The number of women who have difficulty having a child is growing. Among the causes, age is very important: the more it grows, the longer the time of conception, because the oocytes decrease, the uterus becomes less elastic, stress compromises fertility as well as the hormonal changes of premenopause.
Do not underestimate the presence of other risk factors such as sedentary lifestyle, obesity, the presence of diseases such as diabetes, sexually transmitted diseases, for example gonorrhea or alterations in the hormonal cycle, also due to disorders such as depression, which can lead to phenomena such as amenorrhea.
There are therefore many physiological and pathological conditions that lead to female infertility, also called female sterility.
According to data from the Higher Institute of Health, from the National Register of PMA (medically assisted procreation) the couple’s infertility is around 15 percent.
According to several studies, female infertility is around 35.5-45 percent, male infertility 35-40 percent and unexplained (idiopathic) infertility around 13-15 percent.
According to Enrico Semprini gynecologist and reproductive immunologist “in 50 percent of cases, when pregnancy does not arrive within a year of sexual intercourse, the main responsible factor is a “poor quality” of sperm and male seminal fluid; In 20 percent of cases they are ovulatory disorders of the woman and in 30 percent of cases they are damage to the tubes or the presence of endometriosis.
There are several tests to establish the possible causes of infertility in the couple. As far as women are concerned, a particularly reliable examination is transvaginal ultrasound, with which pathologies affecting the uterus, ovaries and uterine cervix can be highlighted. It is possible, for example, to detect congenital or acquired malformations of the uterus (such as fibroids) or the presence of ovarian cysts.
In the event that the doctor, after the appropriate investigations, establishes that spontaneous conception is impossible, or at least remote, and that there is no pharmacological or surgical possibility to solve the cause of infertility, it may be useful for the couple to contact centers specialized in techniques such as in vitro fertilization or assisted fertilization.
Tubal damage
To be affected by disorders that can compromise fertility are not only uterus and ovaries, but also the fallopian tubes, organs of the reproductive system that connect the ovary to the uterine cavity.
The most common cause of tubal damage is the presence of germs acquired during sexual intercourse that give rise to an infection known as salpingitis (from the Latin salpinx, tuba).
Enrico Semprini explains: “The most serious consequence is the closure of the tube and therefore the impossibility for pregnancy to begin or the risk of ectopic pregnancy. Mostly there are no symptoms: the germs remain silent because then they can spread more easily”.
However, it is necessary to keep attention high: even modest genital discomfort, such as burning and irritation or abnormal discharge (normal vaginal secretions are not annoying or abundant and are devoid of coloring) must always make us suspect the possible presence of a germ.
“It is therefore necessary to talk to your doctor for laboratory tests that exclude infections such as chlamydia, mycoplasma or uroplasm or treatment with specific therapies based on antibiotics, for both partners“, warns the expert.
If despite the treatment or exclusion of white discharge, burning or disturbances during sexual intercourse, itching continues, it is good to talk to your doctor again: “There are other germs not so clearly identifiable, but capable of giving rise to cystitis, vaginitis (irritation of the vagina) or cervicitis, ie irritation of the cervix, and also to go up to the tubes and cause tubal damage“, emphasizes Semprini.
If there is inflammation of the fallopian tubes (salpingitis), aggressive antibiotic treatment is necessary, often intramuscularly or intravenously.
“There are salpingites who, by their characteristic or because they have been neglected for too long, can turn into tube-ovarian abscesses: the terminal part of the tube sticks to the ovary due to the formation of pus inside it and in these cases hospitalization is necessary. Timeliness is essential: in 70 percent of cases, in fact, adequate pharmacological treatment resolves the situation without the need for surgery to remove the tube and sometimes the ovary, irreversibly compromising the fertility of the woman » concludes the gynecologist.
Ovulatory disorders
Ovulatory disorders are another important cause of female infertility.
Ovulation, which occurs on average between the 12th and 14th day of the menstrual cycle, is the process by which the egg is released from the ovary, initiating the so-called fertile period.
Failure to ovulate can be due to several causes:
– thyroid dysfunction
– excessive production of prolactin
-Premenopausal
– polycystic ovary syndrome.
«Micropolycystic ovary,” continues Semprini, “is one of the most common causes of female infertility. It is a syndrome that affects both ovaries and is characterized by the presence of many small follicles scattered on the surface. The consequence is the production of excessive amounts of male hormones that unbalance the body. The woman with micropolycystic ovary often suffers from hypertrichosis (excessive presence of hair), acne, overweight and important irregularities in the menstrual cycle (sometimes amenorrhea, absence of menstruation)».
Another characteristic of the micropolycystic ovary is the tendency to anovulation, resulting in the impossibility of getting pregnant.
Hyperandrogenism is also often associated with polycystic ovary syndrome, characterized by clinical manifestations such as acne, hirsutism, androgenic alopecia and seborrhea.
«The diagnosis of micropolycystic ovary is made with blood tests (hormones, prolactin, glucose, thyroid function, SHBG protein) and ultrasound of the ovaries. As long as the woman does not try to get pregnant, the situation is brought back into balance with the pill (oral estroprogestin), clomiphene and gonadotropins» adds the gynecologist.
Hyperprolactinemia
Excessive production of prolactin by the pituitary gland is also a fairly frequent cause of infertility.
“Prolactin is a hormone that increases during pregnancy and lactation, outside of this period it can interfere with the production of GnRh by the hypothalamus and with the functioning of the ovaries, causing ovulation disorders and menstrual irregularities,” highlights Semprini.
The causes? “Stress, certain medications (antihistamines, psychiatric drugs), thyroid dysfunction, pituitary adenoma (a benign pituitary tumor), polycystic ovary syndrome.”
“Among the symptoms, there may be anxiety, nervousness, decreased sexual desire. The disappearance of menstruation (amenorrhea) and galactorrhea (i.e. the leakage of milk from the nipples) occur only if the prolactin is very high. Diagnosis requires the dosage of prolactin in the blood, while therapy consists of drugs that suppress the production of prolactin. In the vast majority of cases the situation normalizes and ovulation resumes.”
Thyroid dysfunction
«If the thyroid is malfunctioning, there can be menstrual irregularities and ovulation disorders, particularly in cases of hypothyroidism,” says Semprini.
“The latter causes a general slowdown in metabolism, including that of sex hormones (FSH may increase). In addition, the hypothalamus and pituitary gland try to stimulate the thyroid by increasing the production of particular hormones (TRH and TSH) which, in turn, can cause hyperprolactinemia. Hypothyroidism and hyperthyroidism give various symptoms (abnormalities in appetite, weight changes, fatigue, cardiac and metabolic dysfunctions). In hypothyroidism menstrual cycles lengthen and blood is scarcer, while in hyperthyroidism cycles tend to shorten and bleeding is abundant; in both cases there may be irregular cycles without ovulation. The diagnosis is made by blood measurement of thyroid hormones (TSH, T3, T4, FT3, FT4), and the search for thyroid autoantibodies. The therapy is pharmacological in the case of hypothyroidism, while for hyperthyroidism it can be pharmacological or surgical.
Other causes
There are numerous other causes that induce infertility in women. Among these, one of the most serious is undoubtedly endometriosis: in the presence of this pathology, the endometrium, instead of being located only inside the uterus, is also located outside the uterine cavity, usually in the pelvic area.
Endometriosis can be asymptomatic or vice versa manifest with symptoms such as pelvic pain.
From a hormonal point of view, in addition to hyperprolactinemia, also a high value of FSH (usually linked to premenopause). And the so-called insufficiency of the corpus luteum can adversely affect the possibility of conception or carrying on the pregnancy beyond the initial stages.
In case of insufficiency of the corpus luteum to undergo alterations is the luteal phase of the cycle, that is the period, which goes from ovulation to menstruation, in which the body prepares the uterus to receive the fertilized egg cells through the production of progesterone.
We speak of luteal insufficiency both when progesterone is produced normally, but the luteal phase is short (less than 12 days), and when its duration is normal (on average 14 days), but the daily production of progesterone is insufficient.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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