What is female infertility?​

Female infertility is a term used when a woman is unable to conceive naturally

CAUSES

There are numerous factors, however the most common causes of difficulties conceiving include the following:

Disorders related to ovulation or hormone imbalance

• Polycystic ovarian syndrome & insulin resistance
• Disorders of the Hypothalamus and/or Pituitary gland
• Thyroid disorder, Hyperprolactinaemia Cushing syndrome, Congenital adrenal hyperplasia. 

Mechanical or structural causes

• Endometriosis, fibroids, adenomyosis
• Pelvic infection or adhesions (scarring) 
• Uterine polyps, septum
• Absent, damaged or blocked the fallopian tubes
• Malformation, trauma or scarring of the cervix

Age or ovarian aging

• Mature maternal age
• Premature aging or depletion of the ovarian follicles (Risk factors: smoking, radiotherapy, chemotherapy, family history and autoimmune disease).

Deconditioning or illn​ess

• Obesity and underweight
• Immune factors (Anti-phospholipid syndrome, coeliac disease)
• Acute and chronic medical illness​​

INVESTIGATIONS

Investigations are arranged after a detailed history and examination

Blood tests

​Analysis of your blood can reveal important information about ovulation, egg count, metabolism, nutrition, current immunity and/or infections.

​If you've had recurrent miscarriages (2 or more), chromosome analysis, thrombophilia screen and a detailed assessment of the uterus will also be ordered. Gene testing is warranted if there is a personal or family history of an inheritable condition. 

Ovulation

Home ovulation prediction kits can be helpful if there is doubt about ovulation. Most women who have regular periods, changes in cervical mucus and premenstrual symptoms are ovulating.  

​An elevated progesterone level about a week before your period is due is a good indication that you have ovulated that month. This can be determined through a blood test.

Anti-Mullerian Hormone (AMH) - egg count

• With a simple blood test, we can estimate your "egg count", also known as your "ovarian reserve". This test is called Anti-mullerian hormone (AMH).
• AMH is a biochemical surrogate marker of egg QUANTITY, not egg quality.
• AMH declines with age and is undetectable as a woman approaches menopause.
• For women undergoing IVF, AMH correlates with the number of eggs retrieved after stimulation, and is the best biomarker for predicting poor and excessive ovarian response.

Imaging

Pelvic ultrasound

Transvaginal ultrasound - A small ultrasound probe is inserted into the vagina to provide clear images of the womb and ovaries. This procedure can estimate the number of follicles you have in your ovaries and detect abnormalities of your womb, endometrium (lining) and fallopian tubes.​

Detailed scan & xray with contrast

Sonohysterography improves the visualisation of the womb's cavity by using sterile saline to distend the womb to further evaluate the presence of polyp, septum or indentation caused by a fibroid.

Hysterosalpingo-contrast-sonography (HyCoSy ) is a non-invasive test to check the function of your fallopian tubes. A contrast solution is infused into the womb and observed to flow along the fallopian tubes with an ultrasound probe.

Hysterosalpingogram (HSG) is similar to a HyCoSy but uses X-Ray rather than ultrasound to capture images of the contrast.

Deep infiltrating endometriosis scan uses an ultrasound probe to look for deposits of endometriosis on your bowel, bladder and other organs.​

Surgery

Laparoscopy is a procedure performed under general anaesthesia to visually check for damage and obstruction of the fallopian tubes, presence of endometriosis, inflammation, adhesions and other abnormalities.

​Hysteroscopy is a procedure involving a small tube containing a light source that is inserted through the cervix and into the uterus. This procedure is performed under general anaesthesia to obtain direct views of the inside of the womb. Samples of the lining of the womb can be taken at the time.

Interpretation of results

The value of ordering tests is to accurately interpret them in the context of your clinical picture. It’s therefore essential to return and discuss your results with Dr Fong to understand your situation thoroughly. In the event of an abnormal result, prompt attention and treatment will be required.

Dr Fong is an endocrinologist and fertility specialist. If you require surgery, she will be able to assist in referring you to a gynaecologist or urologist who has the expertise in the area of concern. 

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