Age of the women is important prognostic factor for conception and pregnancy. The ovaries in puberty contain about 400 000 eggs.
Ovulation is when mature egg is released from the ovary and there is about 350-400 ovulation during the women’s life. The quality of the eggs is reduced after 35 years of age.
Ovulation is result of the coordinated function of hyppothalamus, pituitary gland and ovary.
Every disturbance of this delicate process and imbalance in hormone production results in ovulation disorder and inability to achieve pregnancy
Causes of ovulation disturbance:
- weight loss and eating disorders;
- hard physical training;
- psychological stress;
- policystic ovarian syndrome(PCOS).
PCOS is hormone imbalance when elevated androgen disturb ovulation affecting about 10 % of female population. The symptoms of PCOS are unregular periods, acne, excess of body and facial hair, obesity and infertility. Infertility is treated by ovarian stimulation and in vitro fertilization (IVF).
Tubal factor infertility
Fertilization occurs in fallopian tubes after ovulated egg meets the spermatozoa. Obstruction and damage of Fallopian tubes will not allow the egg and sperm to meet and cause tubal factor infertility. Chlamydia and gonorrhea infections are two common sexually transmitted infections that can cause tubal infertility. Adhesion, previous surgery and endometriosis can also disturb tubal function. IVF is established treatment for this type of infertility. Surgery can be applied in selected cases.
Uterine factor infertility
Fibroids are diagnosed in about 8 % of women between 33-40 years of age. Submucosal (located in uterine cavity) and possibly intramural (located in uterine wall) fibroids affect fertility. Some uterine malformations and uterine adhesions can cause infertility. 1 out of 4000 women is born without uterus and some women remove uterus due to cancer, fibroids and complications after delivery.
Endometriosis is disorder when endometrium (tissue that normally lines the inside of uterus) grows outside of uterus. The symptoms are pelvic pain, painful periods, pain with intercourse and defecation, and infertility. Endometriosis can disturb ovulation and fertilization and can provoke adhesions that affect fallopian tube function.
High level of prolactine and high/low level of thyroid gland hormones affect ovulation and thus can be the reason for infertility.