The number of infertile couples rises with increasing age. Female reproductive problems accounts for about 40% of infertility cases.

Symptoms

Inability on get pregnant after a year of unprotected sex.

Abnormal menstrual cycles.

Causes of infertility

•    Ovulation disorders: It accounts for 25% of infertile couples. These can be due to defect in the regulation of reproductive hormones by the hypothalamus or the pituitary gland or any defect in the ovary.

• Abnormal FSH and LH secretion: These two hormones are responsible for stimulating ovulation every month. These hormones are produced by pituitary gland during menstrual cycles. Excess physical or emotional stress or very high or very low body weight can disrupt this pattern and affect ovulation. It is characterized irregular or absent periods.

• Poly cystic ovarian syndrome (PCOS): It results in over production of male hormones (androgens) which affects ovulation due to changes in hypothalamus, pituitary and ovary.

• Luteal phase defect: It occurs when the ovary does not produce enough of the hormone progesterone after ovulation.

• Premature ovarian failure: It is caused by an autoimmune response. It results in the loss of eggs in the ovary and decreased estrogen production.

• Damage to fallopian tubes

When the fallopian tubes become damaged or blocked, it prevents sperm getting to the egg or close the passage of the fertilized egg to reach the uterus.

Causes of fallopian tube damage or blockage include

• Inflammation of the fallopian tubes (salpingitis) due to Chlamydia or gonorrhea.
• Previous ectopic pregnancy, in which fertilized egg becomes implanted and starts to develop in a fallopian tube instead of in the uterus.
• Previous surgery in the abdomen or pelvis.
• Endometriosis: It is the condition where the uterine tissue grows in other locations. This extra tissue growth and surgical removal of it can cause scarring which impairs fertility.
• Cervical narrowing or blockage: Also called cervical stenosis. In this condition the cervix will be unable to produce the type of mucus for sperm mobility and fertilization. The cervical opening may be closed preventing the sperm from reaching the egg.
• Uterine causes: Like polyps, tumors (fibroids or myomas) in the uterus can impair fertility by blocking the tubes or by disrupting implantation. Uterine abnormalities such as abnormally shaped (bicornate) uterus can impair fertility.
  
• Unexplained infertility: The cause of infertility in unknown.

Risk factors of infertility

• Age: Infertility rate increases with increasing age.
• Smoking.
• Overweight individuals are more prone to infertility.
• Sexual history: Sexually transmitted diseases like Chlamydia, gonorrhea can cause fallopian tube damage.
• Alcohol: Heavy drinking is associated with increased risk of ovulation disorders and endometriosis.
• Caffeine: Consumption of more than six cups of coffee a day may decrease the fertility.

Tests and diagnosis

• Blood tests for measuring progesterone level.
• Hysterosalpingography.
• Laparoscopy.
• Ovarian reserve testing.
• Hormone testing: Testing for hormones like FSH, LH.

Treatment

• Stimulation of ovulation with fertility drugs like clomiphene citrate.
• Gonadotrophins like FSH, human menopausal gonadotropin etc.
• Metformin.
• Fertility restoration surgeries like tubal surgeries.
• Reproductive assistance like in vitro fertilization.