Female infertility

Female infertility reasons

Infertility is the non-occurrence of pregnancy in a married couple with regular sexual activity without contraception within 1 year (or within 6 months if a woman is over 35).

The main causes of female infertility include:

  • lack of ovulation (for various reasons, a woman’s ovulation may be absent, shifted to later days of the cycle, or occur rarely and not well);
  • tubal factor of infertility;
  • uterine factor of infertility.

Lack of ovulation (or as it is also called endocrine infertility)

is the absence of pregnancy within 12 months, associated with ovulatory dysfunction: anovulation (lack of ovulation) or oligoovulation (rare ovulations).
The reasons may be disorders at various levels of the hypothalamic-pituitary-ovarian system, as well as other diseases of the endocrine glands, which lead to dysfunction of the hypothalamic-pituitary-ovarian axis, anovulation, and infertility.

The main causes of anovulation are as follows:

  • hypothalamic-pituitary insufficiency;
  • hypothalamic-pituitary-ovarian dysfunction;
  • ovarian failure.

Identification of patient’s ovulation is carried out using the folliculometry method (successive 2-3 ultrasound scans in one menstrual cycle with determination of the dominant follicle size and subsequently the fact of ovulation itself, the correspondence of the thickness and structure of the endometrium) during 2-3 menstrual cycles or with the help of ovulatory urinary tests.

In the absence of ovulation, diagnostics of concomitant hormonal diseases is performed. After that, the following procedures are carried out:

  • hormonal treatment of identified disorders;
  • drug stimulation of ovulation;
  • in some cases, surgical treatment: electrocautery (drilling) of the ovaries – creating "notches" on the ovaries to stimulate the release of eggs at polycystic ovary syndrome (PCOS);

If the above methods are ineffective, the application of programs of assisted reproductive technologies is recommended.

Tubal peritoneal infertility

Normally, the egg, after leaving the ovary, enters the fallopian tube, where it is fertilized by the spermatozoid. As a result of the previous infectious processes, inflammatory diseases, surgical interventions in the anamnesis or the presence of endometriosis in the small pelvis, adhesions can be formed – connective tissue membranes that make it difficult for the egg to enter the fallopian tube.

Diagnostic methods of the fallopian tube patency are:

  • echohysterosalpingoscopy (using an ultrasound machine);
  • metrosalpingography – assessment of the tubal patency using an X-ray machine when an X-ray contrast agent is injected into the uterine cavity;
  • laparoscopy with chromosalpingoscopy – assessment of the contrast delivery into the abdominal cavity through the tubes during laparoscopy.

The last two methods are the most informative of those described. With metrosalpingography, it is possible to obtain information about the section where the tube is obstructed, as well as about some types of intrauterine pathology.


During laparoscopy, it is possible not only to state the fact of the tubal patency disorder but also to identify the reason, if this condition is caused by an adhesive process. Moreover, the separation of adhesions can be performed, as a result of which it is often possible to overcome this type of infertility. Laparoscopy gives the possibility to simultaneously assess concomitant diseases of the pelvic organs (ovaries, uterus), identify endometriosis, and perform the required treatment. Bilateral obstruction of the fallopian tubes in the isthmic section is absolute tubal infertility. The only way to overcome it is with the help of IVF. In the presence of an adhesive process, the treatment method of laparoscopic adhesiolysis (separation of adhesions) is applied.

Uterine factor of infertility

This is a pathological process that disrupts the anatomical and functional condition of the uterus and the implantation process. It includes congenital malformations of the uterus, absence of the uterus, and acquired uterine lesions that interfere with the implantation process.

Congenital abnormalities of the uterus are formed as a result of exposure to various damaging factors at the stages of embryonic development (or antenatal). Acquired lesions of the uterus arise as a result of previous infectious and inflammatory diseases, changes in the hormonal status of a woman, and surgical manipulations on the uterus.

Acquired uterine pathologies include:

  • polyps and endometrial hyperplasia;
  • myoma of the uterus (growing in the cavity or any localization, deforming the cavity);
  • intrauterine synechiae – connective tissue septa resulting from aggressive intrauterine interventions, abortions, previous acute inflammatory process, etc.;
  • foreign bodies in the uterine cavity;
  • internal endometriosis (adenomyosis);
  • chronic endometritis.

The above-described diseases can be diagnosed both with a targeted search, and they can be found out during other diagnostic examinations on the matter of infertility, such as:

  • pelvic ultrasound scan;
  • metrosalpingography;
  • MRT of the pelvic organs;
  • hysteroscopy;
  • laparoscopy
  • endometrial pipelle biopsy.

It is possible to overcome this form of infertility with the help of surgical and / or drug treatment of the identified diseases. Often a combination of several pathologies takes place that requires long-term complex treatment.

In cases where the performed treatment did not lead to pregnancy, or there is such pathology of the uterus where it is impossible to correct the disorders, as well as in the absence of the uterus, it is recommended to switch to programs of assisted reproductive technologies with a surrogacy procedure.

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