Female Intertility

Pregnancy is a natural and exciting part of life for many women and couples. However, this journey may not always progress as expected. The inability to achieve pregnancy despite regular and unprotected sexual intercourse is medically defined as infertility, commonly known as sterility. This condition is not only a medical issue but also an emotionally and psychologically challenging process for couples.

Female infertility is not as rare as commonly believed. According to data from the World Health Organization (WHO), millions of couples worldwide face infertility issues. In this article, we will comprehensively discuss what female infertility is, its underlying causes, recognizable symptoms, modern diagnostic methods, and promising treatment options. If you are also asking yourself, “Why can't I get pregnant?”, this guide will help lead the way.

What Exactly is Infertility?

Infertility is the condition where a couple is unable to achieve pregnancy despite having regular and unprotected sexual intercourse over a certain period of time. This period is generally defined as:

• For women under the age of 35: 12 months
• For women aged 35 and above: 6 months

The age of 35 is significant because the number and quality of a woman’s eggs begin to decrease noticeably after this age. Infertility may not be solely a female or a male issue. Approximately one-third of cases are due to female factors, one-third to male factors, and the remaining one-third are classified as either a combination of both female and male factors or unexplained infertility. This article will specifically focus on female infertility.

What Are the Common Causes of Female Infertility?

The female reproductive system is built upon a complex and delicate balance between the brain (hypothalamus and pituitary gland), ovaries, fallopian tubes, and the uterus. A disruption at any step within this system can lead to infertility.

1. Ovulation Disorders

The most common cause of female infertility is the absence of regular and healthy ovulation. If ovulation, which is the first step of pregnancy, does not occur or is irregular, fertilization becomes impossible. The main ovulation disorders include:

• Polycystic Ovary Syndrome (PCOS): One of the most common endocrine disorders. Due to hormonal imbalances, the ovaries are unable to regularly produce mature eggs. It can present with symptoms such as irregular menstruation, excessive hair growth, acne, and weight gain.
• Hypothalamic Dysfunction: The hypothalamus in the brain stimulates the pituitary gland, which is responsible for secreting hormones (FSH and LH) that initiate the menstrual cycle. Excessive physical or emotional stress, very high or very low body weight, and sudden weight changes can disrupt the functioning of the hypothalamus, stopping ovulation.
• Premature Ovarian Failure (Primary Ovarian Insufficiency): A condition where ovarian function decreases or stops earlier than normal before the age of 40. Genetic factors or medical treatments such as chemotherapy can cause this condition.
• Hyperprolactinemia (Excess Prolactin): Prolactin is a hormone that normally enables milk production. When its level becomes excessively high, it can suppress estrogen production and prevent ovulation.

2. Damage or Blockage in the Fallopian Tubes (Tubal Factors) The fallopian tubes, where the egg meets the sperm and fertilization occurs, play a vital role in pregnancy. Any damage or blockage in these tubes prevents the sperm and egg from coming together. Causes include:

• Pelvic Inflammatory Disease (PID): An inflammation of the uterus and fallopian tubes, usually caused by sexually transmitted infections such as chlamydia and gonorrhea.
• Previous Abdominal or Pelvic Surgeries: Surgical interventions such as appendectomy, ectopic pregnancy surgery, or cyst removal may lead to adhesions that can block the tubes.
• Endometriosis: A condition where the tissue lining the inside of the uterus (endometrium) grows outside the uterus, for example in the fallopian tubes or ovaries. This can lead to adhesions and blockages.

3. Uterine or Cervical Causes

A healthy uterus is necessary for the fertilized egg (embryo) to implant and grow. Problems related to the uterus or cervix can cause infertility:

• Fibroids (Uterine Fibroids): Benign tumors that develop in the muscle layer of the uterus. Submucosal fibroids, which distort the uterine cavity, can prevent the embryo from implanting.
• Polyps: Benign formations originating from the lining of the uterus, which can interfere with pregnancy.
• Congenital Uterine Anomalies: Structural abnormalities such as a uterine septum or a double uterus can make pregnancy more difficult.
• Cervical Factors: The cervical mucus may be too thick or too scant to allow sperm to pass through.

4. Endometriosis

Endometriosis is a condition where the tissue lining the inside of the uterus grows outside the uterus. This tissue can disrupt the function of the fallopian tubes, ovaries, and uterus, reduce egg quality, and cause adhesions in the pelvic area, leading to infertility. Severe menstrual pain and painful intercourse are the most well-known symptom

5. Advanced Age Factor

Age is one of the most critical factors in female fertility. A woman is born with all the eggs she will ever have, and this reserve decreases over time. Especially after the age of 35, there is a significant decline in the number and quality of eggs. This decline accelerates further during the 40s. With age, the risk of genetic abnormalities in the eggs also increases, which raises the likelihood of miscarriage.

What Are the Symptoms of Female Infertility?

The most obvious and primary symptom of female infertility is the inability to become pregnant despite regular attempts. However, some other signals from your body may indicate an underlying problem:

• Menstrual Cycle Abnormalities: Very irregular periods, absence of menstruation (amenorrhea), or excessively heavy and painful periods (dysmenorrhea).
• Signs of Hormonal Changes: Acne on the skin, weight changes, excessive hair growth on the face or body (hirsutism), hair loss, decreased libido.
• Painful Intercourse (Dyspareunia): May be a sign of conditions like endometriosis or pelvic infection.

If you experience any of these symptoms and are planning pregnancy, do not hesitate to consult a specialist.

How is Infertility Diagnosed?

Accurate diagnosis is essential for proper treatment. A patient suspected of female infertility typically undergoes a comprehensive evaluation that includes the following steps:

1. Medical History and Physical Examination: Your doctor will ask detailed questions about your menstrual cycle, sexual life, past illnesses, medications you use, and lifestyle. This is followed by a gynecological examination.
2. Blood Tests: These are done to measure hormone levels. Levels of AMH (Anti-Müllerian Hormone), which indicates ovarian reserve, FSH, LH, Estradiol that regulate ovulation, and Prolactin, the milk hormone, are checked.
3. Transvaginal Ultrasonography: Used to examine the structure of the ovaries, uterus, and uterine lining in detail. It is an indispensable method for monitoring egg development (follicle tracking) and assessing the presence of fibroids, polyps, or cysts.
4. Hysterosalpingography (HSG - Uterine X-ray): A special X-ray used to check the shape of the uterine cavity and whether the fallopian tubes are open. A contrast agent is introduced through the cervix to visualize the uterus and tubes.
5. Advanced Tests (If Necessary):
   1. Laparoscopy: A camera is inserted through a small incision near the navel to directly observe internal abdominal organs, tubes, ovaries, and the outer surface of the uterus. It is especially used for diagnosis and treatment if endometriosis or adhesions are suspected.
   2. Hysteroscopy: A thin camera is inserted through the cervix to directly inspect the inside of the uterus. It is used for diagnosing and treating fibroids, polyps, or structural abnormalities in the uterus.

Promising Treatment Methods

Fortunately, thanks to advances in medical technology, the vast majority of female infertility cases can be successfully treated today. Treatment is personalized based on the underlying cause of infertility, the woman’s age, and the couple’s specific circumstances.

1.Lifestyle Changes

 Sometimes the solution lies in simple lifestyle changes. Maintaining an ideal weight, balanced nutrition, quitting smoking and alcohol, managing stress, and regular exercise can have positive effects on fertility.

2.Medication Treatments (Ovulation Induction)

This is the first-line treatment especially for ovulation disorders like PCOS. Medications such as oral clomiphene citrate or letrozole, or injectable gonadotropins, are used to stimulate the ovaries with the goal of developing one or more eggs in a controlled manner

3. Surgical Interventions

 Adhesions in the fallopian tubes can be removed and endometriosis lesions cleaned, fibroids or polyps can be excised through methods such as laparoscopy or hysteroscopy. These operations aim to restore the natural function of the uterus and tubes.

4. Insemination (IUI - Intrauterine Insemination)

In this method, the man's sperm is processed to select the most motile and healthy sperm. Then, during the woman's ovulation period, these sperm are directly placed into the uterus using a thin catheter. The aim is to increase the chances of sperm reaching the egg. It is generally preferred in cases of unexplained infertility and mild male factor infertility.

5. In Vitro Fertilization (IVF)

IVF is the most well-known and effective assisted reproductive technique. The process basically consists of the following steps:

• Ovarian Stimulation: The ovaries are stimulated with injections to develop multiple eggs.
•  Egg Retrieval (OPU): The developing eggs are collected vaginally under ultrasound guidance and anesthesia. 
• Fertilization: The collected eggs are combined with sperm cells from the male partner in the laboratory to enable fertilization. If necessary, a single sperm can be directly injected into the egg (ICSI - Intracytoplasmic Sperm Injection). 
• Embryo Transfer: After fertilization, the highest quality embryo(s) are selected and transferred into the uterus using a thin catheter

In vitro fertilization (IVF) treatment is a strong option in cases of blocked fallopian tubes, advanced maternal age, severe endometriosis, diminished ovarian reserve, and when other treatments have failed.

Psychological Support During Infertility

The diagnosis and treatment of infertility can be a source of intense stress, anxiety, disappointment, and even depression for couples. During this process, psychological support is as vital as medical support. Open communication between partners, receiving professional counseling or therapy, and joining support groups with other couples going through similar experiences help manage this challenging journey in a healthier way.

Don’t Lose Hope and Take a Step

Female infertility is a condition with complex causes but can be treated today with high success rates. If you are having difficulties trying to conceive, remember that you are not alone, and modern medicine offers many solutions for you. The most important step in this process is to access accurate information and promptly consult a specialist in reproductive endocrinology and infertility. With early diagnosis and a personalized treatment plan, your chances of having the baby you dream of are quite high. Trust yourself and science, and never lose hope. Bursa EUROFERTIL IVF Center, with its expert team specialized in female infertility and modern technology, supports patients throughout the diagnosis and treatment stages of female infertility. If you have any concerns or questions about infertility, you can contact our center.

For more detailed information, you can reach us and make an appointment via WhatsApp at +90 530 886 52 63 or by phone at +90 224 251 50 00.