From the Guidelines
Female infertility is primarily caused by disruptions in the complex reproductive process, with ovulatory disorders, tubal and pelvic pathology, and uterine factors being the main pathophysiological mechanisms. The most common causes of female infertility include ovulatory failure (21%), tubal damage (14%), and unexplained infertility (28%) 1. Ovulatory disorders, such as polycystic ovary syndrome (PCOS), are characterized by hormonal imbalances involving the hypothalamic-pituitary-ovarian axis, preventing regular egg release. PCOS is the leading cause of anovulatory infertility, affecting at least 7% of adult women 1.
Some key factors that contribute to female infertility include:
- Deterioration of oocyte quality with increasing maternal age
- Ovulatory disorders, such as PCOS
- History of salpingitis, such as that caused by chlamydia infection
- Endometriosis
- Uterine cavity abnormalities interfering with implantation
Imaging techniques, such as transvaginal ultrasound (TVUS), can be used to diagnose polycystic ovarian morphology (PCOM) in women suspected of having PCOS 1. TVUS is considered reliable for determining ovarian volume and follicle count, with a revised criteria for diagnosing PCOM consisting of 25 follicles that are 2 to 9 mm in diameter, in at least one ovary 1.
The diagnosis and treatment of female infertility depend on the specific pathophysiology identified, and a thorough evaluation is necessary to determine the underlying cause. Treatment approaches range from ovulation induction medications, surgical interventions for structural issues, to assisted reproductive technologies like intrauterine insemination or in vitro fertilization. Age-related fertility decline is significant, as egg quality and quantity diminish after age 35, with accelerated decline after 37 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pathophysiology of Female Infertility
The pathophysiology of female infertility is complex and multifactorial. Several factors contribute to female infertility, including:
- Ovulatory disorders: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility, accounting for approximately 70-80% of cases 2. Hyperinsulinemia is a key contributor to anovulation in PCOS, and reducing insulin levels through weight loss or insulin-sensitizing agents can restore ovulation.
- Tubal damage: Post-infectious tubal damage is a major cause of female infertility, with pelvic inflammatory disease being the most common cause of tubal damage 3.
- Endometriosis: Endometriosis is a common gynecologic condition that can cause pain and infertility, although the exact mechanisms of its pathogenesis are unknown 3, 4.
- Uterine anomalies: Congenital or acquired uterine anomalies, such as septate uterus or myomas, can lead to infertility, pregnancy loss, and other obstetric complications 3, 5.
- Pelvic adhesions: Pelvic adhesions can cause infertility by obstructing the fallopian tubes or interfering with ovulation 5.
Anatomical Causes of Female Infertility
Anatomical causes of female infertility include:
- Tubal blockage: Tubal blockage can prevent fertilization by blocking the sperm from reaching the egg 3, 5.
- Mullerian anomalies: Mullerian anomalies, such as unicornuate or bicornuate uterus, can increase the risk of infertility and pregnancy complications 5.
- Uterine cavity abnormalities: Abnormalities affecting the uterine cavity, such as leiomyomata or endometrial polyps, can interfere with implantation and increase the risk of miscarriage 5.
Treatment Options for Female Infertility
Treatment options for female infertility depend on the underlying cause and may include:
- Ovulation induction: Medications such as clomiphene citrate or gonadotropins can stimulate ovulation in women with ovulatory disorders 2, 6.
- Surgery: Surgery may be necessary to repair tubal damage, remove endometriosis, or correct uterine anomalies 3, 6.
- In vitro fertilization (IVF): IVF may be recommended for women with severe tubal damage, endometriosis, or other causes of infertility that cannot be treated with surgery or ovulation induction 3, 4.