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By Nonika Tarlatzi

Female infertility: What are the causes and how they are treated

Infertility is when a couple cannot get pregnant despite having frequent, unprotected sex for at least a year, and may result from an issue with the woman, with the man, or with both of them. The causes of female infertility include:

  1. Age, which is related to a progressive decline in the quantity and quality of oocytes and a parallel increase in the frequency of chromosomal abnormalities.
  2. Menstrual irregularities, such as irregular or absent menstrual periods due to anovulation, which are found in women with polycystic ovary syndrome, hyperprolactinemia, severe weight loss or excessive stress.
  3. Fallopian tube issues, such as blockage, salpingectomy, wall damage or extended adhesions that alter tubal function and are often caused by inflammation of the fallopian tube or surgery.
  4. Endometriosis which can affect the ovaries or/and the fallopian tubes.
  5. Ovarian insufficiency, i.e. when ovaries show a reduced or absent ovarian reserve and ovarian function.
  6. Uterine abnormalities, including congenital abnormalities, polyps, fibromas, adhesions or an absent uterus.

The treatment of female infertility should take into consideration all the relevant parameters in a couple, such as female age, sperm features, duration of infertility etc.

For menstrual irregularities due to anovulation, ovulation induction with fertility drugs is recommended, in order to conceive after regular sexual intercourse or intrauterine insemination.

Tubal damage, a damaged uterus, as well as endometriosis may require surgery. Laparoscopy or/and hysteroscopy are used to remove polyps and fibromas, divide and remove adhesions, perform resection (e.g. of a uterine septum) and treat endometriosis, whereas in fallopian tube blockage a salpingoplasty may be attempted.

Tubal issues that have never been dealt with or chosen to be dealt with surgically, or infertility that persists despite surgical treatment can be bypassed with IVF. Medically assisted reproduction is also proposed for women of advanced maternal age. IVF is a therapeutic option when all other methods (ovulation induction with sexual intercourse or intrauterine insemination) have not lead to the desired effects.

In patients with premature ovarian failure or early menopause, oocyte donation is the proposed solution, while, in patients that cannot get pregnant due to medical problems that prevent them from conceiving or due to an absent uterus, gestational surrogacy is a feasible method.

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Nonika (Theoni) Tarlatzi

MD, MSc

Obstetrician – Gynecologist, Associate Scientific Officer FIVI Fertility & IVF Center, European Interbalkan Medical Center

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