Female Fertility
Fertility and sexuality are both influenced by the female reproductive system.
It includes:
- Vagina
- Womb (uterus)
- Fallopian tubes
- Ovaries
The reproductive cycle includes:
- Menstrual periods
- Ovulation
- Pregnancy
- Giving birth
- Menopause
Natural family planning
To plan or avoid conception, natural family planning entails recognising the signs and symptoms of fertility during your menstrual cycle.
You can track and record three key fertility signs for natural family planning.
- Daily measurements of your body temperature
- Changes to your cervical secretions (cervical mucus)
- Length of your menstrual cycle
However, age and frequent female fertility issues can impact a woman’s ability to conceive.
Common causes of female infertility
Did you know only 30% of fertility problems are female-related?
For ovulation to occur, your glands and hormones must work together to trigger your menstrual cycle. Your hypothalamus (Highlight these words and add a feature where when the curser touches it, this definition pops out “It is a section of the brain that controls hormone production. The hormones produced help your body control several functions including but not limited to temperature, thirst, hunger, sleep, and heart rhythm”) this prompts your pituitary gland (Highlight these words and add a feature where when the curser touches it, this definition pops out- “It (also found in your brain and is about the size of a pea) produces many different hormones and secretes them into your bloodstream. One of its functions is to trigger the menstrual cycle.”) to secrete hormones to trigger your ovaries to ripen your eggs. Irregular or infrequent periods may indicate that ovulation is not occurring properly.
The menstrual cycle, occurring approximately every 28-34 days, is a recurring process in which the body prepares for a potential pregnancy. However, individuals with irregular ovulation experience cycles outside this typical 28-34-day timeframe. Sometimes, the body does not release an egg, a condition called anovulation.
When you are ovulating.
An ovulation occurs when an egg (ovum) fails to be released from the ovary during the menstrual cycle, which is necessary for a potential pregnancy. The process of ovulation relies on the coordination of multiple hormones, and as a result, there can be various causes of anovulation.
‘Polycystic’ literally translates as ‘many cysts’. It is a condition in which the ovaries produce an abnormal amount of androgens (male sex hormones that are usually present in women in small amounts).
Diagnosing PCOS
Your healthcare provider will ask about your medical history and your symptoms. You will also have a physical test. This will likely include a pelvic test. This test checks the health of your reproductive organs, both inside and outside your body.
Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as:
- Ultrasound: This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).
- Blood tests: These look for high levels of androgens and other hormones. Your healthcare provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.
If you are concerned about PCOS affecting your ability to become pregnant, we recommend seeing a fertility specialist with expertise in PCOS.
If you want to make an appointment, please call us on 03 9769 3707 or complete the form below.
Causes of blocked fallopian tubes
Fallopian tubes are usually blocked by scar tissue or pelvic adhesions. These can be caused by many factors, including:
- Pelvic inflammatory disease: This can cause scarring or hydrosalpinx.
- Endometriosis: Endometrial tissue can build up in the fallopian tubes and cause a blockage. Endometrial tissue outside other organs can also cause adhesions that block the fallopian tubes.
- Certain sexually transmitted infections (STIs): Chlamydia and gonorrhea can cause scarring and lead to pelvic inflammatory disease.
- Past ectopic pregnancy: This can scar the fallopian tubes.
- Fibroids: These growths can block the fallopian tube, particularly where they attach to the uterus.
- Past abdominal surgery: Past surgery, especially on the fallopian tubes, can lead to pelvic adhesions that block the tubes.
If your fallopian tubes are blocked by small amounts of scar tissue or adhesions, your doctor can use laparoscopic surgery to remove the blockage and open the tubes.
However, talk to your doctor before treatment to understand your chances for a successful pregnancy.
The uterus is where the fertilised egg lodges itself. Problems within the uterus may hamper implantation.
These may include:
Fibroids: Non-malignant tumours inside the womb.
Polyps: Overgrowths of the endometrium (the membrane lining the womb, which thickens during the menstrual cycle in preparation for possible implantation of an embryo), which the presence of fibroids can prompt.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant.
Endometriosis can start during a person’s first menstrual period and last until menopause. It is a common condition affecting women of reproductive age, especially women over 30 who have not yet had children. Mild endometriosis is often associated with infertility, and more severe degrees of endometriosis will have a greater impact on your ability to conceive naturally.
Symptoms of endometriosis include:
- Pelvic pain
- Painful periods
- Pain during intercourse and premenstrual spotting
How does endometriosis affect fertility?
While endometriosis does not inevitably lead to infertility, there is a recognized correlation between endometriosis and fertility issues, although the exact cause is not fully understood. It’s important to note that even individuals with severe endometriosis can still achieve natural conception. Studies estimate that approximately 60-70% of individuals diagnosed with endometriosis have the potential to get pregnant without the need for assisted reproductive techniques.
Causes of Endometriosis
Although the exact cause of endometriosis is not certain, possible explanations include:
- Retrograde menstruation: In the case of endometriosis, menstrual blood, which contains endometrial cells, can flow in the opposite direction, moving back through the fallopian tubes and into the pelvic cavity rather than exiting the body. This leads to the attachment of these endometrial cells to the surfaces of pelvic organs and the pelvic walls. Over subsequent menstrual cycles, these cells grow, thicken, and cause bleeding within the pelvic cavity.
- Transformation of peritoneal cells: In what’s known as the “induction theory,” experts propose that hormones or immune factors promote the transformation of peritoneal cells (cells that line the inner side of your abdomen) into endometrial-like cells.
- Embryonic cell transformation: Hormones such as estrogen may transform embryonic cells (cells in the earliest stages of development) into endometrial-like cell implants during puberty.
- Surgical scar implantation: Endometrial cells may attach to a surgical incision after surgery, like a C-section or a hysterectomy.
- Endometrial cell transport: The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other body parts.
- Immune system disorder: A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.
Seek advice from your GP or a fertility specialist if you experience symptoms that might be due to endometriosis and are also having trouble conceiving naturally.
In a woman’s early to mid-20s, she typically has a 25-30% likelihood of getting pregnant each month. However, fertility generally declines in the early 30s and decreases more notably after age 35. When a woman reaches 40, the probability of getting pregnant during any given monthly cycle drops to approximately 5%.
Women’s age and IVF
There is a widespread misconception that in vitro fertilization (IVF) treatment can overcome the challenges of age-related infertility. However, it’s important to note that a woman’s age still significantly impacts the success rates of IVF. In Australia, the likelihood of achieving a live birth from a complete IVF cycle, which encompasses all fresh and frozen-thawed embryo transfers resulting from a single ovarian stimulation, is influenced by age.
- 43% for women aged 30 to 34 years
- 31% for women aged 35 to 39 years
- 11% for women aged 40 to 44 years
“I have dedicated my life to offering my patients a broad range of treatments depending on the underlying cause. As a Fertility Specialist, I aim to find out if your situation in nature needs a helping hand or if significant scientific help is required. I then analyse and discuss the treatment options available/suitable for your situation.”
– Dr Myran Ponnam-Palam.
“I have dedicated my life to offering my patients a broad range of treatments depending on the underlying cause. As a Fertility Specialist, I aim to find out if your situation in nature needs a helping hand or if significant scientific help is required. I then analyse and discuss the treatment options available/suitable for your situation.”
– Dr Myran Ponnam-Palam.
Ovulation Induction (OI) involves using fertility medications to trigger increased hormone levels. This encourages your ovaries to release eggs to help your pregnancy chances.
It’s a standard treatment if you produce low levels of hormones for ovulation or are not ovulating at all. OI may also be used to regulate ovulation.
Your results closely monitor throughout the OI process. Ultrasounds are conducted to monitor the development of the follicles and the uterus lining. By conducting the ultrasound, your follicle’s progress can be accurately assessed, and based on that, you will be advised when the optimum time is for you and your partner to have unprotected intercourse or insemination. The OI process may maximise your chances of conceiving successfully.
When lack of ovulation causes infertility, letrozole blocks estrogen production; doing so triggers ovulation as the body senses a low estrogen level and increases hormone production. Letrozole can be used alone in ovulatory infertility, and it can be used in unexplained infertility.
Follicle Stimulating Hormones (FSH) is one of the gonadotropic hormones, the other being luteinizing Hormone (LH).
FSH is one of the essential hormones that stimulate the growth of the ovarian follicles in the ovary before the release of an egg occurs as a result of one follicle at ovulation.
Firstly, the medication Gonal F or Puregon may be prescribed, which is administered by injection. Then your prescribed treatment plan and how to do the injections will then be explained. Injections will commence on the second or third day of your menstrual cycle and continue for several days until a mature follicle is ready. An ultrasound will assess this to monitor your progress and view the growth of your follicle(s).
Once a mature follicle has formed, this will mature into an Oocyte (egg). Some patients require assistance for an egg’s maturation and release; in this case, a fertility specialist will administer a “trigger” shot of HCG.
Some patients may require the assistance of fertility medications to help release a mature egg into the uterus for fertilisation by sperm. In this instance, the doctor will administer or recommend a dose of Ovidrel. Ovidrel can be taken in a cycle paired with Gonal F injections or independently, depending on your assessment outcomes.
Once you have had a course of Ovidrel, you will be advised when it is suitable for you and your partner to have unprotected intercourse or arrange the time for your insemination.
We understand that injections can be confronting if you haven’t used this form of treatment before. Rest assured, our office will book you for a consultation where Dr. Myran will thoroughly explain how to self-administer injections. Bring your partner or family member you feel comfortable assisting with injections for this consultation. The injections are in pen form and less intimidating than a drawn-up needle. To select dosages, you click the pen to the directed amount and inject it into the fatty tissue of the stomach or upper thigh.
Possible side effects:
- slight bloating
- Abdominal discomfort
- Breast tenderness
- Nausea
- Muscle aches
- Tiredness.
IUI is usually done with hormonal medication (as described above) to help you stimulate ovulation at the right time. After following the recommended treatment cycle of medications, the end step (if prescribed) is Intrauterine Insemination (IUI). An IUI is best broken down into these three steps:
Step 1: Semen Collection
On the day of the insemination, your partner must produce an ejaculate into a sterile container. We recommend abstinence from intercourse for 2-3 days before a sample is required. The sample will then be required at the clinic within an hour.
Step 2: Sperm preparation
The sample then goes through a process of being “washed” and filtered, removing any non-motile sperm. This process filters the sperm into its most concentrated sample of active sperm for insemination.
Step 3: Sperm insertion
The concentrated sample of motile sperm is then inserted through the cervix into the uterus. This part of the procedure doesn’t require anaesthetic as it is very similar discomfort level you would experience in a pap smear.
Dr. Palam’s caring and nurturing bedside manner will ensure you are relaxed throughout the procedure. Once insemination has occurred, you must remain lying down for 10-15 minutes before leaving the clinic.