Sunday, April 8, 2007


Female Infertility
Requirements For Conception to Occur:
In both sexes-
A normal functioning reproductive system
An adequate sex drive, and full sexual intercourse
In Women
A regular ovulatory cycle.
Fully functioning fallopian tubes.
The production of watery mucus by the cervix around the time of ovulation, this permits the ejaculated sperm to pass into the uterus from the vagina.
A uterus which permits implantation of the embryo.
In Men
Producing semen which contains sufficient numbers of healthy motile sperm.
The ability to achieve erection and ejaculate semen into the vagina.
Normal Cycle
At the beginning of the menstrual cycle the pituitary gland in your brain releases follicle - stimulating hormone (FSH) which stimulates the ovary to produce follicles. One of these follicles grows faster to become the " dominant follicle". It is from this follicle that the egg will be released.
The ovaries also produce many hormones, the most important ones are oestrogen and progesterone. Oestrogen promotes growth of the follicles and development of the endometrium, while progesterone, which is released after ovulation, is important in preparing the endometrium for pregnancy.
When the egg is released, it is swept into the fallopian tube, then begins to move slowly down the tube to be fertilised in the outer third of the fallopian tube, and then continues to the uterus to implant in the lining ( endometruim ) resulting in a pregnancy. If the egg is not fertilised, the endometium is shed as a menstrual period approximately 14 days after ovulation.
Common Causes of Infertility in the Female:
Ovulatory disorders
This occurs as a result of hormonal imbalance either within the hypothalamus, the pituitary or in the ovaries. Common causes of this includes stress, excessive weight loss or weight gain, and polycystic ovaries. Polycystic ovaries (POC) can affect up to 30% of women with infertility problems. The ovaries contain many tiny cysts and although the majority of women with PCO have normal regular cycles and have no problems conceiving, others may experience menstrual irregularities, fertility problems, excessive growth of body hair, acne and obesity. Treatment usually involves the use of drugs to correct the hormonal imbalance and stimulation of the ovaries. Alternatively, laparoscopic ovarian drilling using diathermy or laser may be performed.
Fallopian Tube Blockage
May occur as a result of previous infection or abdominal surgery complicated by adhesions. Fluids collecting in the tube (hydrosalpinx) may become a potential source of chronic infection and may also be detrimental for the development and implantation of the embryos. Some blockages can be treated surgically; otherwise IVF treatment might be the best option
Is a condition where the tissue, which normally lines the uterus, is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Blood filled cysts may develop within the ovaries (chocolate cysts) also pelvic scarring may affect the motility or the patency of the fallopian tubes leading to infertility.
Treatment of endometriosis is either medical using drug therapy or surgical treatment either laparoscopically or by open surgery depending on the extent of the disease. IVF is an appropriate treatment for infertility associated with endometriosis where other methods have failed.
Cervical Factors
Some women have antisperm antibodies within their cervical mucus or produce very little unfavorable mucus at the time of ovulation which interferes with sperm migration through the cervical canal. Hostile mucus may be by passed by intrauterine insemination with or without superovulation.
Unexplained Infertility
Affects 20 - 25% of infertile couples, caused by factors which cannot be assessed by using conventional tests. It is not always possible to determine if, the eggs are actually released from the follicles, if the fallopian tubes are able to pick up the egg, if the sperm is capable of reaching the site of fertilisation and fertilising the egg. Intrauterine insemination using washed sperm suspended in culture medium combined with ovarian stimulation offers a simple relatively non-invasive procedure. If pregnancy does not occur within the three cycles alternative methods such as IVF should be considered which will be both diagnostic and hopefully therapeutic.

No comments: