Common causes of infertility in women

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Bui Thi Thu and Specialist Doctor II Tran Thi Mai Huong - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.
Infertility is defined as when a couple has been trying to get pregnant for at least a year without success. In which, the cause of infertility is from women accounting for a third of cases, the rest is due to men or both sides.

1. Causes of infertility in women

In order to become pregnant, each of the following factors is completely independent of the decision for this success:
Ovulation : In order to become pregnant, the ovaries must nourish and release at least one egg follicle. This is the important result to get every month, called ovulation. Your doctor can help assess your menstrual cycle and confirm when you're ovulating. Presence of sperm: For most couples, this shouldn't be a big deal unless your partner has a medical or surgical history. At this point, the doctor will need to perform some simple tests to assess the health of the sperm through a semen analysis. Frequency of intercourse: You need to have regular sex, especially around the time of ovulation. Your doctor can help you better understand your own cycle to make it easier for you to conceive. Clear fallopian tubes and normal uterus: The egg and sperm meet in the fallopian tube, and the embryo needs a healthy uterus to implant and develop. So, for pregnancy to happen, every step of the human reproductive process has to be done precisely. The steps in this procedure first require one of the ovaries to release one mature follicle each cycle. The egg is then attracted to the fallopian tube. At this time, if there is the presence of sperm that swim up from the cervix, through the uterus and into the fallopian tubes to reach the egg, fertilization will occur. The fertilized egg then travels down the fallopian tube and back into the uterus to implant and gradually develop into a fetus in the womb.
In a woman, certain factors, reproductive pathology or systemic diseases can disrupt this process at any step. Accordingly, the common cause of female infertility is due to one or a combination of the following factors:
1.1. Ovulation disorder Ovulation disorder means that you ovulate irregularly or completely irregularly in your menstrual cycle. This possibility causes infertility in about 1 in 4 couples who visit the doctor because of a delay in having children. These are just the results of abnormalities in the regulation of reproductive hormones by the hypothalamus or pituitary or problems in the ovaries that can cause this disorder:
Polycystic ovary syndrome : This is a Problems causing female hormone imbalance in general are quite common in women, directly affecting ovulation. Furthermore, polycystic ovary syndrome is associated with insulin resistance, causing overweight, obesity, diabetes, hirsutism, and acne. Therefore, this pathology is the leading cause to be investigated when infertility is suspected due to female origin if there are external suspicious manifestations. Hypothalamic dysfunction: The two hormones produced by the pituitary gland that are responsible for stimulating ovulation each month are FSH and LH. Any excessive physical or mental stress, too high or too low body weight, or recent significant weight gain or loss can disrupt the production of these hormones and affect your health. ovulation. Irregular menstrual cycles or recent missed periods are the most common signs. Premature ovarian failure: This disease is also known as primary ovarian failure, caused by intrinsic autoimmune reactions or genetic reduction in egg count, due to chemotherapy... When the ovaries no longer exist. Not only is a woman unable to become pregnant, but also suffers from a host of other systemic disorders caused by decreased estrogen production in the pre-40s. Too much prolactin: The pituitary gland is the source of the egg's ability to nourish and release eggs. causes overproduction of prolactin, which in turn inhibits estrogen production and can cause infertility. This is the result of problems with the pituitary gland as well as the effects of medications you are taking for another medical condition.

1.2. Fallopian tube damage When one or both fallopian tubes are damaged, it will inevitably limit the passage of sperm to meet the fertilized egg, or it may also block the route of the fertilized egg. fertilization and implantation in the uterus. Causes of fallopian tube damage or blockage include:
Pelvic inflammatory diseases, uterine and fallopian tube infections caused by chlamydia, gonorrhea or other sexually transmitted diseases. History of previous surgery in the lower abdomen or in the pelvis, including surgical removal of ectopic pregnancy or general gynecological conditions. Pelvic TB, a cause of infertility due to blocked fallopian tubes, is often overlooked. 1.3. Endometriosis Endometriosis occurs when the cells lining the innermost layer of the uterus form and grow anywhere else. The presence of this abnormal endometrium may be due to the woman's own nature or to surgical intervention on the uterine wall.
If the endometrium grows in the fallopian tubes, it can cause a blockage, making it impossible for the egg and sperm to fuse together. If localized in the uterine cavity, this disease affects the implantation process of the fertilized egg. Accordingly, although this condition appears to affect fertility indirectly, it carries the potential for failure of subsequent infertility interventions.
1.4. Uterine and cervical causes Several uterine or cervical causes can affect fertility by interfering with embryo implantation or increasing the likelihood of miscarriage:
Benign polyps or tumor in the uterus; Among them, uterine fibroids are quite common. In some cases, the tumor can block the fallopian tubes, easily causing miscarriage or preterm labor. Therefore, many women with uterine fibroids or polyps are still able to conceive. Endometriosis due to scarring or inflammation in the uterine cavity. Congenital abnormalities in the uterus, such as double uterus, uterus with septum, uterine adhesions (Asherman's syndrome), endometrium not developing (less than 7mm).... will make it difficult to get pregnant. . Cervical stenosis due to genetic defects or pre-existing damage to the cervix. The cervix is ​​not able to secrete mucus effectively to help sperms pass smoothly through the cervix to enter the uterus. 1.5. Unexplained Infertility Sometimes and in many cases the cause of infertility is never found, despite being very active.
Just the presence of one or a combination of two even minor factors on the woman herself as well as her partner can cause unexplained reproductive system problems. Although it can be difficult to wait patiently for a definitive answer, many couples unexpectedly get pregnant if they both agree to work together and not delay starting infertility treatment.

2. Risk factors for female infertility

A number of factors can put you at a higher risk of infertility than other women:
Age: The quality and quantity of a woman's eggs begin to decline as she ages. From the age of 35, the rate of follicle loss, resulting in the number of oocytes released from each cycle becomes less and the quality decreases. This makes conceiving more difficult as well as increases the risk of miscarriage. Smoking: Tobacco smoke contains toxic chemicals that affect the cervix and fallopian tubes. Furthermore, smoking increases the risk of miscarriage and ectopic pregnancy. This is also thought to be responsible for premature aging of your ovaries and depleting the number of eggs. Therefore, it is important to stop smoking before starting fertility treatment. Weight: Being overweight or underweight can both affect ovulation. Only with a healthy body mass index (BMI) can a woman increase the frequency of ovulation and improve her chances of becoming pregnant. Gynecological inflammatory diseases: Sexually transmitted diseases such as chlamydia and gonorrhea can damage the fallopian tubes. Alcohol: Alcohol is also a factor in difficulty conceiving. Therefore, it is necessary to limit the amount of alcohol you drink if you want to get pregnant.

3. Infertility prevention in women

If you plan to become pregnant in the future, the following tips will help optimize your fertility:
Maintain ideal weight: Overweight and underweight women are at risk ovulation disorder. However, if you need to lose weight, get moderate exercise. Strenuous, intense exercise more than five hours a week has been shown to be associated with decreased ovulation. Quit smoking: Smoking has many negative effects on fertility, not to mention your general health and the health of your unborn baby. If you are a smoker and are looking to get pregnant, make a plan to quit smoking now. Avoid alcohol: Drinking too much alcohol or using strong alcohol can lead to decreased fertility. At the same time, any alcohol use can affect the health of the fetus in the future. If you're planning to get pregnant, avoid alcohol and don't drink while you're pregnant. Reduce stress: Several studies have shown that couples with psychological stress have a worse response to infertility treatment. If you want to get pregnant, always stay in a good mood and this will come naturally before deciding on interventional treatment. In short, pregnancy and motherhood are the vocations of every woman. Knowing the common causes of infertility in women described above will help you somewhat proactively prevent yourself. In addition, if there is a physical cause, it is necessary to choose a reputable specialist facility to actively treat and intervene early, helping to hope for good news and more complete family happiness.

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Reference source: National guideline on reproductive health services - Ministry of Health