Infertility is a condition of the reproductive system that impairs the ability to achieve pregnancy. Primary infertility is the inability to conceive a child after regular intercourse for at least 1 year. Secondary infertility occurs in couples who have previously been pregnant at least once, but are unable to achieve another pregnancy. Infertility affects men and women equally. About one-third of the cases are due to a male factor, one-third to the female and the remaining to the combination of both partners. Causes of infertility include a wide range of physical as well as emotional factors. For a woman to be fertile, her reproductive organs must be healthy and functional. To conceive a child, the ovaries must release healthy eggs regularly and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes for a possible union 50% of the infertile cases are due to a problem in the woman. The problem could either be a hormonal one or an anatomical one or a pathological one. The most common causes of female infertility are listed here and each one is linked to a very simple explanation of the causes, the symptoms, the diagnostic tests and the treatment modalities. In addition we have filtered the hundreds of web sites on the related topics and have provided links to a select few.

Premature Ovarian Failure

Poly Cystic Ovarian Disease
Disorders of the Fallopian Tube
Cervical Hostility
Uterine Fibroids

What is Premature ovarian Failure?

Every woman is born with a finite stock of oocytes (eggs) at the time of her birth. After she attains puberty, every month, some of the egg-containing follicles start growing. Some release an egg while the others die a natural death mid-way through their growth phase. Thus, this stock of eggs depletes as a woman ages and very few eggs remain in the ovary when a woman is in her forties. This is natural phenomenon of menopause also resulting in a cessation of menstruation. However, some women attain menopause much earlier in their life and this state is known as "premature ovarian failure".

How is it diagnosed?

The first indication of premature ovarian failure would be absence of menstruation for several months or several years. In normal women in the reproductive age group, the pituitary gland in the brain secretes hormones, follicle stimulating hormone (FSH) and Luteinizing hormone (LH) which specifically binds to the receptors on the ovarian cells, stimulates them to grow and in turn produce the hormone estradiol. This estradiol enters the blood stream and as its concentration in the blood increases, it sends a message to the pituitary, preventing it from secreting any more FSH and LH. Now, in women with premature ovarian failure, the FSH and LH cannot bind to its specific receptors in the ovary because of the diminished reserve of such cells. Therefore, there is no estradiol produced to send a negative feed-back message back to the pituitary. In the absence of any feedback from the ovary, the pituitary continues secreting large quantities of both FSH and LH. Therefore, pituitary ovarian failure can be identified by testing the concentrations of hormones FSH and LH in the blood. Very high concentrations of these hormones in the blood similar to that found in menopausal women confirms premature ovarian failure.

What are the causes of premature ovarian failure?

In half the women with premature ovarian failure, the cause remains unclear. While in the other half, premature ovarian failure is a result of destruction of the ovaries either by chemotherapy, radiation therapy or surgery. Cancers may necessitate treatment with chemo-therapeutic agents which can damage the ovaries. Tumours of the ovaries or of other abdominal organs may need irradiation therapy which also result in the destruction of the ovarian cells. Certain infections of the ovaries may need removal of the ovary.

Damage to the ovaries results in premature ovarian failure.

Pre-mature ovarian failure is irreversible. As the cause of premature ovarian failure is unknown in more than half of such patients, the day we are able to decipher the cause, will any treatment be possible. But at the moment this disorder of the ovaries is irreversible. Can a woman with premature ovarian failure ever be able to bear a child? Advances in assisted reproductive technologies has made it possible even for women with premature ovarian failure to bear a child. This is possible only if woman’s general health is fine and her uterus responds to external hormones. However, since there are no eggs in the woman’s ovaries, she would need "oocyte donation". These donated oocytes are fertilized in the laboratory with her husband’s sperms and the resultant embryo is transferred into the uterus. The patient would need to take hormone supplements daily for more than 3 months if she does conceive following embryo transfer. The woman can have the joy of a pregnancy and giving birth to a child although the child may not have her genetic material.

What are poly cystic ovaries (PCO)?

Every woman is born with millions of eggs at the time of birth. Each of these eggs is covered by specialised cells and this entire unit is called as a "follicle". After the woman attains puberty, every month a few of these follicles start growing of which one ruptures to release the egg while the others whither away. However, in some women several follicles start growing and then remain static in that state. Such ovaries which have these "cystic" follicles are termed as poly cystic ovaries.

What are the symptoms that indicate that a woman could have PCO?

Women with PCO have irregular menstrual cycles, are generally obese, have a high waist to hip ratio; excess hair growth on the face, abdomen limbs and other parts of the body. Ultra-sonographic scanning of the ovaries show the presence of several small follicles. The concentration of reproductive hormones in the blood is also altered. The hormone luteinising hormone (LH) is present in high concentration while the ratio of the hormones LH and FSH is also high. Both these hormones are produced by the pituitary gland and is responsible for the timely growth of the follicles and the release of the eggs. Some of the women may also have high concentrations of the hormone insulin in the blood and also excess of male hormones (androgens). Not all women will exhibit all these criteria associated with PCO.

How is it diagnosed?

PCO can be diagnosed by ultrasonography of the ovaries which clearly shows several hypoechogenic regions in the ovaries forming what has often been termed as "pearly necklace appearance". Blood tests for determining the concentrations of the pituitary hormones FSH and LH, the concentration of insulin and also the androgens. These tests has to be done preferably on the second or third day after menstruation. A thorough clinical examination for any evidence of hirsuitism - excess of hair growth in the woman; a waist to hip ratio and the body mass index also has to be noted.

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