Reasons of Infertility in Women

What is Infertility? 

According to the World Health Organization(WHO), infertility is the absence of pregnancy despite regular intercourse for a period of one year without the use of any contraceptive method. Infertility in women can be caused by ovulation problems, blocked tubes, obesity, endometriosis and many other problems. In order to provide the right treatment, the cause of infertility must first be determined correctly. 

What are the Symptoms of Infertility in Women? 

The most obvious symptom of infertility in women is the absence of pregnancy. In some patients, infertility may not show any symptoms other than the inability to conceive and therefore the patient may not realize that she is infertile until she wants to have children. While many diseases can make it difficult for a woman to conceive, sometimes there may be no reason for the patient not to be able to conceive. Symptoms of infertility in women can be as follows; 

• Failure to menstruate  
• Menstrual irregularities; although the menstrual cycle is different in every woman, different menstrual onset every month indicates a problem in ovulation  
• Menstrual bleeding may be more or less than normal
• Very painful menstruation  
• Excessive pimples, discoloration of the skin  
• Excessive hair growth on the chin, upper lip and breasts  
• Hair loss  
• Being overweight, and obesity 
• Painful sexual intercourse  
• White milk-like fluid coming from the breast even though she is not breastfeeding 

Causes of Infertility in Women: 

• Hormonal disorders; hormone levels that interfere with egg development, release or implantation of the fertilized egg in the uterus  
• Congenital abnormalities or tumours in the uterus can prevent the embryo from implanting (attaching to the uterus) after it has formed   
• Obesity; excessive weight can cause infertility by preventing ovulation or creating problems.  
• Obstruction in the tubes(canals); the egg cell secreted from the ovaries reaches the tubes where it is fertilized with the sperm cell and the embryo passes from the tubes to the uterus and settles. When the tubes are blocked, the egg cell cannot meet and fertilize with the sperm and pregnancy cannot occur. Tubal obstruction can occur after surgery or infection.  
• Immunological causes; low or low quality of cervical mucus 
• Endometriosis; It is a condition in which the endometrium layer, which forms the inner lining of the uterus, is located in a different place outside the uterus (such as ovaries, tubes, intra-abdominal). It grows where it is located, causes bleeding and causes chocolate-like fluid accumulation over time. This condition can affect the quality of the egg and can also prevent pregnancy. 
• Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder observed during female infertility. 
• Hyperprolactinemia is an abnormally high level of the hormone Prolactin, which is responsible for the development of breast tissue and the production of milk during breastfeeding. This can be caused by a benign pituitary tumour that secretes prolactin hormone, but it can also be elevated due to pituitary trauma, chest trauma or various medications. High prolactin levels cause infertility. In hyperprolactinemia; milk-like fluid from the breast, amenorrhea, infertility and even visual disturbances and headaches may occur if there is a pituitary adenoma. Pituitary adenoma is detected by MRI. 
• Cancer and cancer treatment; cancers in the reproductive organs or chemotherapy and radiotherapy for different types of cancer can affect reproductive functions in women. 
• Age; age is a very important factor affecting fertility in women who want to have children. Women are born with a certain ovarian reserve at birth, and they spend from this reserve. As the woman ages, the eggs age and the number of abnormal eggs increases. Especially after the age of 35, the possibility of conception starts to decrease and after the age of 40, the rate of normal eggs drops to 10%. 
• Adhesions in the uterus caused by surgery or infection  
• Pelvic (lower abdominal) infection (PID)  
• Endocrine diseases such as thyroid  
• Genetic diseases 

Which factors increase the likelihood of infertility in women? 

• Substance abuse 
• Psychological disorders 
• Excessive tobacco and alcohol consumption 
• Obesity or anorexia 
• Exposure to harmful chemicals 
• Radiation exposure 

What are the diagnostic tests for infertility in women? 

• Hormone tests; some hormone values in blood are checked to determine whether ovulation has occurred and to evaluate the ovarian reserve.     
• Ultrasonography(USG) is the first test to be performed to visualize the ovaries, tubes and uterus. Vaginally performed ultrasonography gives the physician an idea about possible issues. Polycystic ovary is detected with the ovarian image on ultrasound.   
• Saline Infusion Sonography (SIS); In order to evaluate the findings in the uterus that arouse suspicion with vaginal ultrasound but cannot be clearly detected, it can be detected by ultrasound applied by giving very little serum into the uterus after the end of menstruation. Problems such as polyps or fibroids in the uterus are detected and treated with the appropriate surgical method.  
• Hysterosalpingography (HSG); In HSG, also known as uterine film, a special radioactive substance is administered vaginally into the uterus and a film of the uterus and tubes is taken. Problems in the uterus or obstructions in the tubes can be better detected. 
• Hysteroscopy; With a special optical device, the inside of the uterus and the part where the tubes open to the uterus are visualized by entering through the cervix. It can be performed only for diagnostic purposes, for visualization, or surgical intervention can be performed when an abnormal situation (such as polyps, adhesions, fibroids) is observed. Since it is a painful procedure, it is always performed under anaesthesia.  
• Laparoscopy; The uterus and tubes are evaluated by entering the abdomen through a small tube with a camera inside. It is checked whether the dye given vaginally reaches the abdomen through the tubes. It is used for surgical removal of fibroids, endometriosis or larger problems. 

Treating Infertility in Women 

• In the treatment of infertility in women, the patient must first be evaluated thoroughly, and the source of the problem must be identified. Problem-oriented treatment methods are then applied. It is recommended for patients seeking pregnancy to quit habits such as smoking and alcohol, eat healthily and avoid stress as much as possible. 
• Hormone therapy; hormonal irregularities in the woman are taken under control. Hormones to induce ovulation are given and ovulation is monitored.  
• Surgical treatment; conditions that prevent pregnancy, such as fibroids, polyps or adhesions in the uterus, obstruction in the tubes, fluid accumulation or endometriosis that can damage the ovary are corrected by surgical interventions.  
• IUI (Intra Uterin Insemination); It can be applied in patients with open tubes and no sperm problems. Ovulation is achieved and prepared sperm cells are injected into the uterus with a thin catheter. The sperm cells are expected to fertilize the egg. It is shared with the patient that the chance of pregnancy in intra uterin insemination treatment is around 15-20%.  
• IVF Treatment; The ovaries of the woman are stimulated with hormone injections. The eggs that reach a certain size are collected vaginally under anaesthesia. The sperm sample given by the male patient is prepared in the andrology laboratory. The embryo obtained after microinjection is transferred to the uterus of the female patient and pregnancy is achieved.