnose infertility but every woman should be immune to the rubella virus before planning to conceive. If a woman gets the virus in the first 3 months of pregnancy, complications with the fetus can occur like body part dysfunction or defected body part.
6. Thyroid testing:
Free T3, thyroid stimulating hormone (TSH) and Free T4 are thyroid hormones which if not found during the testing may indicate overactive or underactive thyroid gland. Thyroid dysfunction has the big impact on both ovulation fertility and pregnancy. It is one of the important Infertility Profiling Tests that need to be done.
Prolactin is the hormone that is very useful for maintaining fertility in women for the long term. It inhibits reproductive hormones- gonadotropin-releasing hormone (GnRH) and follicle stimulating hormone (FSH).
8- AMH (Anti-Mullerian Hormone):
This hormone is produced by the cells in the ovarian follicles.
9- FSH test:
It is the main hormone that is responsible for stimulating the production of eggs to conceive. A high FSH level simply indicates poor ovarian reserve and a low level is usually associated with polycystic ovarian syndrome (PCOS).
10- LH (on day 2 or day 3 of the period):
LH is among one of the most important hormones for reproduction needed. If LH has the high levels, these can interfere with the process of menstruation, ovulation that contributes to infertility. It could also indicate PCOS/PCOD.
What are Female Infertility signs related to the menstrual cycle and ovulation?
Abnormal Period: Heavier or lighter than normal bleeding
Irregular Period: The number of days between each period varies monthly
Absent Periods: Periods are not occurring at all
Painful Period: Severe cramps or back/pelvic pain occurs during periods
All of these period-related signs indicate that there might be a problem with ovulation.
What are Risk factors for Female Infertility?
Certain factors may put you at higher risk of infertility, including:
- Age. The quality and quantity of a woman’s eggs begin to decline with increasing age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
- Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It’s also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.
- Weight. Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
- Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
- Alcohol. Stick to moderate alcohol consumption of no more than one alcoholic drink per day.
What are tests for identifying Female Infertility?
Fertility tests may include:
- Ovulation testing. An at-home, over-the-counter ovulation prediction kit detects the surge in luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone — a hormone produced after ovulation — can also document that you’re ovulating. Other hormone levels, such as prolactin, also may be checked.
- Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you’ll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
- Ovarian reserve testing. This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply — including women older than 35 — may have this series of blood and imaging tests.
- Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
- Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that can’t be seen on a regular ultrasound.
Depending on your situation, rarely your testing may include:
- Other imaging tests. Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease.
- Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
- Genetic testing. Genetic testing helps determine whether there’s a genetic defect causing infertility.
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