Definition

Infertility in women is the inability of a woman to conceive after at least 1 year of having unprotected sexual intercourse or insemination procedures (receiving sperm from a third-party donor or a female spouse). For women over 35 years of age, they are considered infertile if they do not become pregnant after 6 months of unprotected intercourse. Women can also be considered infertile if they repeatedly experience miscarriages.

This condition can affect the patient and her spouse and cause psychological and physical problems for the patient. Infertility can affect a woman's ability to conceive and sustain her pregnancy. At least about 10% of women experience infertility, and the chances of experiencing infertility may increase over time.

Infertility in women is divided into two types:

• Primary infertility refers to women who have never been pregnant before.
• Secondary infertility is a condition of infertility in women who have been pregnant before.

We also have articles on the issue of infertility in men that you can read here: Male Infertility - Definition, Cause And Risk Factors.

Causes

Infertility in women can be caused by age, hormonal disorders, medical conditions, lifestyle, and environmental factors. Although there are many possible conditions that cause infertility, it is difficult to determine the exact cause. Below are some medical conditions that can cause infertility in women.

Ovulation Disorder

The monthly release of the egg during the menstrual cycle does not occur. Fertilization and pregnancy are not possible in the absence of an egg. This condition can be caused by:

• Hormonal imbalances
• History of eating disorders
• Substance abuse
• Polycystic ovary syndrome (PCOS)
• Thyroid gland conditions
• Severe stress
• Pituitary gland tumors in the brain, etc.

Egg Problems

Women are born with all the eggs they will have throughout their lives, and this supply can "run out" more quickly before menopause. The quality of the eggs is also important; some of these eggs may have the wrong number of chromosomes and cannot develop into a healthy fetus.

Uterine Problems

These include problems such as polyps, benign tumors, or cancer in the uterus. Congenital abnormalities in the uterus, although rare, are also associated with infertility in women. An example of a congenital abnormality is the presence of a septum or membrane in the middle of the uterus, which divides the uterus into two parts. A uterine septum is associated with recurrent pregnancy loss.

Endometriosis

This disease refers to the growth of endometrial tissue (one of the layers of the uterus) outside the uterus. Endometriosis is also associated with infertility problems.

If you are interested in reading more about endometriosis, you can read it here: Endometrosis - Definition, Cause And Risk Factor.

Risk Factor

Over time, a woman's ability to conceive naturally decreases. Age is one of the common factors causing infertility in women. Women over 35 years of age have a higher risk of infertility problems. Advanced age is associated with a decrease in the number of eggs, as well as the possibility that the eggs have an abnormal number of chromosomes.

Being overweight or underweight also risks causing infertility. A low body fat composition due to extreme exercise can also increase the risk of infertility. Additionally, infertility in women is also associated with smoking habits and excessive alcohol consumption.

Symptoms

The main symptom of infertility is the failure to become pregnant despite the couple being sexually active for at least a year without using contraception. Sexual intercourse is considered regular if done 2-3 times a week. If you experience menstrual cycle disturbances, such as cycles that are too long, too short, irregular, or absent, there may be problems with ovulation.

Other complaints may refer to underlying medical conditions causing infertility. However, sometimes there are no signs and symptoms in infertile women.

Diagnosis

When you come for a consultation about your complaints, the doctor may ask further about:

• Menstrual cycle
• History of previous pregnancies and miscarriages
• Duration of unpregnant
• History of medical procedures or surgeries on reproductive organs
• History of previous disease, including sexually transmitted diseases
• Frequency and timing of sexual intercourse
• Daily lifestyle, such as smoking, alcohol consumption, drug abuse, exercise, diet, and occupation
• Family medical history

In infertility cases, the spouse's health condition will also be explored by the doctor.

Additionally, the doctor may conduct a physical examination by checking:

• Vital signs such as blood pressure, pulse, breathing, etc.
• Signs of deficiency or excess of certain hormones
• Thyroid gland
• Breasts and genitals if abnormalities are identified
• Pelvic examination

To further determine the exact cause of infertility in women, the doctor may suggest the following additional tests:

• Blood tests to check hormones in the body
• HSG (hysterosalpingography), using X-rays and a special dye injected into the cervix, to visualize the reproductive organs
• Transvaginal ultrasound
• Hysteroscopy for examining conditions within the uterus

Management

For women diagnosed with infertility, treatment will be tailored to each patient's condition. The first recommendation will be modifying your lifestyle. For example, if you are obese, you will be advised to lose weight to improve your ovulation or fertile period. Many studies say that a 10% weight loss can restore fertility in 50-100 percent of women within less than 1 year.

The doctor may prescribe medication, hormone therapy, or surgery to address infertility problems caused by the patient's medical condition. Additionally, some patients may need artificial insemination, a procedure to insert processed sperm into the uterus when your ovaries release an egg (during the fertile period).

Complications

Three main complications associated with infertility therapy are:

• Pregnancy with more than one baby (multiple pregnancies) at one time, which increases the risk of delivery complications for the mother
• Ectopic pregnancy, which can endanger the mother
• Ovarian hyperstimulation syndrome, which can cause various symptoms such as digestive complaints, ovarian enlargement, kidney failure, respiratory distress, heart rhythm disturbances, etc.

Prevention

About 20% of couples with infertility problems still do not know exactly what causes infertility. However, you can prevent infertility by controlling some risk factors by changing your lifestyle. You can reduce or avoid alcohol consumption, quit smoking, and maintain an ideal weight.

When to See a Doctor?

If you and your spouse have had regular unprotected sexual intercourse for a year (or six months if you are over 35 years old), you should consult a doctor. The doctor will determine whether infertility is caused by a problem in the woman, the man, or a combination of factors in the couple.

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