Causes of female infertility include ovarian dysfunction, damage to the fallopian tubes or uterus, and endometriosis. Being overweight or underweight, stress, age, and pelvic inflammatory diseases can cause infertility.
Ovarian dysfunction is the most common cause of infertility in women. An irregular and long menstrual cycle (over 37 days) may be a symptom of polycystic ovarian syndrome (PCOS), a condition in which excess production of male hormones (androgens) stops the development of the follicle, causing menstrual and ovulation disorders.
Since excess production of prolactin and thyroid gland problems may cause egg dysmaturity, the secretion of these hormones is always determined by means of a blood test. Being overweight or underweight may also affect the ovarian function, and in these cases it is important to achieve a healthy weight. Excessive physical exercise may prevent follicle growth and thus make it difficult for the woman to conceive.
About one percent of women experience premature menopause. This means that ovarian function ceases, for an unknown reason, before the age of 40. In this case, treatment using the woman’s own ova is not possible.
Damage to the Fallopian Tubes
Damage to the fallopian tubes is discovered in about 15 percent of women undergoing infertility examination. The damage may be due to a previous pelvic inflammatory disease, surgery in the lesser pelvis area, or endometriosis. Only one of the tubes may be damaged, in which case conception is possible without treatment, but a complete obstruction prevents natural conception and in vitro fertilization treatment is needed. An obstruction can sometimes be removed by surgery, but it may expose the woman to the risk of an intrauterine pregnancy. The first examination carried out to investigate fallopian tube function is hysterosalpingosonography (HSSG). It is a procedure in which warm saline solution and air bubbles are injected into the uterus via a catheter, and the release of the air into the abdominal cavity is monitored using ultrasound. If an obstruction is suspected, a laparoscopy may be performed to confirm its presence.
Endometriosis is a condition in which cells from the lining of the uterus grow outside the uterus as separate areas. The areas thicken and bleed in the same way as the lining inside the uterus. Menstrual pain as well as pain during intercourse or induced by vibration may indicate endometriosis. Endometriosis is a common condition in women of fertile age. It may be discovered in the form of tender nodules in a gynecological examination, and if it has damaged the ovaries, it is visible as chocolate cysts in an ultrasound examination. Sometimes endometriosis can only be confirmed by means of laparoscopy.
For more information, see the website of the Endometriosis Association of Finland.
Myomas protruding into the uterine cavity and congenital structural problems may affect conception and pregnancy. Recurring uterine curettage and infections may also cause intrauterine adhesions and thereby decrease the chances of pregnancy. Myomas can be confirmed by an ultrasonic examination, and information on the uterine cavity can be obtained through a hysterosalpingosonography (HSSG).