5 - Laboratory Challenges of Female Infertility Diagnosis - Part 5 (Classification of Types of Infertility Causes)

5 - Laboratory Challenges of Female Infertility Diagnosis - Part 5 (Classification of Types of Infertility Causes)

Early infertility assessments in women should determine if there is a problem with one or a combination of the following factors:

• Ovarian development (hormonal or genetic problems)

• Ovulation (hormonal problem)

• A blockage that prevents the transfer of a fertilized egg from the fallopian tube into the uterine cavity (structural disorders)

• Inability of the egg to replace the uterine wall (there are several causes and can generally be called Recurrent Implantation Failure = RIF).


Causes of infertility in women
1- Ovulation disorder (causes 35 to 40% of female infertility)

2 - Disorders of the fallopian tubes (along with disorders of the cervix and the uterus itself causes 40% of female infertility)

3- Disorders of the uterus or uterus

4 - Endometriosis (endometriosis is the cause of 13% of infertility cases and about 70% of women have endometriosis, infertility).

5- Problems with the body's immune system

6- Inability of the egg to implant in the uterine wall

7- Unknown factors

1- Impaired ovulation
Ovulation disorders are a major cause of infertility in women. So that 39% of the causes of female infertility are related to this issue.

Fertilization is not performed without ovulation, and therefore the woman does not become pregnant.

Some women may not ovulate or ovulate irregularly, so they may either not have menstruation or their menstrual cycle may be low (irregular or equal to 9 in a year). And even some women, even though they have regular menstruation,

They have an ovulatory disorder called Luteinized Unruptured Follicle Syndrome (LUFS) or trapped egg syndrome.

Overall, 95% of women with regular menstruation also ovulate, but in LUFS, the dominant follicle enters the process of leuteinization and progesterone production without breaking down and ovulating. As a result, the endometrium enters the secretory phase and continues all the growth stages of the luteal phase.

This condition may only be seen in a cycle (or more) at childbearing age, but it has been observed that such cycles are more unexplain infertility in infertile women than in fertile women.

However, these people can easily be forced to ovulate by using injectable ovulatory stimulants such as hCG or GnRH agonists such as Lupron.

Prostaglandins play an important role in the ovulation process, and LUF cycles have been found to be more common in women taking NSAIDs (non-steroidal anti-inflammatory drugs) that control their analgesic action by inhibiting prostaglandins. Can be seen.

It is also more common in women undergoing the IUI cycle, pelvic adhesions, endometriosis, fallopian tube closures, and PCOs than in the control group.

Factors such as high levels of prolactin, hypothalamic dysfunction (leading to decreased GnRH production and, of course, FSH and LH), polycystic ovary syndrome (PCOS), and early menopause. The group is placed.


According to the World Health Organization (WHO), ovulation disorders fall into three groups:

- WHO-1 Hypo-gonadotrophic - Hypo-estrogenic (10-15%)

- WHO-2 Normo-gonadotrophic - Normo-estrogenic (80-85%)

- WHO-3 Hyper-gonadotrophic - Hypo-estrogenic (5%)

WHO Criteria for Ovulation Disorders

- Oligo menorrhea: The duration of menstruation is more than 35 days or less than 8 menstruation during the past year.

Amenorrhea or lack of menstruation: This term is used when a woman's daughter has not had a period before the age of 16 (primary amenorrhea) or if her menstrual cycle is more than 6 months in a woman who has had regular periods. Cut off (secondary amenorrhea).

1- Group I or hypogonadotropic group - hyposterogenic (due to defects in the hypothalamic-pituitary axis):

Typically, these patients have amenorrhea (either primary or secondary) and are characterized by decreased levels of gonadotropins and estrogen. Ovarian disorders account for 10% of ovulation disorders. .

2- Group II (due to defects in the hypothalamic-pituitary-ovarian axis):

Which includes PCO and amenorrhea hyperprolactinemia. The most important cause of ovulation defects is in this group (about 85%).

.
3- Group III (due to defects in the ovaries):

It is the same form of hypergonadotropic and hypoaestrogenic form that there is a primary defect in the ovaries themselves and is the cause of 5% of ovulation disorders related to this group. .

Infertility due to age-related hormonal disorders
Hormonal function is a key factor in getting pregnant. The most common cause of hormonal dysfunction is aging.

Having an old reproductive system also affects the other stages needed to have a baby.