FEMALE INFERTILITY AND STERILITY

In about 1/3 of cases of infertility the mother is the origin. The causes of female infertility are diverse, but today, there are solutions for many of them.

Sterility is the inability to conceive a child after one year of regular sexual intercourse without the use of contraception methods. Unlike infertility, which refers to the inability to maintain a viable pregnancy, sterility focuses on the difficulty or impossibility of achieving conception in the first place.

Kinds of Sterility

1. Primary sterility:
   • Refers to the situation where a couple has never been able to conceive a child, despite having regular, unprotected sexual intercourse for a year or more.
2. Secondary sterility:
   • Occurs when a couple who have previously conceived (either a full-term pregnancy, miscarriage or ectopic pregnancy) are unable to conceive again after trying for a year or more.

If there are no problems in sexual intercourse and there is no medical history in the woman’s medical record, a year’s wait before consultation if she is under 30 years of age is reasonable, between 6 months and 12 months if the age is between 30 and 35 years. Six months up to the age of 40 and immediately if she starts looking for pregnancy after that age.

Classification according to cause

1. Female sterility:
   • Caused by factors related to the woman’s reproductive system, such as ovulatory problems, tubal obstructions, endometriosis, uterine problems, among others.
2. Male sterility:
   • Related to problems in the male reproductive system, such as low sperm quality or quantity, ejaculation problems, hormonal disorders, among others.
3. Sterility of mixed origin:
   • Occurs when both parents have factors that contribute to sterility.
4. Unknown cause sterility:
   • In some cases, after extensive testing, no clear cause of infertility is found in either member of the couple.

What are the cases of female sterility?

Female sterility, or the inability to conceive after a year trying, can have several causes, affecting different aspects of the reproductive system. Here are some of the most common ones:

1. Ovulation disorders:
   • Polycystic Ovary Syndrome (PCOS): A hormonal imbalance affecting ovulation.
   • Premature ovarian failure: When the ovaries stop functioning before the age of 40.
   • Hormonal disorders: Alterations in hormones such as prolactin, thyroid, or luteinising hormone (LH).
2. Tubal abnormalities:
   • Fallopian tube obstruction: can be caused by infections such as pelvic inflammatory disease, previous surgeries or endometriosis.
   • Hydrosalpinx: Fluid accumulation in one or both fallopian tubes, which may prevent conception.
3. Endometriosis:
   • Growth of endometrial tissue outside the uterus, which can affect the fallopian tubes, ovaries and other parts of the reproductive system.
4. Uterine problems:
   • Uterine fibroids: Benign tumours in the uterus that may interfere with embryo implantation.
   • Uterine malformations: Alterations in the structure of the uterus, such as bicornuate, septate, or unicornuate uterus.
   • Endometrial polyps: growths on the inner lining of the uterus that may hinder implantation.
5. Cervix factors:
   • Insufficient or poor-quality cervical mucus: Cervical mucus helps sperm reach the egg, and if inadequate, can make conception difficult.
   • Cervical incompetence or short cervix: The cervix does not close properly, which can lead to repeated miscarriages.
6. Immunological factors:
   • Anti-sperm antibodies: The woman’s immune system produces antibodies that attack the sperm.
   • Embryo rejection: The body may react against the embryo as if it were a foreign body.
7. Age:
   • As women get older, both the quantity and quality of her eggs decrease, reducing the likelihood of conception and increasing the risk of miscarriage.
8. Lifestyle and environmental factors:
   • Stress: May affect hormones and ovulatory cycle.
   • Obesity or underweight: Affects hormone balance and ovulation.
   • Smoking, alcohol and drug use: Can damage the reproductive system.
   • Exposure to toxins: Chemicals such as pesticides, radiation, and pollutants may affect fertility.
9. Genetic causes:
   • Chromosomal or genetic alterations may interfere with fertility or cause recurrent miscarriages.
10. Unknown causes:

• In some cases, no clear cause is found, known as infertility of unknown origin.

Each of these causes may require a different diagnostic and therapeutic approach. It is important that women facing difficulty conceiving consult fertility specialists for a complete evaluation.

Treatment options:

Treatment of female sterility depends on the underlying cause and the patient’s individual circumstances. Some of the most common treatments are listed below:

1. Fertility drugs

• Clomiphene: Stimulates ovulation by promoting the release of more than one egg per cycle.
• Gonadotropins: Hormones that induce ovulation. Most of them are administered by subcutaneous injection.
• Metformin: Used in women with polycystic ovary syndrome (PCOS) to improve ovulation.
• Letrozole: Similar to clomiphene, used to induce ovulation.

2. Surgery

• Laparoscopy: Used to treat problems such as endometriosis, pelvic adhesions or problems in the fallopian tubes.
• Hysteroscopy: Used to treat uterine abnormalities such as polyps, fibroids, or resection of uterine septa.

3. Assisted Reproduction Techniques (ART)

• Artificial Insemination (AI): Sperm is introduced directly into the uterus during the ovulation period.
• In Vitro Fertilisation (IVF): Eggs are fertilised by sperm in a laboratory and then transferred to the uterus.
• Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into an egg, used in cases of severe male fertility problems or previous IVF failures.

4. Hormonal Treatments

• They are used to correct hormonal imbalances affecting ovulation, such as progesterone or oestrogen therapy.

5. Changes in Lifestyle

• Weight Loss or Gain: Adequate body weight can improve ovulation and the chances of pregnancy.
• Exercise and Diet: Maintaining a healthy diet and regular exercise regime can improve fertility.
• Stress Reduction: Relaxation techniques, such as yoga or meditation, can be beneficial.

6. Treatment of Underlying Conditions

• Endometriosis: It may require medication or surgery to shrink the endometrial tissue outside the uterus.
• Polycystic Ovary Syndrome (PCOS): In addition to fertility drugs, metformin and lifestyle changes are essential.

7. Oocytes or Embryo Donation

• In cases of ovarian failure, advanced maternal age or genetic problems, donated eggs or embryos may be used.

8. Natural and Alternative Treatments

• Some women opt for acupuncture, herbs or nutritional supplements as a complement to conventional medical treatments, although scientific evidence of their efficacy is limited.

9. Intra-ovarian platelet-rich plasma

Intraovarian platelet-rich plasma (intraovarian PRP) is an experimental technique being explored in the field of reproductive medicine for the treatment of female infertility, especially in women with premature ovarian failure, low ovarian reserve or advanced age.

¿What is PRP?

Platelet-rich plasma (PRP) is a concentrate of platelets obtained from the patient’s own blood. Platelets are blood cells that, in addition to being essential for clotting, contain growth factors that can stimulate tissue regeneration and cell repair.

How is PRP used in the ovarian context?

Intra-ovarian PRP involves the direct injection of PRP into the ovaries. The aim of this treatment is to rejuvenate ovarian tissue and stimulate folliculogenesis (the formation and development of new ovarian follicles) in women who have decreased ovarian function. This could improve ovarian response, increase egg production and, consequently, improve fertility rates.

Choosing the right treatment depends on medical evaluation, including hormone testing, imaging studies and medical history analysis. It is important for women facing fertility problems to consult a fertility specialist for an accurate diagnosis and a personalised treatment plan.