Anovulation is a common phenomenon in a menstrual cycle. But, in some menstrual cycles, an egg does not mature, and a woman does not ovulate. This is known as anovulation. Anovulation may cause irregular menstrual cycles or no periods at all. Anovulation can result from hormonal imbalance or due to the improper development of the ovaries. Nearly, 35% of women experience anovulation. The prime cause of this abnormality is a polycystic ovarian syndrome (PCOS). Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder which is responsible for irregular menstrual cycles or lack of menstruation (amenorrhea), obesity and features of hyperandrogenism like acne and hirsutism.
This problem can be treated by losing weight and lifestyle changes. If your normal ovulation is not achieved, then you need to consider medical treatment with medications or injectable hormones to normalize the hormonal functions and stimulate ovulation. Sometimes, ovarian drilling is considered to improve the ovarian hormonal microenvironment.
Endometriosis (en-doe-me-tree-O-sis) is a painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Symptoms of endometriosis are,
Endometriosis can also cause blood cysts in the ovaries. Endometriosis might also be caused by the effect on the tubes’ functionality, which is caused by the inflammatory and wound-healing component of the endometrial tissue. Nearly 35% of infertile women suffer from endometriosis. Surgical treatment by laparoscopy (diathermy/argon/exeresis) is usually recommended to improve the patient’s fertility.
Tubal factor infertility occurs when a blockage in the fallopian tubes will not allow the egg and sperm to meet. Tubal factor infertility accounts for about 25-30% of all cases of infertility. The condition includes cases of completely blocked fallopian tubes and cases where just one is blocked tube or scarring narrows the tubes.
Infections, abdominal surgery, and diseases such as endometriosis can cause scarring between the end of the fallopian tube and ovary. Infections may be, but are not necessarily, sexually transmitted. Chlamydia and gonorrhea are two common sexually transmitted infections that can cause tubal infertility. Tuberculosis, uncommon in North America, and a ruptured appendix can both cause a tubal infection. Surgery can also damage your fallopian tubes.
Pelvic Inflammatory Disease (PID) can also travel from the cervix through the uterus to the tubes, which can ultimately cause the delicate inner lining of the tubes to become permanently scarred. The opening of the tube next to the ovary may become partially or completely blocked; scar tissue will often form on the outside of the tubes and uterus.
Between 20-25 percent of all cases of infertility are related to tubal factor. Sometimes, the tubal damage is not very serious. Nevertheless, when after standard fertility testing is performed there is no other obvious cause of infertility found, it is generally attributed to tubal factor infertility.
Nearly 25% of female infertility occurs due to the disorder of the Fallopian tubes. Fallopian tubes play an imperative role in the reproduction process. Damage to the Fallopian tubes will interfere in the vital functions and hence, prevent pregnancy. The turbo-peritoneal factor can cause an ectopic pregnancy (pregnancy in the Fallopian tube). Tubal damage can occur due to:
Genital tuberculosis :
Genital TB in females is a chronic disease with low-grade symptoms. The fallopian tubes are affected in almost all cases of genital TB, and along with endometrial involvement, it causes infertility in patients. Infections arising from the uterine cervix or (Pelvic Inflammatory Disease, PID). The bacterial infections involved with PID are Gonorrhoea and Chlamydia which produce an inflammatory reaction causing scarring and fibrosis. These prevent the proper functioning of the Fallopian tubes.
Sometimes, a previous pelvic surgery can cause adhesions around the tubes or endometriosis which might cause a tubal blockage. The Fallopian tube gets filled with inflammatory fluids and thus, becomes a potential source of chronic infections which results in Hydrosalpinx. In this case, tubal damage can be treated by endoscopic surgery, tubal microsurgery and ART techniques like IVF/ICSI.
A surgeon generally implants embryo in the uterine cavity. If the cavity is filled up with fibroids, polyps or adhesions, the embryo will fail to implant. In addition, some women may be born with anomalies of the uterine cavity like an intrauterine septum or bicornuate uterus. The miscarriage rate among women with a large uterine septum is quite higher as compared to those who have normal uterine septum.
Most of the above conditions can be resected or corrected surgically and are usually followed by a subsequently normal implantation rate.