Female Infertility

Infertility means not getting pregnant after one year of sexual intercourse without using contraceptive methods. Infertility can be due to a male or female problem or a combination of both. Also, in some couples, the cause of infertility cannot be identified. In this article, you will learn more about the causes, symptoms and treatment of infertility in women.

Causes of female infertility

Women are born with a certain number of eggs. The number and quality of eggs decreases with age. After the age of 30, the chance of having a child decreases by 3 to 5 percent every year, and after the age of 40, the decrease in fertility continues more strongly. In addition to age, infertility in women may be due to the following reasons:

Fallopian tube damage

Uterine or fallopian tubes are responsible for carrying the egg from the ovary to the uterus, and the presence of any problem in these tubes can prevent the egg and sperm from reaching each other. Pelvic infection, endometriosis and surgery can lead to adhesions in the fallopian tubes and their closure or damage.

Hormonal changes

Disorders in the secretion of reproductive hormones in women can lead to ovulation problems. These hormones play a role in the release of the egg or ovulation and the thickening of the inner lining of the uterus or endometrium to prepare the uterus for implantation of the fertilized egg. If there is a hormonal disorder in women, the process of ovulation, fertilization and implantation may face problems. Hormonal disorders usually lead to changes in women’s menstrual periods.

Cervical problems

Cervical problems can prevent sperm from reaching the egg. Abnormality of cervical secretions or history of cervical surgery may cause this problem. Although this is not a common problem in infertile women, it can be treated with intrauterine sperm insemination or IUI.

Uterine problems

The abnormality of the anatomy of the uterus, such as when there is a polyp or fibroid in the uterus.

Infertility with an unknown cause

The cause of infertility in a large percentage of couples cannot be diagnosed with current methods, which is called infertility with an unknown cause.

Ways to treat female infertility

Infertility treatment is done in different ways according to the cause of this problem in women. In cases where some chronic diseases such as diabetes or

thyroid have led to the problem of infertility, the physician will first try to treat the disease and at the same time will take methods to improve fertility. Below are some common infertility treatment methods:

Drug treatment

This treatment is usually prescribed for people who have problems with ovulation or ovarian laziness or in cases where the problem of infertility is not known. In this method, the physician stimulates the ovulation process by prescribing drugs such as clomiphene citrate, letrozole or gonadotropin. Usually, after prescribing the medicine, the physician asks the man and woman to try to get pregnant again naturally. These drugs increase the number of released eggs by stimulating the ovaries, which increases the chances of a woman’s fertility. In the process of drug treatment, the physician may prescribe a vaginal ultrasound to determine the number of released follicles and eggs in terms of the effect of drug treatment.

ART

It is a treatment that includes the following:

IUI

In cases where the physician considers the cause of infertility to be a problem in the cervix or sperm reaching the fallopian tubes, he/she may proceed through the intrauterine insemination method. In this method, on the day of ovulation, after collecting the sperms from the man and washing them, the physician drains the sperms through a narrow and long plastic catheter through the cervix into the uterus. The physician may use medication to stimulate ovulation to increase the chances of pregnancy before the insemination procedure.

IVF

In cases where the cause of infertility is unknown, the physician usually uses the IVF method to impregnate the woman. In this method, eggs are transferred to the mother’s uterus after being fertilized by sperm in the laboratory. First, the physician prescribes a course of ovulation stimulation medication such as gonadotropin to release a large number of eggs. After the maturation of the eggs, the physician removes the eggs through a vaginal puncture and with the help of ultrasound. After collecting the sperm from the man and washing them, the sperms are added to the eggs in the laboratory for fertilization. A few days later, after fertilization and cell division, one or more fertilized eggs are transferred into the mother’s uterus using a tool. The physician may freeze the extra embryos for future times at the couple’s request.

ICSI

This method is used if the number of healthy male sperm is low. The microinjection method is completely similar to IVF, except that healthy sperms are injected precisely into the egg. In this case, the chance of egg fertilization increases greatly. In this method, like the IVF method, after the eggs are fertilized, they are transferred to the mother’s uterus. Nowadays, microinjection method is used in Iran for fertilization to increase the accuracy and chance of fertility.

PGD

PGD is pre-implantation genetic diagnosis and is an assisted reproductive technology that is used in the IVF process to increase the probability of pregnancy and successful delivery. PDG is a genetic test on the cells taken from the embryo, which helps to select the best embryo for pregnancy and prevent the transmission of the genetic disease to the couple who carry the gene.

PGS

Pre-implantation genetic screening includes comprehensive screening of all chromosomes. This test, also called PGT-A, is used to screen for disorders of a number of chromosomes (aneuploidy). These disorders include common syndromes such as Down syndrome and Turner syndrome.

Hatching

After the penetration of the sperm into the egg and the formation of the embryo, this embryo is protected by an outer layer called zona pellucida until implantation in the uterus. This layer is made of protein sugar molecules that protects the egg and embryo. The embryo must be removed from this shell before penetrating into the uterine tissue. In cases such as in vitro fertilization, some factors prevent the spontaneous thinning and tearing of the zona pellucida, so an external agent such as a laser is needed, which causes a cut in the zona pellucida. The laser hits a part of the fetal wall in a completely controlled manner and a cut of about 40-35 micrometers is removed from the zona pellucida, this process is called laser hatching.

Use of donated eggs

Women who are over 40 years old and have ovarian failure, and as a result, their ovaries do not work properly or the ovulation is not of sufficient quality, but their uterus is normal, can get pregnant through egg donation. In this method, after taking fertility drugs and stimulating ovulation of the donor, a few eggs are extracted from the donor’s ovary, then the donated eggs are combined with the sperm of the recipient’s husband, and fertilization takes place in the laboratory, then the fertilized eggs are transferred to the recipient mother’s uterus.

Surrogate uterus

Women who have uterine problems and cannot get pregnant, but have healthy ovaries and eggs, can use a surrogate. In this method, the egg and sperm of the husband and wife are combined outside the laboratory, and the fertilized egg is transferred into the womb of the surrogate mother, and the embryo grows and is born in the womb of another woman.

Treatment of female sexual disorders

There are many factors in women’s lives that interfere with sexual performance and can lower their quality of life. Research shows that almost half of women experience at least one of the symptoms of sexual dysfunction. Sexual dysfunction is a problem in part of the sexual relationship, from arousal to orgasm. Physical factors such as illness, surgeries and hormonal changes following menopause, along with psychological factors such as depression, anxiety and stress, are involved in the occurrence of sexual disorders in women.

Types of sexual disorders

Sexual disorders have 4 different types:

Sexual desire disorder:

low sexual desire and lack of interest in having a relationship

Arousal disorder:

This problem is related to physical problems related to achieving an erection.

Orgasm disorder:

In this type of disorder, the person is unable to reach orgasm.

Desire for pain disorder:

These people have a desire to experience pain during sex.

Treatments for sexual disorders include:

Drug treatment

If the cause of sexual dysfunction is a disease or medical condition, medicine will probably be used to treat it. One of the common reasons in such situations is hormonal imbalance. Hormone therapy in both women and men can have a dramatic effect in improving sexual disorders. There are also drugs that can increase blood flow to the penis, such as Viagra. Sometimes the drugs that a person takes are the cause of sexual arousal, in which the physician can change the drugs used.

Psychiatric consultation

This method is based on psychological counseling by a psychologist or sex therapist. If the cause of sexual disorder is mental and psychological problems such as fear, stress, anxiety, childhood problems, etc., this treatment method can be used to improve sexual disorders. In this case, the sex therapist or counselor helps the person to learn, practice and acquire new skills, with their help, he can solve her sexual disorder.

Surgical treatment of sexual disorders

Laparoscopy

Prolapse of pelvic organs and urinary incontinence are among the factors that cause sexual dysfunction in women. Anterior and posterior colporrhaphy surgery is one of the treatment methods to correct these problems.

Hysteroscopy

In the hysteroscopy method, which is used to solve uterine problems such as polyps and fibroid tumors or uterine tube problems, the physician examines the problems by inserting the hysteroscope device through the vagina into the uterus and, if needed, it removes extra tissues or opens blocked uterine tubes.

In women who have diseases related to the uterine tubes or the reproductive system, the physician performs laparoscopic surgery to reconstruct and fix the problem of the reproductive organs. It is possible that after the laparoscopy operation and solving the problems of the reproductive system, the physician will diagnose the need for artificial insemination to get pregnant. In laparoscopic surgery, the surgeon can remove ovarian cysts, treat endometriosis, or open blocked uterine tubes by inserting several tubes with a camera into the abdomen.

Myomectomy

Myomectomy, which is also sometimes called fibroidectomy, is the name of a type of women’s surgery in which leiomyomas of the uterine tissue, known as fibroids, are removed. In fact, myomectomy refers to the removal of a non-cancerous mass of muscle tissue that has grown abnormally. In this surgery, the goal is to restore the uterine tissue and relieve the symptoms, not to remove the entire uterine tissue, which happens in a hysterectomy.