Female sterility or infertility is more and more widespread in France, an increase over 20 years due in particular to environmental and behavioral factors. We take stock with Dr. Juan Berrocal, gynecological surgeon.
Definition: what is female infertility?
” Female infertility refers to the inability of a woman to procreate subject to having full, regular sex (two to three times a week) and without contraception within 12 to 24 months “, explains Dr. Juan Berrocal, gynecological surgeon. This term is relatively aggressive, some prefer to use the infertility infertility, or hypo-fertility. Naturally, a woman is fertile in a variable way according to her age . Fertility increases until the age of 25 and then stabilizes.
To start a pregnancy, the woman must have “at least”:
- Regular and good quality ovulation
- A permeable collar and tubes
- Good quality mucus
- A uterine lining (endometrium)
- Contact with sperm …
Causes of female infertility
The main causes can in particular be:
- A genital infection caused by STDs(Chlamydiae, gonococci,) or other types of germs that can affect the cervix (cervicitis) or the tubes (salpingitis).
- Salpingitis, which is acute or chronic inflammation of the fallopian tubes (ducts that connect the ovaries and the uterus), usually caused by infections. In almost half of cases, the infection is triggered by Chlamydiae. Gonococci and mycoplasma germs can also be involved. They cause tubal obliteration directly or through adhesions.
- An ectopic pregnancy (GEU): the aftereffects of an ectopic pregnancy (the tube duct is partially or totally blocked) or the consequences of surgery.
- Endometriosis, which is a gynecological abnormality: the endometrial tissue that lines the lining of the inside of the uterus, normally eliminated during menstruation, is found outside the uterus, for example in the fallopian tubes or of the peritoneum. “This tissue located outside the uterus can create inflammation in the pelvis and can block the tubes or ovaries and prevent fertilization”, insists the doctor.
- Exposure to distilbene can cause an abnormality of the tubes but also malformations of the uterus. Distilbene is a drug prescribed to about 200,000 women between 1950 and 1977. This treatment was then indicated to prevent miscarriages. Following numerous complications, its use was banned in France in 1977. This phenomenon remains exceptional.
- Ovulation disorders: In the event of anovulation, ovulation is completely absent. In case of dysovulation, it is of lower quality. Ovulation disorders involve failure or poor production of a fertilizable oocyte. They are at the origin of most cases of female infertility and concern more than 3 cases out of 10. “ The origin is often an imbalance of hormonal production, whether of ovarian origin such as polycystic ovaries but also of other organs (pituitary, adrenals, thyroid, pancreas.) They can also occur in the event of early menopause “, continues our interlocutor.
- Mechanical sequelae such as, for example, after conization for the treatment of papillomaviruses, in the case of uterine polyp or fibroma or after ovarian surgery (in case of puncture of ovarian cysts for example)
- Other pathologies such as anorexia nervosa , too rapid weight gain or liver, kidney or digestive diseases.
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Cervical mucus abnormalities
Cervical mucus is necessary for the proper functioning of fertilization because it facilitates access to the “best” spermatozoa. During ejaculation, millions of sperm enter the vagina and migrate to the uterine tubes in order to reach the oocyte and fertilize it. The first step is the passage of cervical mucus, secreted via the glands of the cervix. Cervical mucus filters sperm and only allows the most mobile, weak and abnormal to pass through.
Only a few hundred of them will eventually reach the fallopian tubes, where fertilization will take place. Poor quality of cervical mucus can be an obstacle for sperm and be a cause of reproductive difficulties. Knowing that the mucus is different in density depending on the time of the menstrual cycle (at the origin of the so-called Ogino contraception) ” The cervical mucus may be absent, in insufficient quantity, too viscous or gelled. Moreover, it may contain anti-sperm antibodies and destroy them, “observes Dr. Berrocal.
The Turner syndrome is a chromosomal abnormality (loss of part of a chromosome X) that results in atrophy and malfunction of the ovary.
Allergies to seminal fluid
The allergy to semen (sperm) are rare, but can be a cause of infertility.
Apart from any pathological condition, several psychological factors can negatively influence female fertility. The causes may be due to:
- A memory of a painful past event: the anniversary of the death of a loved one, a commemorative date of birth, an old trauma …
- The fear of repeating the mistakes of one’s own parents.
- Guilt felt after a voluntary termination of pregnancy (abortion).
- An unconscious fear of becoming a mother in turn
- Loss of a child
- Having had an unhappy childhood or having been abused by his parents
- About having suffered sexual violence
In women, fertility decreases from the age of 30. This can be explained by the fact that the eggs produced at this age more frequently have genetic abnormalities. Men over the age of 40 can also have reduced fertility. In men, the maximum fertility rate is 30 to 34 years / Beyond 35 to 40 years, the risks of infertility are increased.
Is it hereditary?
Overall, it can be argued that there is no hereditary infertility in women. In any case, nothing is proven except.
What are the symptoms ?
“Most often there are no symptoms. The infertility of a couple remains in 15% of cases unexplained”, notes the specialist. In some cases, we can see:
- Abnormal menstrual cycles
- Abnormally painful periods
- Painful intercourse
What treatments can be offered?
The treatments offered to depend on the causes of infertility found during medical investigations. Despite the variety of treatments available, some causes of infertility cannot be corrected. ” In women, hormonal treatments for menstrual cycle disorders can be effective, says the gynecological surgeon. Treatments such as clomiphene citrate (Clomid, by mouth) are prescribed to stimulate ovulation. In some cases, surgery may be necessary. If the fallopian tubes are blocked, an operation may remedy this disorder. ” In case of endometriosis, drugs to stimulate ovulation or in vitro fertilization may be necessary to hope to conceive a child.
The assisted reproduction techniques thus reveal sometimes necessary in cases of infertility. In vitro fertilization is the most frequently used technique. The man’s sperm are placed in the presence of the woman’s egg in the laboratory, then the embryo is reimplanted in the uterus of the future mother (IVF).
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Average times to conceive a child
At 25, a couple has an average 25% chance of achieving pregnancy each cycle, with an average time of conception of 3 to 6 months. On average, a couple succeeds in delivering a baby after 6 to 12 months. The percentage of women who have conceived a child:
- After a year of regular intercourse without contraception is 84%
- After 2 years, it is 92%
- Almost 80% of couples naturally conceive a child after 2 years. 60% of couples who experience difficulties conceive a child after 1 year.