Female Infertility
Overview:
- As per the WHO definition, infertility is characterised by the inability to achieve conception after one year of consistent sexual intercourse without the use of contraception.
- Female infertility is a condition where a woman with a uterus is unable to get pregnant.
- Various factors including age, hormonal imbalance, medical conditions, abnormal menstrual cycle, inability to produce eggs, anatomical issues, lifestyle and environmental factors can lead to female infertility.
Which women are more vulnerable to female infertility Treatment in Surat?
- Age – almost after the age of 30 years, the rate of follicular formation decreases resulting in fewer and poor quality of eggs. This leads to difficulty in conception and increases risk of miscarriage.
- Weight – Being obese or underweight may poorly respond to induction of ovulation. Obese women have a lower fertility rate than normal women. Excess weight can cause hormonal imbalance which leads to reduced fertility.
- STD (Sexually Transmitted Diseases) – such as syphilis, gonorrhoea, chlamydia, etc can damage the fallopian tubes.
- Alcohol, tobacco, smoking – damages cervix and fallopian tubes which increases risk of miscarriage and ectopic pregnancy.
- Chronic illness – such as diabetes, lupus, hypothyroidism, uterine fibroids, hypertension, arthritis, or asthma can affect female fertility.
- Issues such as stress, anxiety, sedentary lifestyle, malnourishment etc may lead to female infertility.
Causes of Female Infertility
Ovulation disorders
- Ovulatory dysfunction means abnormal, irregular, or absent ovulation.
- Chronic ovulatory dysfunction in premenopausal women is caused by PCOS, high prolactin levels, low ovarian reserve, hypothalamic-pituitary dysfunction, and other conditions that can cause anovulation (e.g. diabetes, depression, thyroid dysfunction, obesity, excessive exercise, weight loss, use of drugs that contains estrogen or progestin, etc.)
PCOS (Polycystic Ovarian Syndrome)
- PCOS is a medical condition in which the women’s ovaries produce immature or partially mature ovum in large numbers and over time this ovum becomes cysts.
- Due to this, ovaries become larger in size and secrete a large amount of male hormones and this leads to female infertility.
- PCOS also causes irregular menstrual cycles, hair loss, and abnormal weight gain.
- PCOS can be controlled by diet, lifestyle modifications, and medications.
Ovarian Insufficiency
- Primary Ovarian Insufficiency, also known as premature ovarian failure, is a condition in which there is loss of normal ovarian function in women before age 40 years.
- This condition results in irregular or absent menstrual periods, challenges in conceiving, and a reduction in estrogen levels.
Low ovarian reserve (Low AMH levels)
- Less than 1ng/ml is considered a low AMH level.
- The causes of low AMH are age, endometriosis, genetic factors, auto-immune diseases, smoking, pollution, and obesity.
- Chances of pregnancy may increase if you take a healthy and nutritious diet, do adequate exercise, yoga, and pranayama.
Hyperprolactinemia (Higher level of prolactin)
- Prolactin is a hormone that is mainly responsible for the development of mammary glands within breast tissue, milk production and lactation.
- The pituitary gland is mainly responsible for producing and secreting prolactin.
- Hyperprolactinemia common causes are prolactinoma (pituitary benign tumour), certain medications or certain health conditions.
- Hyperprolactinemia can cause infertility, loss of interest in sex, low bone mass and galactorrhea (milky discharge from nipples).
Blocked fallopian tubes
- Blocked or damaged fallopian tubes keep sperm away from getting to the egg (ovum).
- Pelvic inflammatory disease or previous surgery for ectopic pregnancy can cause fallopian tube block.
Endometriosis
- Endometriosis is when endometrial tissues are found outside the uterus.
- Endometriosis may grow on the outside of the uterus, ovaries, tubes, and even on the bladder or intestines.
- This tissue can irritate structures.
- This causes pain and scars on organs.
- Up to 30% – 50% of women with endometriosis may experience infertility.
Uterine fibroids
- Fibroids are Benign (non cancerous) Growth in the uterus.
- The cause of fibroids isn’t well known, up to 10% of infertile women are known to have fibroids.
- Uterine fibroids may obstruct the fallopian tubes and prevent implantation.
- Many women who have uterine fibroids don’t have any symptoms and fibroids decrease after menopause.
- However, when fibroids are big, they can cause heavy menstrual bleeding, pelvic pain and pain during sex.
Diseases affect infertility
- Female infertility can be affected by various illnesses such as diabetes, hypothyroidism, hypertension, or sexually transmitted diseases.
- Hypothyroidism can cause infertility by affecting ovulation. Women with these conditions may not release an ovum regularly, this makes it difficult to get pregnant.
- When diabetes is not well controlled in females it can affect fertility. Diabetes can result in irregular or absent menstrual cycles, increase the risk of abortions and congenital anomalies.
Unexplained (Idiopathic) infertility
- 20 to 30% infertile couples are diagnosed with unexplained infertility.
- Fertility treatments and assisted reproductive technologies like IUI (intrauterine insemination) and IVF can help.
Common symptoms of female infertility:
-
Amenorrhea (Absence of monthly menstruation):
- It is common for women to miss periods.
- Stress, physical exertion, and lifestyle habits can lead to irregular menstrual patterns. Prolonged absence of periods should be taken seriously.
-
Irregular periods:
- There are multiple reasons behind irregular periods, including stress, hormonal imbalances, PCOS, specific medical conditions, medications, and other factors that could potentially result in infertility.
-
Heavy and painful periods:
- Reason behind this may be uterine fibroids, polyps, endometriosis, adenomyosis, uterus or cervix cancer.
- This may be one of the reason behind female infertility.
How to diagnose female infertility?
-
Medical history:
Your physician may also inquire about your sexual and menstrual behaviours and the progression of your sexual development during adolescence. -
Physical examination:
This consists of examining your reproductive organs and inquiring about any genetic conditions, chronic health issues, illnesses, injuries, or surgeries that could potentially impact fertility. -
Blood tests:
Sample of blood can be tested for hormone levels(FSH, AMH, PRL, progesterone, TSH etc), blood sugar levels etc. -
Ultrasound Sonography (USG):
The female reproductive system can be visualised through ultrasound images of the ovary, uterus, fallopian tube. This diagnostic tool is useful in detecting structural irregularities of uterus, uterine fibroids, endometrial thickness, endometriosis. -
Laparoscopy:
Pelvic Inflammatory Disease, fallopian tube/s blockage, and endometriosis can be effectively identified through the application of laparoscopy. -
X-Rays:
An X-ray of the uterus and fallopian tubes is performed by injecting a specialised dye, which is known as a hysterosalpingogram. It can be used to find blockages in fallopian tubes.
Meet Dr. Mahendra Rupapara
Ayurvedic Infertility Specialist, Surat
- BAMS | 35+ Years | Gulabkunverba Ayurved University
- Dr. Rupapara has dedicated his 35-year career to one field: infertility. Since 1987, he has treated over 50,000 patients across Gujarat - including complex cases of azoospermia, low AMH, repeated IVF failure, and unexplained infertility. His approach combines personalised Ayurvedic diagnosis (tridosha assessment), herbal medicine from Ojas Ayurved's own pharmacy, and advanced Panchakarma therapies.
Ayurvedic concept on female infertility:
- Ayurvedic traditional texts cover the topics of obstetrics and gynaecology in various sections, under the category of ‘Yonivyapad.’ It includes diseases affecting female reproductive organs in a structural and functional manner.
- All the Acharyas are in agreement regarding the existence of twenty Yonivyapad, which can be broadly linked to modern disease categories. However, there is considerable variation in the clinical features described for each by different authors, and additional diseases are also identified with ‘yoni’ as a prefix.
- In the 20 yonivyapad , women’s health issues could be linked to certain contemporary diseases based on their primary symptoms. For instance, conditions like oestrogen deficiency, endometriosis (Vatala yonivyapad), Pelvic inflammatory disease-PID (Paittiki yonivyapad), and recurrent miscarriage (Putraghni yonivyapad) were directly associated with women’s ailments.
नहि वातह्रते योनि: नारीणां संप्रदुष्यति | चरक संहिता चि.30/115
- All acharyas have agreed that there is no Yovivyapadas without a vitiated Vata dosha. “The genital organs of women do not get afflicted without the aggravated Vata dosha.”
Causes of yonivyapad:
मिथ्या आचरेण ता: स्त्रीणां प्रदुष्टेन आतॅवेन च |
जायन्ते बीजदोषा: च दैवा: च श्रुणु ता: पृथक: | चरक संहिता चि.30/8
- Mithya Ahara (False diet)
- Mithya Vihara (Wrong lifestyle)
- Pradushta artav (Menstrual morbidities)
- Beej Dosha (Defective genes, ovum)
- Daiva (Divine or fortune)
Types of yonivyapad (in Charak):
- Vatala
- Pittala
- Kaphaja
- Tridoshaja
- Raktaja
- Arajaska
- Acharana
- Aticharana
- Prakcharana
- Uplupta
- Paripluta
- Udavartini
- Karnini
- Putraghni
- Antarmukhi
- Suchimukhi
- Shuska
- Vamini
- Shandhi
- Mahayoni
चिकित्सा (Treatment):
स्नेहन स्वेदन बस्त्यादि वातजा: अनिलापहम् |
कारयेत् रक्तपितध्नं शीतं पितकृत आसु च ||
श्लेष्मजासु च रुक्ष उष्णं कर्म कुयाँत् विचक्षण: | चरक चि. 30/41
- To treat uterine disorders caused by vata imbalance, it is advisable to undergo therapies like oleation (Snehana), sweating (Swedana), medicated enema, and other similar treatments.
- To treat uterine disorders caused by pitta imbalance, it is advisable to undergo therapies like cooling and raktapitta (Bleeding disorders), and other similar treatments.
- To treat uterine disorders caused by kapha imbalance, it is advisable to undergo therapies like dry and hot.
एवं योनिसु शुद्धासु गर्भ विन्दन्ति योषित: |
अदुष्टे प्राकृते बीजे जीव उपक्रमणे सति || चरक चि. 30/125
When the female reproductive organs get cleansed by the aforesaid treatment, the woman becomes capable of pregnancy. Conception of unpolluted sperm and ovum possessed of natural attributes and there is entry of the soul.
Ways of treatment for female infertility:
- Counselling: Couples struggling with female infertility may benefit from counselling, as the experience of infertility is both stressful and emotional.
- Lifestyle modifications: Lifestyle modifications such as quitting alcohol, tobacco, and smoking, taking up a healthy diet, and avoiding excessive exposure to environmental toxins may help to improve fertility and improve ovum quality.
- Medications: Herbs such as Shatavari, Ashwagandha, Yashtimadhu, Ashoka, Gokshur, Kumari, Bala etc are useful in improving female fertility rate.
