Female infertility: causes, symptoms, treatments

What is female sterility?

“Female sterility designates the impossibility for a woman to procreate provided that you have complete, regular sexual intercourse (two to three times a week) and without contraception and this within 12 to 24 months“, explains Dr. Juan Berrocal, gynecological surgeon. This term being relatively aggressive, some prefer to use that of infertility, infertility, or hypo-fertility. Naturally, a woman’s fertility varies depending on her age. Fertility increases until the age of 25 and then stabilizes.

To start a pregnancy, the woman must have “at least”:

• Regular and good quality ovulation
• A permeable cervix and tubes
• Good quality mucus
• A lining of the uterus (endometrium)
• Contact with sperm…

What are the possible causes of infertility in women?

The main causes may in particular be:

• A genital infection caused by STDs(Chlamydiae, gonococci,) or other types of germs which can affect both the cervix (cervicitis) and the tubes (salpingitis).

• Salpingitis which is an acute or chronic inflammation of the uterine tubes (ducts that connect the ovaries and uterus), usually caused by infections. In almost half of cases, the infection is triggered by Chlamydia. Gonococci and mycoplasma germs can also be involved. They lead to obliteration of the tubes directly or through adhesions.
• An ectopic pregnancy (GEU): the after-effects of an ectopic pregnancy (the tube duct is partially or totally obstructed) or the aftermath of surgical intervention.

• Endometriosis which is a gynecological anomaly: the endometrial tissue, which lines the wall of the interior of the uterus, normally eliminated during periods, is found outside the uterus, for example in the ovarian tubes or the peritoneum . “This tissue located outside the uterus can create inflammation in the pelvis and can obstruct the tubes or ovaries and prevent fertilization,” insists the doctor.

• Exposure to distillbene can cause an abnormality of the tubes but also malformations of the uterus. Distilbene is a medication prescribed to approximately 200,000 women between 1950 and 1977. This treatment was then indicated to prevent miscarriages. Following numerous complications, its use was banned in France in 1977. This phenomenon remains exceptional.
• Ovulation disorders: In case of anovulation, ovulation is completely absent. In the event of dysovulation, it is of lower quality. Ovulation disorders involve non-production or poor production of a fertilizable oocyte. They are the cause of most cases of female sterility and affect more than 3 out of 10 cases.The origin is often an imbalance in hormonal production, whether of ovarian origin such as polycystic ovaries but also other organs (pituitary, adrenals, thyroid, pancreas.) they can also occur in the event of early menopause“, continues our interlocutor.

• Mechanical after-effects such as, for example, after a conization for the treatment of papillomaviruses, in the case of uterine polyps or fibroids or after ovarian surgery (in the case of puncture of ovarian cysts for example)

• Other pathologies such as anorexia nervosatoo rapid weight gain or liver, kidney or digestive diseases.

Cervical mucus abnormalities

Cervical mucus is necessary for fertilization to function properly because it facilitates access to the “best” spermatozoa. During ejaculation, millions of sperm are found in the vagina and migrate towards the uterine tubes in order to reach the oocyte and fertilize it. The first step is the passage of cervical mucus, secreted via the glands of the cervix. Cervical mucus allows sperm to be filtered and only allows the most mobile ones to pass, the weakest and abnormal ones cannot continue their journey.

Only a few hundred of them will ultimately reach the fallopian tubes, where fertilization will take place. Poor quality of cervical mucus can be an obstacle for sperm and be a cause of procreation difficulties. Knowing that mucus is different in density depending on the time of the menstrual cycle (the origin of so-called Ogino contraception) “Cervical mucus may be absent, in insufficient quantity, too viscous or gelled. Furthermore, it can contain anti-sperm antibodies and destroy them.“, observes Dr. Berrocal.

Genetic abnormalities

THE Turner syndrome is a chromosomal abnormality (loss of part of an X chromosome) which causes atrophy and poor functioning of the ovary.

Seminal fluid allergies

Allergies to seminal fluid (sperm) are rare, but can be a cause of infertility.

Psychological causes?

Apart from any pathological condition, several psychological factors can negatively influence female fertility. The causes may be due to:

• A memory of a painful past event: death anniversary of a loved one, a commemorative date of birth, an old trauma…
• The fear of repeating the mistakes of one’s own parents.
• Guilt felt after a voluntary termination of pregnancy (abortion).
• An unconscious fear of becoming a mother in turn
• The loss of a child
• Having had an unhappy childhood or having been the victim of abuse from one’s parents
• Having suffered sexual violence

The age involved?

In women, fertility declines from the age of 30. This can be explained by the fact that eggs produced at this age more frequently contain genetic anomalies. Men over the age of 40 may also have decreased fertility. In men, the maximum fertility rate is 30 to 34 years old. Beyond 35 to 40 years old, the risks of infertility are increased.

Is infertility hereditary?

Overall, we can say that there is no hereditary infertility in women. In any case, nothing is proven except.

What are the symptoms of infertility?

“Most often there are no symptoms. A couple’s infertility remains unexplained in 15% of cases,” notes the specialist. In certain cases, we can see:

• Abnormal menstrual cycles
• Abnormally painful periods
• Painful sex

What treatments can be offered?

The treatments offered depend on the causes of infertility found during medical investigations. Despite the variety of existing treatments, some causes of infertility cannot be corrected. “In women, hormonal treatments in the event of menstrual cycle disorders can be effective, assures the gynecological surgeon. Treatments like clomiphene citrate (Clomid, by mouth) are prescribed to stimulate ovulation. In some cases, surgery may be necessary. If the fallopian tubes are blocked, an operation can remedy this problem“. In case of endometriosis, medications to stimulate ovulation or a in vitro fertilization may be necessary to hope to conceive a child.

THE medically assisted procreation techniques are therefore sometimes necessary in cases of infertility. In vitro fertilization is the most frequently used technique. The man’s sperm are placed in the presence of the woman’s egg in the laboratory, then the embryo is re-implanted in the uterus of the future mother (IVF).

When do we start talking about sterility?

At 25 years old, a couple has an average 25% chance of getting pregnant each cycle, with an average conception time of 3 to 6 months. On average, a couple succeeds in giving birth to a baby after 6 months to 12 months. The percentage of women who have conceived a child:

• After a year of regular intercourse without contraception is 84%
• After 2 years, it is 92%
• Nearly 80% of couples naturally conceive a child after 2 years. 60% of couples who experience difficulties conceive a child after 1 year.

Thanks to Dr Juan Berrocal, gynecological surgeon at the Clinique de l’Europe in Rouen.