Female infertility

BY: Ahmed Desouky

Definition

Infertility is the inability of a couple to get pregnant after 12 months of regular sex
without the use of birth control in women less than 35 years of age; and after six
months of regular sex without the use of birth control in women 35 years and older.
 Genetic factors of infertility

Genetic infertility occurs when the structure of the eggs' genes is disturbed.

Chromosomes in an adult can be damaged:

•under the influence of radiation and chemicals;

•due to environmental pollution and improper

lifestyle, such as drug use .
Causes of genetic infertility in women:

•Violation of the mechanisms of chromosome divergence

during egg maturation. After 40 years, about 80% of the
eggs have chromosomal abnormalities.

•Congenital chromosomal abnormalities, such as fusion of

chromosomes or inversion, in which a section of the
chromosome turns.

•Congenital anomalies in the number of sex chromosomes:

Shereshevsky-Turner and Swier syndromes, as well as X-
chromosome trisomy, a syndrome in which ovarian failure
develops and the risks of intrauterine fetal death increase.

•Noonan syndrome (Ulrich-Turner) - a woman cannot get

pregnant due to primary ovarian failure.
Chromosomal causes of infertility
 Molecular genetic disorders:

•Mutations in genes responsible for the blood coagulation •Kallman syndrome - mutations in genes, due to which
system. Excess homocysteine, increased blood clotting secondary ovarian failure has developed, or
and a tendency to form blood clots can lead to infertility hypogonadotropic hypogonadism (disturbances in the
and miscarriage . hypothalamic-pituitary system).

•Impaired endometrial implantation ability and

displacement of the time of the implantation window.

•Martin Bell Syndrome (Fragile X Syndrome). In women

who are carriers of the pre-mutation state, in 15–25% of
cases, the syndrome of early ovarian depletion develops .

Genetic abnormalities in infertility occur no more often than in 10% of cases, and
predominate in men . In women, disorders are mainly associated with changes in the number
and structure of chromosomes, gene mutations. Such pathologies more often appear after 40
years
Fragile X Syndrome
 Risk factors
Certain factors may put you at higher risk of infertility, including:

•Age. The quality and quantity of a woman's eggs begin •Sexual history. Sexually transmitted infections such as
to decline with age. In the mid-30s, the rate of follicle chlamydia and gonorrhea can damage the fallopian tubes.
loss speeds, resulting in fewer and poorer quality eggs. Having unprotected sex with multiple partners increases
This makes conception more difficult, and increases the your risk of a sexually transmitted infection that may
risk of miscarriage. cause fertility problems later.
•Smoking. Besides damaging your cervix and fallopian •Alcohol. Excess alcohol consumption can reduce
tubes, smoking increases your risk of miscarriage and fertility.
ectopic pregnancy. It's also thought to age your ovaries
and deplete your eggs prematurely. Stop smoking
before beginning fertility treatment.
•Weight. Being overweight or significantly
underweight may affect ovulation. Getting to a healthy
body mass index (BMI) might increase the frequency of
ovulation and likelihood of pregnancy.
 functional disorders
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in
this process are:

•One of the two ovaries releases a mature egg.

•The egg is picked up by the fallopian tube.
•Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
•The fertilized egg travels down the fallopian tube to the uterus.
•The fertilized egg attaches (implants) to the inside of the uterus and grows.

In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or
more of the factors below.
Female reproductive system
The ovaries, fallopian tubes, uterus,
cervix and vagina (vaginal canal) make
up the female reproductive system.
Fertilization and implantation
During fertilization, the sperm and egg unite in
one of the fallopian tubes to form a zygote. Then
the zygote travels down the fallopian tube, where
it becomes a morula. Once it reaches the uterus,
the morula becomes a blastocyst. The blastocyst
then burrows into the uterine lining — a process
called implantation.
Ovulation disorders

Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of
reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause
ovulation disorders.
• Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation.
PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and
acne. It's the most common cause of female infertility.

Polycystic Ovary Ultrasound Laparoscopic Ovrain Drilling

Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for
stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight
gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are
the most common signs.
Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an
autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or
chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age
40.
Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia),
which reduces estrogen production and can cause infertility. This can also be caused by medications
you're taking for another condition.
Damage to fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or
block the passage of the fertilized egg into the uterus. Causes of fallopian
tube damage or blockage can include:

•Pelvic inflammatory disease, an infection of the uterus and fallopian tubes

due to chlamydia, gonorrhea or other sexually transmitted infections

•Previous surgery in the abdomen or pelvis, including surgery for ectopic

pregnancy, in which a fertilized egg implants and develops somewhere
other than the uterus, usually in a fallopian tube
Endometriosis

Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places.
This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian
tubes and keep an egg and sperm from uniting.

Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect
fertility in less-direct ways, such as damage to the sperm or egg.

Endometriosis
With endometriosis, bits of the uterine lining
(endometrium) — or similar endometrial-like
tissue — grow outside of the uterus on other
pelvic organs. Outside the uterus, the tissue
thickens and bleeds, just as typical
endometrial tissue does during menstrual
cycles.
Uterine or cervical causes

Several uterine or cervical causes can interfere with the egg implanting or increase the
risk of miscarriage:

•Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can
block fallopian tubes or interfere with implantation, affecting fertility. However, many
women who have fibroids or polyps do become pregnant.
•Problems with the uterus present from birth, such as an unusually
shaped uterus, can cause problems becoming or remaining pregnant.

•Cervical stenosis, a narrowing of the cervix, can be caused by an

inherited malformation or damage to the cervix.

•Sometimes the cervix can't produce the best type of mucus to allow the
sperm to travel through the cervix into the uterus.
Unexplained infertility

In some cases, the cause of infertility is never found. A combination of several minor
factors in both partners could cause unexplained fertility problems. Although it's
frustrating to get no specific answer, this problem can correct itself with time. But
you shouldn't delay treatment for infertility.
THANK YOU!