Author Name: Dr. Runu Kumari || Mentor Name: Dr. Puja Rani on April 08, 2020
Infertility is a condition that affects about 10-15% of world population. Infertility affects men and women equally. In couples experiencing infertility about 35% is due to male factors, 35% due to female factors, 20% of cases have combination of both male and female factors and about 10% have unexplained infertility. when the cause of infertility exists within the female partner, it is referred to as FEMALE INFERTILITY.
• Ovarian factors
• tubal factor
• uterine factor
• others- Including immunological, vaginal causes and endocrinal causes
In the recent time it has been seen that there are multitude of options for treatment of female infertility, in a gynecologist’s armamentarium.
So yes, we can say that for every problem we have a solution, and female infertility is curable.
* 30-40% of all cases of female infertility are due to ovulatory dysfunction.
Ovulation disorders( anovulation ) can be caused by – PCOS, hypothalamic dysfunction, premature ovarian failure and excess prolactin.
The Symptoms of ovarian disorders are irregular menstrual cycles, either too long or too short, or absent menses.These two signs predict that a woman may not be ovulating.
Previously to diagnose ovulation certain tests were used like – Basal Body Temperature, cervical mucus study, hormonal study, and endometrial biopsy. But now these tests are no longer used. Now we have a more reliable method of diagnosing ovulation I.e. USG(TVS to be particular). It is the most commonly performed test these days and it is very accurate.
By ultrasound we can get an idea of not only about ovulation but about other ovarian pathologies including PCOD, ovarian cyst and endometrioma which can be reason behind female infertility.
Laparoscopy can also help us for diagnosing ovulation and to find out other causes of infertility .
Treatment for anovulation- medicines for ovulation induction, and controlled ovarian stimulation.
The drugs commonly used for ovulation induction –
1) clomiphene citrate alone or in combination with CC+HCG, CC+Glucocorticoid, CC+Insulin sensitizer, CC+Bromocryptine, CC+Gonadotrophins
2) Aromatase inhibitor
4) Laproscopic ovarian drilling in resistant PCOS.
• In cases of premature ovarian failure- IVF with donor eggs can be used.
• Endometriosis-occurs when tissue that normally grows in uterus implants and grows in other location. It causes inability to conceive if remain untreated, due to various reasons. In cases of minimal and mild endometriosis ovulation induction and IUI is the effective treatment. severe endometriosis may sometimes need surgery and IVF.
It is responsible for about 30% cases of female infertility. Tubal patency is necessary for natural conception, as well as for IUI.
Damage to the fallopian tubes can be caused by –
• Pelvic inflammatory disease
• Genital tuberculosis
• Previous ectopic pregnancy
To see whether tubes are functional or not, we go for tubal patency test as a part of initial investigation for infertility. Tubal patency test can be done by
• Saline infusion sonography
• Lap chromopertubation (lap&dye)
Treatment for tubal block- in cases of proximal tubal block we go for selective salpingography under fluoroscopic guidance, fluroscopic cannulation, hysteroscopy cannulation, resection anastomosis and microsurgical tubal anastomosis.
In case of distal tubal obstruction – PID is the most common cause leading to fimbrial block ,and the treatment for which includes fimbrioplasty, adhesiolysis and neosalpingostomy.
In cases of tubal problems like hydrosalpinx, lap. Salpingectomy and clipping are done, followed by IVF.
Tubal surgeries and tuboplasty are not preferred these days due to poor success rate and increased risk of ectopic pregnancy after tubal reconstructive surgeries . IVF is the best option for those having tubal problems with high success rate and without any risk of invasive surgery.
• Mullerian anomaly,
• L eiomyoma,
• Endometrial polyps
• Asherman syndrome.
These pathological conditions can be diagnosed by HSG, 3D TVS and hysteroscopy and can be treated as required .
Immunological and cervical factor contribute to about 5% cases of female infertility. treatment depends on cause like in cases of anti sperm antibody cases we can go for IUI. In cases of cervicitis the patient is treated with antibiotics before planning for further treatment.
CONCLUSION – Most of the causes of female infertility are curable. And due to advancement in medical science ,there are more options available now than ever before. Right diagnosis and right treatment will give you the desired results. So female of any age and having any problem who wants to conceive, just don’t worry, meet your doctor and follow the advice because female infertility is curable.
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