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Causes of Infertility in Women

What is infertility?

Infertility, or in other words, infertility, is the inability to have children in women and men due to medical reasons. Infertility in medicine is defined as the inability to have a baby despite regular sexual intercourse for one year without any protection. Today, it is possible to correct this situation with various treatments in infertile candidates whose reproductive capacity has decreased to different degrees. However, not all of the reasons for not having children can be corrected. Such infertility is called true infertility, sterility. Examples of this include women entering menopause under the age of 35 and experiencing early menopause, women having their uterus or ovaries surgically removed, and azoospermia, where the man cannot produce sperm.


In order to treat infertility in women and men, the underlying causes need to be determined. During these investigations, some diseases, problems and structural changes that may have been overlooked before may be noticed. The treatment to be applied is selected accordingly.


What are the causes of infertility in women? Which diseases can cause infertility?

Infertility is seen in 20-25% of the society. Among these reasons, the rate of not being able to have children due to problems related to the woman is 50%. The most important reason for female infertility is that the woman cannot produce the eggs she should produce every month or cannot produce them correctly even if she does. This problem is called ovulation disorder, i.e. ovulation disorders. The second most common reason for infertility is the blocked fallopian tubes. The fallopian tubes; take the egg in the ovaries and take it inside, and then fertilization occurs in the fallopian tube with the sperm coming from the uterus. Infertility can occur as a result of blockage, adhesion in the tubes, poor functioning or the loss of function of the millions of tiny hairs that bring the egg and sperm together in the tube. Fallopian tube problems mostly occur not in those who have never had children, but in those who cannot have a second child after having a child. Apart from this, the main reasons for a woman not being able to get pregnant are;


  • Ovulation irregularities,

  • Tubes are closed,

  • Endometriosis ,

  • Hyperprolactinemia (high milk hormone levels),

  • Thyroid hormone disorders such as goiter, hypothyroidism, hyperthyroidism,

  • Endometrial ossification,

  • Antisperm antibodies,

  • Surgeries related to the uterus and ovaries,

  • Past infections related to genital organs,

  • Decreased ovarian reserve due to advanced age,

  • Causes related to the cervix, cervical factor,

  • Although 10-15% of candidates have infertility, no cause can be found.



Ovulation Irregularities

Ovulation irregularities are the most common cause of female infertility. Ovulation is the process of the eggs that develop and mature in the ovaries being expelled from the fluid-filled sacs (follicles) in which they are located. If ovulation does not occur, fertilization and pregnancy cannot occur. Not having menstrual periods at all, having infrequent menstruations or having very frequent menstrual periods may suggest problems with ovulation. In order to determine the presence of ovulation, examinations such as ultrasonography and blood tests (progesterone) are performed in expectant mothers whose menstrual periods are irregular, infrequent or frequent or who have been diagnosed with polycystic ovary syndrome. However, ovulation irregularities can also be seen in women who have no problems with their menstrual cycle. Having regular ovulation every month is an important factor in increasing the likelihood of pregnancy . It is not possible to get pregnant in a menstrual period without ovulation. In patients whose infertility is due to ovulation irregularity, pills that will ensure ovulation or hormone medications (popularly known as needle therapy) are usually used as treatment.


Obstruction of Uterine Ducts

If the uterine tubes are partially or completely blocked, the sperm cannot reach the egg. In cases where both tubes are blocked, it is impossible for the egg to pass through the tube and meet the sperm. Therefore, pregnancy cannot occur. Factors that cause the tubes to be blocked or damaged include a history of intra-abdominal or reproductive organ infection, ectopic pregnancy, and endometriosis. The tubes can close due to such reasons. A hysterosalpingography (HSG) is performed to find out whether the tubes are blocked. Laparoscopy is usually performed to ensure that the tubes that appear closed on the hysterosalpingography are closed. Tubes that appear closed on HSG can be detected open on laparoscopy. If it is understood that both tubes are blocked, IVF treatment is required.


Endometriosis

Endometriosis is the presence of the uterine tissue, which lines the inside of the uterus and causes menstruation, in the form of foci outside the uterus. These foci, which are outside of their normal location, can cause uterine obstruction or disrupt ovulation over time. Endometriosis can prevent pregnancy by creating adhesions in the abdomen and tubes. Infertility is seen in nearly 70% of endometriosis patients. Surgical treatments may be required.


Increased milk hormone (Hyperprolactinemia)


Increased milk hormone levels can cause ovulation irregularities and infertility.


Uterine Related Causes

Uterine problems that cause infertility may include deformities, infections, poor mucus quality, polyps that develop in the cervix or uterus. Inflammation in the uterine cavity where the baby will grow or some congenital adhesions, polyps, myomas that grow into the uterus, double uteruses, etc. may also make pregnancy difficult or cause miscarriage. If the cervical secretion is very inflamed, it may make it difficult for sperm to pass or kill sperm, which may also cause pregnancy. Pathologies that are present in the uterus, such as a septum, or that develop later, such as myomas and polyps, may cause infertility. Myomas can only cause infertility when they are in the inner cavity of the uterus and are large. In order to treat such pathologies, surgery must usually be performed using hysteroscopy. Some of these causes can be corrected with surgical procedures.


Woman's Age

The most important and natural reason for infertility is the woman's age. The number of eggs decreases as the woman ages. Her ovulation deteriorates, their quality deteriorates and their number gradually decreases. The cessation of menstruation due to age is called menopause and special tests performed on the third day of each menstrual period can be used to estimate the woman's probable age of menopause. Today, due to late marriages and late childbearing, ovarian aging and the resulting inability to have children are very common.


Today, as women marry later and postpone having children, ovarian aging and related infertility are more common. Despite advanced technology, there is no solution to this problem.


Allergic Causes

Allergic causes can be the cause of infertility. Diagnosis and treatment of such causes are difficult.


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