Introduction
Female factor infertility is responsible for about 40% of all infertility. There are several conditions that contribute to female factor infertility:
Failure to ovulate regularly
Normally, a woman should ovulate each month around day 13-16 of the menstrual cycle. Often, but not always, this is reflected in a regular, easily managed period. Failure to ovulate regularly is often reflected by irregular, few, or absent periods.
Recruiting, maturing, and releasing an egg is a complex interplay between the Follicular Stimulating Hormone (FSH) and Luteinizing Hormone (LH) from the pituitary gland and the oestrogen and progesterone levels from the ovary. Disruptions in this interplay will lead to hormonal imbalances and failure to ovulate.
The most common causes of failure of regular ovulation include:
- Polycystic ovarian syndrome.
- Underactive thyroid gland activity.
- Raised prolactin levels, due to a small tumour on the pituitary called a microadenoma.
- Being significantly underweight (from excessive exercise or eating disorders), or overweight.
- Initial testing of the infertile couple will involve blood testing of the female to check if ovulation is occurring, and if it is not, then why not.
Tubal Issues
The Fallopian tubes need to be open and working correctly for the egg and sperm to meet and fertilise naturally. If the tubes have been damaged and blocked prior, usually due to a Chlamydia infection, but also occasionally due to endometriosis then IVF will be required to fertilise the egg and sperm in the laboratory.
Endometriosis
Endometriosis is a condition where developing cells from the endometrium break away and adhere to the pelvic contents, affecting the ability of a woman to achieve a pregnancy. It is unknown why this happens. Up to 70 per cent of women with endometriosis experience some degree of infertility. Endometriosis can only be diagnosed by a laparoscopy (see section on this), and is removed from the pelvis if it is seen at laparoscopy to improve the fertility situation.
Uterine cavity problems
Fibroids, polyps and a uterine septum in the uterus can also impair fertility. These are diagnosed also via a short surgical procedure called a hysteroscopy, when a small thin camera is inserted into the uterus to visualize the cavity. Polyps, small fibroids and uterine septae can be removed using the hysteroscope, improving fertility.