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Female Infertility

PCOD

Infertility might be attributable to the male, the female, or even a mixture of both. For 8-10% of women, polycystic ovary syndrome (PCOS) plays a role in infertility, as the male partner can trigger infertility in 30% of cases and the condition is treatable. It is normal for women with PCOS to also have insufficient follicle-stimulating hormone (FSH) and luteinizing hormone (LH) development (LH). As a consequence, they experience limited follicular growth (follicles are small sac-like structures within the ovaries, and each follicle contains an egg). Egg growth will not occur with restricted follicular production. Restricted egg production can, technically speaking, lead to irregular ovulation or an utter absence of ovulation (anovulation) that may last for months or even years. In such women, this ovulatory dysfunction is what ultimately triggers infertility. Also, the endometrial tissue in the uterus can become very thick when anovulation is protracted, leading to heavy and/or erratic periods. Excess hair production and acne are also responsible for the increase in androgens. 

Polymorphism or other alteration of the nucleotide creates a malfunction in a gene’s transcriptional function that contributes to PCOS. It is primarily responsible for genes encoding the androgen receptor, luteinizing hormone receptors, follicular stimulating hormone receptors, and leptin receptors. The deficiency in the gene disturbs the biochemical pathway and contributes to ovary dysfunction. Polymorphisms like StAR polymorphs, polymorphism of FSHR, polymorphism of FTO, polymorphism of VDR, polymorphism of IR and IRS, polymorphism of GnRH, are thought to be associated in the cause of PCOS. If the amount of insulin and androgen improves, the development and intensity of PCOS increases. Hyperinsulinemia influences the cells of the ovary and increases the level of androgen. This disease decreases SHBG and IGFBP-1 hepatic biosynthesis. On the other hand, elevated androgen levels activate visceral adipose tissue (VAT) that develops free fatty acids (FFAs) that lead to insulin resistance.

Ladies with PCOS are typically successful in achieving pregnancy, either naturally or by assisted reproduction, such as initiation of ovulation and in vitro fertilization (IVF).

Endometriosis

Endometriosis is a condition in which outside the uterine cavity, tissue identical to the tissue that surrounds the interior of the uterus develops. The endometrium is considered the lining of the uterus. When endometrial tissue develops on our ovaries, bowel, and tissues lining our pelvis, endometriosis arises. Endometriosis is graded into each of four stages (I-minimal, II-mild, III-moderate, and IV-severe) centered on the exact location, duration, and depth of the endometriosis implants, the existence and intensity of the scar tissue, and the prevalence and size of ovarian endometrial dentures.

This condition is ought to be inherited in polygenic/multifactorial form of inheritance which arises when a combination of multiple genes and environmental effects influences the phenotype. A variant of a gene named transforming growth factor β1 gene-509C/T is one possible target. Endometriosis susceptibility might well be correlated with the NAT2 G590A SNP, and the 590A allele may play a defensive part in the growth of the disease.

Endometriosis could also impact the fertility by encouraging inflammatory changes to create a malicious environment for the egg, sperm, as well as an embryo inside the pelvis. In acute cases of endometriosis, the uterine inner lining refers to as endometrium may also be affected, which in turn may impair implantation.

For females with endometriosis or even cysts with IVF therapy, conceiving a child may be an exceedingly annoying experience. Most women with endometriosis are concerned about whether or not they will be able to have a child. That’s because the aggregation of weakened endometrial tissues from outside uterus could be observed in situations like this, leading to agonizing swelling with the array of blood-filled cysts in the ovary and also groups of scar tissues.

Dependent on fertilization, implantation as well as maternity rates, IVF findings were analyzed. After age group and endometriosis process control, it was evident that the best recurrent maternity rate was obtained in patients who underwent IVF 6-25 months post their endometriosis surgical intervention.

Age and Ovulation 

Age affects men’s and women’s fertility. Age is the single largest factor determining the ability for a woman to conceive and have a healthy infant. In her early 30s, a woman’s fertility begins to decline, even more so after the age of 35. On average, women reach menopause around age 51, deemed as the official end of ovulation.

The natural fertility rate per month is around 25 percent between the ages of 20 and 30. After the age of 35, that drops to under 10 percent. For females aged 18 to 24, birth rates are decreasing. Some leave families until they are in their 30s and 40s for professions.

Age also tends to affect not only egg quality but also its quality. 

Women are less likely to get pregnant and are more likely to have miscarriages as the quality of eggs declines as the number of existing eggs decreases. When she hits her mid-to-late 30s, these modifications are most noticed. Therefore, the most reliable measure of egg quality is the age of a woman. The severity of genetic defects, called aneuploidy, is a substantial advancement in assessing egg quality. 

In elderly ladies, this goes some way to explaining the relatively low chance of pregnancy and better likelihood of miscarriage. In the ovaries, the declining amount of egg-containing follicles is called “loss of ovarian reserve.” Before they become infertile and then before individuals stop having regular periods, women gradually lose ovarian reserve. The pool of waiting follicles is incrementally used up, since women are born with all of the follicles they will ever have. The follicles become less and less sensitive to FSH stimulation as ovarian reserve decreases, so that they require more stimulation for an egg to mature and ovulate. The follicles gradually become unable to respond well enough to ovulate regularly, resulting in long, erratic cycles. The reduced ovarian reserve is typically age-related and is caused by natural egg loss and a decline in the average content of the remaining eggs. However, due to smoking, a family history of premature menopause, and previous ovarian surgery, young women could have a decreased ovarian reserve. Even if they have no known risk factors, young women may have reduced ovarian reserve.

Ovarian reserve medical tests are available, but none have been reported to accurately assess the probability to become pregnant. Day-3 FSH, antimüllerian hormone, and estrogen levels checks include blood screening on the menstrual cycle’s 2nd, 3rd, or 4th day. Elevated concentrations of FSH or estrogen mean that there is a low ovarian reserve. However, several women with reduced ovarian reserve may have normal FSH levels on day 3, so normal FSH on day 3 does not confirm normal reserve of the ovary. The clomiphene citrate challenge test (CCCT) and ultrasound measurement of follicle numbers, termed the antral follicle count, include other ovarian reserve measures that are often used.

Uterine Factors

This may include infertility caused by fibroids, polyps, scar tissue, damage to the uterus by radiation or injury that prevents a pregnancy. Asherman’s syndrome is a rare disorder where adhesions, physical barriers, within the uterus are formed by the scar tissue in the uterus, preventing pregnancy.

The main symptom isn’t ever having menstrual periods in women who’ve had absolute uterine factor infertility (who haven’t had a hysterectomy). That’s often the indication that leads a doctor to perform and reveal the diagnosis with a physical examination or an imaging test.

If you have infertility with the congenital absolute uterine factor, it means you were born without the uterus, a condition known as Mayer-Rokitansky-Küster-Hauser syndrome. This condition causes the underdevelopment of parts of the female reproductive system, meaning that the vagina may be shorter than normal or the shape and size of the uterus may not be correct. There’s no uterus present at birth in extreme cases. The ovaries are active and working in MRKH, so patients would still have changes in mood and other symptoms of a menstrual cycle, but no bleeding might occur. Although the ovaries are not impaired, kidney and skeletal issues are associated with MRKH. 

When the uterus is removed surgically, the acquired absolute infertility factor is exacerbated. For a myriad of reasons, this can occur and is done through a procedure called a hysterectomy. Hysterectomy might’ve been performed to save life of a woman, such as those in life-threatening bleeding or diagnosis of cancer, or due to extreme pain, like severe endometriosis facets.

Tubal Factors

Tubal factor infertility occurs when a blockage in the fallopian tubes will not allow the egg and sperm to meet. Tubal factor infertility accounts for about 25-30 percent of all cases of infertility. Another very common cause of tubal factor infertility is infection. Other reasons of blocking and scarring involve: Endometriosis, a disease in which outside the uterus the tissue that normally lines the uterus grows. Inflammatory pelvic disease (PID), an infection of the reproductive organs of women. The egg and sperm cannot find each other if either of the fallopian tubes are damaged or obstructed. This is titled infertility of the tubal factor, which is basically a mechanical obstacle that stops fertilization. Blocked fallopian tubes prevent natural conception, but in vitro fertilization (IVF) can bypass the tubes. 

Forms of conditions for the tubal include:

Proximal occlusion of the tubal-the sperm does not penetrate the section of the fallopian tube where fertilization typically takes place.

Distal tubal disease, ranging from slight attachments to complete obstruction.

A proximal tubal blockage is considered a tubal blockage found near to the uterus. In the center of the fallopian tube, mid-segment tubal blockage may be triggered by any form of damage or scarring that may result from tubal ligation, ectopic pregnancy, or failed attempts to reverse surgical sterilization. 

Hydrosalpinx is a fluid-filled fallopian tube. It is caused by an injury to the end of the tube, causing the tube’s fringe-like edges to adhere (agglutinate) together and close. A watery fluid that collects inside the tube and causes swelling is produced by glands in the tube. It is recognized that the fluid could be toxic to the embryo in a dilated tube and could influence implantation.

The finger-like tissue fringes that aid whisk an unfertilized egg from the ovary into the fallopian tube are fimbriae. Damage to fimbriae may prevent the fallopian tubes from reaching the egg.

Surgical and nonsurgical procedures to patch the weakened tube are the two key treatments for tubal factor infertility (s). In vitro fertilization (IVF) is usually done to achieve pregnancy if these attempts fail.

Several methods of fixing a tube and selecting the form depending on the location and nature of the damage to the tubal as:

  • In order to unblock them, tubal cannulation includes inserting a catheter driven by a wire and connected to a balloon into the Fallopian tubes.
  • Fimbrioplasty is a laparoscopic operation situated at the rear of the fallopian tube near the ovary, opening the fimbriae.
  • Salpingectomy surgically cuts the diseased or damaged fallopian tubes.
  • Salpingostomy produces a surgical opening without cutting the tube in the fallopian tube and is used specifically for the treatment of an ectopic pregnancy.

Overall, for tubal infertility, IVF is a very safe and successful fertility treatment, but the final decision of the right treatment may concentrate on our age and ovarian reserve.

STD causing infertility

Most instances of infertility of the tubal factor are due to unresolved sexually transmitted diseases that rise along the reproductive tract and thus are able to cause inflammation, injury, and scarring of the tubal. Impact of Chlamydia trachomatis and Neisseria gonorrhoeae as pathogenic bacteria implicated in morbidities of the reproductive tract, including infertility of the tubal factor as well as pelvic inflammatory disorder. In addition, many other pathogens within the vaginal microbiome, like Mycoplasma genitalium, Trichomonas vaginalis, as well as other microorganisms, can also play important roles in tubal damage and other contributing factors of infertility. The roles of various STD pathogens, co-infections, and interactions to host characteristics which all impact the consequential potential of a woman to conceive, particularly her specific vaginal microbiome.

N. gonorrhoeae, C. trachomatis, and M. genitalium would not be the only organism which is capable of harming the reproductive tract. As potential causative agents for infertility and pelvic inflammation, both Mycoplasma hominis and Ureaplasma urealyticum, two common species of genital mycoplasma, have been examined. M. hominis is normal to find in the upper genital tract.

Often examined as possible culprits of female infertility were ureaplasmas, including U. Urealyticum. Like M. hominis, ureaplasmas have been isolated from PID patients’ fallopian tubes, but their appearance in PID patients is rare. Alterations in the overall vaginal microbiome, such as in bacterial vaginosis (BV), might even have a role in infertility rather than a single organism affecting female fertility. The role of BV in infertility has also shown that BV in infertile women is significantly more common than in pregnant women. In comparison, BV was related to laparoscopically-confirmed PID, endometritis, and salpingitis after adjustment for several factors, particularly current infection with N. Gonorrhoeae, C. Trachomatis, or T.Vaginalis, indicating that the symptoms of BV are not limited to the lower genital tract and may therefore interfere with female fertility. In essence, in the fallopian tubes of women with laparoscopically verified PID and acute salpingitis, microorganisms which are extremely common in the vagina among women with BV have been retrieved.

Both sexually active women 25 and younger are advised to be tested for chlamydia and gonorrhea at least a year. It also should be screened each year for women older than 25 who may have multiple sex partners or a new sex partner. Make sure that the partner is screened and handled if you do have an STD, or that he might re-infect you.

In vitro fertilization (IVF) is an important method of treatment for fertility in women who have experienced STD damage to their fallopian tubes. Sperm and egg are mixed in the laboratory throughout IVF in order to enable fertilization outside the body with the subsequent transfer of the embryo back into the uterus.