Infertility In Women

1. Infertility In Women Lesson 2

2. Review of the Female reproductive system

3. How Is Infertility Diagnosed In A Woman? • If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology. Her diagnostic tests may include:

4. Simple Tests: • Blood tests and urine tests to check hormone levels. • A Pap smear to study the health of the cervix. • Urine tests to evaluate LH surges. • A basal body temperature test

5. Simple Tests: • An endometrial biopsy – Tells the doctor if eggs have been released as well as whether there is enough progesterone. • An ultrasound to look for fibroids and cysts in the uterus and ovaries. • A postcoital test- must be done within 12 hours of intercourse to see if the man’s sperm can survive the cervical mucus.

6. More complex tests include: • A laparoscopy: Looks for ovarian or fallopian tube scarring or endometriosis. • Sometimes the scar tissue will be removed during this operation. • Accurate diagnosis.

7. A hysterosalpingogram:  checks the condition of the fallopian tubes by using dye and X-rays. It can reveal: • Blocked fallopian tubes, fibroid tumours, structural abnormalities and endometrial polyps. • Can produce false positives and false negatives.

8. Why Does A Woman Become Infertile? • Infertility in a woman may stem from many causes, such as hormonal deficiencies, problems in the reproductive organs, and some illnesses. Complications from surgery and certain medications may also impair fertility.

9. The most likely causes for female infertility are: Pelvic Inflammatory Disease (PID) - PID is the most common cause of infertility worldwide. • It's an infection of the pelvis or one or more of the reproductive organs, including the ovaries, the fallopian tubes, the cervix or the uterus. • PID usually stems from the same bacteria that cause sexually transmitted diseases, such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75 percent of fallopian tube infections.

10. PID may also develop from bacteria that reach the reproductive organs through abortion, hysterectomy, childbirth, sexual intercourse, use of an intrauterine (IUD) contraceptive device or a ruptured appendix.

11. Not only does PID cause infertility, but it may also lead to ectopic pregnancy and blood poisoning, a potentially fatal complication.

12. Polycystic ovary syndrome (PCO) • Polycystic ovary syndrome (PCO) - Another major cause of infertility. Due to hormones in the wrong quantities, follicles do not produce eggs. Instead they form fluid-filled cysts that eventually cover the ovaries. • caused by the failure of muscle, fat and liver cells to accept glucose

13. It also increases the risk of diabetes, cancer and even heart disease. The symptoms include: • Excessive facial hair • Thinning hair • Acne • Depression • Unexplained weight gain • Irregular or no periods • High insulin or cholesterol readings

14. Endometriosis - This disease is another common cause of female infertility. • Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants eventually form cysts that grow with each menstrual cycle, and may eventually turn into blisters and scars. The scars can then block the passage of the egg.

15. Other Problems • Other sexually transmitted diseases such as genital herpes can decrease fertility. • Ovary Problems - Decreased production of any one of the five hormones that regulate a woman's reproductive cycle may result in infertility

16. Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm, mistaking it for a toxic invader. • Luteal Phase Defect - the fertilized egg may be unable to implant in the uterine lining.

17. Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result, the sperm or fertilized egg cannot reach the uterus or implant there. • Other Uterine Problems - Abnormal reproductive organs or endometritis (an abnormal swelling of the uterine lining) may make it difficult for the fertilized egg to implant.

18. Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by weakening the cervix or by leaving scar tissue that obstructs the uterus.

19. Uterine muscle problems - Some women may produce weak, infrequent or abnormal contractions in the uterus. During ovulation, these contractions usually push the sperm up to the fallopian tubes. • Poor quality cervical mucus- Sometimes a woman's mucous fails to thin around the time of ovulation, and consequently it prevents the sperm from traveling through it.

20. Illness - Certain diseases, such as diabetes, kidney disease or high blood pressure. Ectopic pregnancy and some urinary tract infections may also elevate the risk of infertility. • Medications - hormones, antibiotics, antidepressants, and pain killers may bring on temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in the body, impairing fertility.

21. Premature Menopause - Some women may experience premature menopause, when their ovaries stop producing eggs. Often the cause is excessive exercise or anorexia. • More about this on Monday

22. How Is Infertility In A Woman Treated? • Medications can help solve hormonal problems and ease infections in women with fertility problems. • Most of the drugs increase specific hormones that help the eggs to be release • Antibiotics - They may cure infections in the reproductive system, such as in the cervix or lining of the uterus, and some sexually transmitted diseases. • Corticosteroids - treatment of endometriosis.

23. Oral contraceptives, antiandrogens, and drugs to reduce insulin levels – • Drugs to treat thyroid disease, benign tumors or to improve poor quality cervical mucus.

24. What Surgeries Treat Female Infertility? • Fibroids surgery or defects in the woman's uterus. • Endometriosis in the woman. In these surgeries, the doctor removes the uterine tissue that has grown outside the uterus.

25. A scarred fallopian tube in the woman. In surgeries for this problem, the scarred tissue is removed or the entire scarred section of the tube may be cut out. The tube is then rejoined and reattached to the uterus

26. Questions • Why are the simple tests for infertility, more invasive procedures for women then the ones done on men? I (1) • In your opinion, why do you think that some women would avoid getting tested if it required more complex tests? I (1) • What is the most common infertility problem that women have? K (1) List some of the causes of this problem. Do you think that this is the reason why it is so common? Explain I (2) • Why do hormonal problems affect women’s fertility more than men? I (1)