Female infertility BY: Ahmed Desouky Definition Infertility is the inability of a couple to get pregnant after 12 months of regular sex without the use of birth control in women less than 35 years of age; and after six months of regular sex without the use of birth control in women 35 years and older. Genetic factors of infertility Genetic infertility occurs when the structure of the eggs' genes is disturbed. Chromosomes in an adult can be damaged: •under the influence of radiation and chemicals; •due to environmental pollution and improper lifestyle, such as drug use . Causes of genetic infertility in women: •Violation of the mechanisms of chromosome divergence during egg maturation. After 40 years, about 80% of the eggs have chromosomal abnormalities. •Congenital chromosomal abnormalities, such as fusion of chromosomes or inversion, in which a section of the chromosome turns. •Congenital anomalies in the number of sex chromosomes: Shereshevsky-Turner and Swier syndromes, as well as Xchromosome trisomy, a syndrome in which ovarian failure develops and the risks of intrauterine fetal death increase. •Noonan syndrome (Ulrich-Turner) - a woman cannot get pregnant due to primary ovarian failure. Chromosomal causes of infertility Molecular genetic disorders: •Mutations in genes responsible for the blood coagulation system. Excess homocysteine, increased blood clotting and a tendency to form blood clots can lead to infertility and miscarriage . •Kallman syndrome - mutations in genes, due to which secondary ovarian failure has developed, or hypogonadotropic hypogonadism (disturbances in the hypothalamic-pituitary system). •Impaired endometrial implantation ability and displacement of the time of the implantation window. •Martin Bell Syndrome (Fragile X Syndrome). In women who are carriers of the pre-mutation state, in 15–25% of cases, the syndrome of early ovarian depletion develops . Genetic abnormalities in infertility occur no more often than in 10% of cases, and predominate in men . In women, disorders are mainly associated with changes in the number and structure of chromosomes, gene mutations. Such pathologies more often appear after 40 years Fragile X Syndrome Risk factors Certain factors may put you at higher risk of infertility, including: •Age. The quality and quantity of a woman's eggs begin to decline with age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage. •Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It's also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment. •Weight. Being overweight or significantly underweight may affect ovulation. Getting to a healthy body mass index (BMI) might increase the frequency of ovulation and likelihood of pregnancy. •Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later. •Alcohol. Excess alcohol consumption can reduce fertility. functional disorders For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are: •One of the two ovaries releases a mature egg. •The egg is picked up by the fallopian tube. •Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization. •The fertilized egg travels down the fallopian tube to the uterus. •The fertilized egg attaches (implants) to the inside of the uterus and grows. In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below. Female reproductive system The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system. Fertilization and implantation During fertilization, the sperm and egg unite in one of the fallopian tubes to form a zygote. Then the zygote travels down the fallopian tube, where it becomes a morula. Once it reaches the uterus, the morula becomes a blastocyst. The blastocyst then burrows into the uterine lining — a process called implantation. Ovulation disorders Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders. • Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility. Polycystic Ovary Ultrasound Laparoscopic Ovrain Drilling Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs. Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age 40. Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and can cause infertility. This can also be caused by medications you're taking for another condition. Damage to fallopian tubes (tubal infertility) Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include: •Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections •Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube Endometriosis Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting. Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Endometriosis With endometriosis, bits of the uterine lining (endometrium) — or similar endometrial-like tissue — grow outside of the uterus on other pelvic organs. Outside the uterus, the tissue thickens and bleeds, just as typical endometrial tissue does during menstrual cycles. Uterine or cervical causes Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage: •Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant. •Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems becoming or remaining pregnant. •Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix. •Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus. Unexplained infertility In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it's frustrating to get no specific answer, this problem can correct itself with time. But you shouldn't delay treatment for infertility. THANK YOU!
