Female infertility problems
A woman usually produces a single follicle in the ovaries each month as a result of various hormonal changes. Once the egg which develops within the follicle is mature, it is released. The fallopian tube subsequently picks the egg up and moves it towards the uterus. The quality of cervical mucus at the time of ovulation must be such that it allows free passage of the sperm into the uterus.
Common female infertility problems are due to the following:
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Tubal blockage
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Ovulatory problems
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Polycystic ovaries
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Endometriosis.
Tubal blockage
In normal circumstances, the fallopian tubes act like fishing rods or wicket keepers, picking up the released egg and helping to move it towards the uterus. Damage to the tubes may impede the pick-up or transport of the egg, thereby preventing fertilisation. Greater damage may result in complete tubal blockage.
Tubal blockage can occur as a result of any infection which travels up into the tubes from the cervix or uterus, or which arrives at the tubes from other sites in the peritoneal cavity, such as the appendix, or from previous surgery. If fluid collects in the fallopian tube (hydrosalpinx), it may be a potential source of chronic infection. The removal of hydrosalpinx is recommended prior to IVF treatment as this fluid may also be detrimental for the development of the embryo.
Some blockages can be treated by micro-surgical techniques, but in other cases pregnancy can only be achieved with IVF.
Ovulatory problems
Ovulatory problems are the most common cause of female infertility and occur as a result of hormonal imbalance. This imbalance may arise either within the hypothalamus, the pituitary gland, or in the ovaries. Common causes of this include stress, weight loss or weight gain, excessive prolactin production (the hormone that stimulates milk production in the breasts) and polycystic ovarian disease.
Polycystic ovaries
About 20% of women have polycystic ovaries (PCO). This term describes the appearance, as seen on an ultrasound scan, of an increased number of small cysts under the surface of the ovary. Many women with PCO have normal regular cycles and have no problems conceiving.
However, some women with these ultrasound findings have a condition known as polycystic ovarian syndrome (PCOS). These women have a hormone imbalance with irregular or absent periods and they may have difficulty conceiving because they are not ovulating regularly.
Treatment in the first instance usually involves the use of drugs to correct the hormone imbalance and to stimulate ovulation. If the woman is overweight, weight loss may also improve the hormonal imbalance. Alternatively, laparoscopic ovarian drilling (making tiny holes on the surface of the ovaries using diathermy or laser) may be performed. In cases of PCOS these two modes of treatment may precede an IVF treatment cycle.
Endometriosis
Endometriosis arises when tissue, which normally lines the womb, is found at other sites in the pelvis. At the time of menstruation, bleeding occurs from this tissue and this may give rise to abdominal pain and painful intercourse. Blood-filled cysts may also develop within the ovaries. These cysts are known as chocolate cysts because of their dark brown appearance. It is not clear why mild to moderate endometriosis is associated with infertility, but there have been suggestions that endometriosis reduces the ability of the tube to pick up the eggs.
Ovarian diathermy treatment through the laparoscope is a possible method for improving the fertility of the patient. Drug therapy is not helpful in improving fertility although it is effective in reducing the pain.
In cases of extensive endometriosis, especially in the presence of chocolate cysts, surgical correction (laparoscopically or by open surgery) may be required before embarking on IVF treatment.
IVF is an appropriate treatment for infertility associated with endometriosis where other methods have failed. Any resulting pregnancy is usually an excellent temporary cure for endometriosis.
