Female Infertility
In women, the most common cause of infertility is ovarian dysfunction.
Causes of female infertility include ovarian dysfunction, fallopian tube damage, endometriosis, and various uterus disorders. Overweight and underweight, stress, age and pelvic inflammations also cause infertility.
How is female infertility examined?
Women’s infertility examinations usually begin with studying the menstrual cycle.
The menstrual cycle is studied in order to find out if there are any abnormalities in the functioning of the ovaries, whether the egg cell is released and whether the functioning of the corpus luteum is adequate for pregnancy. These are examined based on blood samples taken at different stages of the cycle. The development of the ovarian follicle is monitored with ultrasound examinations.
The examinations are typically followed by a tubal patency test, which is carried out at the beginning of the next menstrual cycle.
These basic studies help identify the most typical causes of female infertility, i.e. mild hormonal disorders and damaged fallopian tubes.
Learn more: Menstrual cycle and ovulation
Causes of infertility related to ovaries
In women, the most common cause of infertility is ovarian dysfunction. Irregular, long menstrual cycles (more than 37 days) may be a symptom of polycystic ovarian syndrome (PCOS). In PCOS, the overproduction of male hormones, or androgens, causes the development of the ovarian follicle to stop, resulting in, among other things, menstrual cycle and ovulation disorders.
Excess production of milk hormone (prolactin) as well as thyroid disorders can result in egg cell maturation failure. The secretion of these hormones is examined with a blood test from everyone beginning infertility examinations. Ovarian function is also disturbed due to being overweight or underweight. In these cases, controlling weight within normal limits is important. Excessive physical activity can make it difficult to get pregnant by preventing the growth of the ovarian follicle.
Approximately one percent of women will have premature menopause, that is, their ovarian function will cease for unknown reasons before the age of 40. In this case, treatments with the woman’s egg cells cannot be carried out.
Obstructed fallopian tube as a reason for infertility
About 15% of women undergoing infertility examinations are diagnosed with fallopian tube damage. The fallopian tubes may be either completely obstructed or surrounded by adhesions that interfere with the passage of the egg in the fallopian tube. The obstruction of fallopian tubes is most commonly caused by a sequela of inflammation. Pelvic surgeries or endometriosis can also cause the fallopian tube to become obstructed due to adhesions. The damage may affect only one of the tubes, in which case the pregnancy can begin without treatment, but a total obstruction prevents the onset of natural pregnancy. In such cases, the mode of treatment used is in vitro fertilisation. In some cases, the obstruction can be removed with surgical treatment, but it can increase the risk of ectopic pregnancy.
The examination of the function of the fallopian tubes begins with a tubal patency test, or hysterosalpingosonography (HSSG). In this test, a catheter inserted into the uterus is used to inject warm saline and air bubbles into the uterus, the release of which into the abdominal cavity is examined with ultrasound. If necessary, a suspected obstruction of the fallopian tubes is confirmed with an endoscopy of the abdominal cavity.
The fallopian tubes may be either completely obstructed or surrounded by adhesions that interfere with the passage of the egg in the fallopian tube. The main reason for the obstruction of the fallopian tube is a post-inflammatory state. Pelvic surgeries or endometriosis can also cause adhesions to develop.
Endometriosis reduces female fertility
In endometriosis, the woman’s fertility is impaired as the endometrium appears as separate colonies also outside the womb. The colony becomes thick and bleeds like the mucous membrane inside the uterus. Menstrual pain and pain from intercourse or vibrations can be signs of endometriosis. Endometriosis is a common disease among women of reproductive age. It can be identified in a gynaecological examination as tender bumps. If endometriosis has damaged the ovaries, the condition will be visible as so-called chocolate cysts in an ultrasound examination. Some endometriosis colonies can only be found in an abdominal endoscopy.
Learn more about endometriosis and its treatment.
Uterine anomalies and infertility
Muscle tumours that grow towards the uterine cavity (myomas) and congenital anomalies can interfere with the onset and course of pregnancy. Repeated scrapings and inflammations of the uterine cavity can also cause adhesions and thus complicate the onset of pregnancy. Myomas are detected in an ultrasound examination and additional information about the uterine cavity can be obtained in a tubal patency test or hysterosalpingosonography (HSSG).
Fragile X and female fertility
The X chromosome contains a gene called FMR-1, the mutation of which causes Fragile X syndrome. It is one of the most well-known causes of genetic developmental disorders.
The mutation can be a premutation, in which case the carrier of the mutation is asymptomatic, or a full mutation, which can result in an intellectual disability. Those who carry a premutation can suffer from infertility and, therefore, DNA testing for Fragile X syndrome can be performed in conjunction with infertility treatments.
Read more about Felicitas Mehiläinen’s genetic counselling services
Effect of progesterone on pregnancy
In ovulation, the part of the ovarian follicle that forms the corpus luteum remains. The corpus luteum produces progesterone. It is needed in order for the pregnancy to continue.
The volume of progesterone in the blood is significantly larger after the release of the egg. The content of progesterone in a blood sample is examined one week after a positive ovulation test result.
Thyroid disorders and infertility
Infertility may be caused by an overactive or underactive thyroid gland. The thyroid stimulating hormone (THS) test is one of the basic studies used in studying fertility disorders. Mild thyroid dysfunctions that would be only monitored in other circumstances are treated when examining infertility. Good diagnostics of autoimmune diseases and treatment of the disorder improve the prognosis of pregnancy.
In most cases, good treatment of thyroid disorders alone is enough for the pregnancy to begin and no actual fertility treatments are even needed.
Identify the cause of infertility
The cause of infertility can be identified already at the first appointment with an experienced doctor. It is advisable to come to the first appointment together with your partner, if you have one.