Female Infertility – A Basic Guide

Infertility is a term used to describe the inability of achieving pregnancy within one year of normal sexual activity without the use of any contraceptive. This is problem that can affect the relationship of any couple. This is a serious social and medical problem because in about half of the cases there are incurable damages to the reproductive organs. About 20% of married couple in their fertile age are sterile.

What leads to female infertility?

There are many different reasons why some women are infertile. Extragenital causes like hormonal, immune, psychogenic and other similar causes are usually more frequent than the others.

On the other hand, genital causes are separated depending on their location and they are known as vaginal, uterine, cervical, ovarian and tubal causes.

The cervical factor is present in more than 15% of women and this is usually some type of inflammation. One of the main reasons why the treatment approach of infertile couples is starting with the determination of the bacteriological situation of the cervical and vaginal swabs and examination of the presence of certain infection is the fact that their treatment reduces the risk of infertility and that this approach is the basis for many other diagnostic procedures like hysteroscopy, laparoscopy, HSG etc. maintain hard erection

The vaginal factor is present in between 5 and 10% of the cases. In some cases we are talking about mechanical barriers or poor coitus techniques while in other we have more serious problems like congenital malformations and inflammation.

The uterine factor is present in 10% of the cases. Tumors of the uterus or fibroids, polyps, adenomyosis, iterine synechia, congenital anomalities belong to this group of factors.

The tubal factor is definitely the most common cause of female infertility and it is present in almost half of the cases. The main reason is inflammation caused by sexually transmitted diseases. Finally, the ovarian factor is present in between 15 and 25% of the cases. Endometriosis is the most common cause.

Treatment of female infertility

Treatment of infertility in women is versatile and it depends on the cause of infertility. Some of these treatments include surgeries, anti-inflammation medicines, hormone therapy, antibiotics, artificial insemination, in vitro fertilization etc.

It has been scientifically proven that practicing a healthy diet that includes many minerals and vitamins, the use of natural multinutrient supplements, moderate physical activity and avoiding stressful situations can have positive effect on both female and male fertility.

When it comes to female infertility, it is very important for the partner to understand the situation and tries to solve this problem together as a couple. Thanks to this understanding and support and with the help of medical professionals it is possible to achieve the wanted pregnancy.

Couples can use the fact that more than 50% of women after therapies and treatments were able to give birth to a healthy baby as a way to encourage themselves. The truth is that female infertility can be cured easier than male infertility. Finally, in about 5% of the cases, women manage to get pregnant although the real cause of infertility was never determined.

Vulvovaginal candidiasis

This is one of the most common genital infections and is caused by Candida albicans in around 80–92 per cent of cases. Other non-albican species like C. tropicalis, C. glabrata, C. krusei and C. parapsilosis can also cause similar symptoms, although sometimes more severe and recurrent. C. albicans is a diploid fungus and is a common commensal in the gut flora. It is important to confirm the diagnosis with a perineal and/or vaginal swab. Conditions such as contact dermatitis, allergic reactions and non-specific vaginal infections can present in a similar manner. Testing can be done with a Gram stain or wet film examination and direct plating on to fungal media. Further testing to type the species may be required in recurrent or very severe cases as some species such as C. krusei can be resistant to some of the imidazoles, such as fluconazole.

Pregnancy, high-dose combined oral contraceptive pill, immunosuppresion, broad spectrum antibiotics, diabetes mellitus, hormone replacement therapy and HIV-infected women have a higher predisposition to develop vulvovaginal candidiasis.

Up to 30–40 per cent of asymptomatic women may have C. albicans grown on a vaginal swab. These women do not need treatment even if they are pregnant. There is no evidence of any adverse effects in pregnancy to either the mother or the baby if treated with topical imidazoles. However, the oral imidazoles are contraindicated in pregnancy.

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Women should be advised to avoid using any soaps, perfumes and synthetic underwear. The high-dose o estrogen combined oral contraceptive pill should be changed to a lower-dose pill. If there are persistent or recurrent symptoms, consideration should be given to change to a progesterone-only contraception. Check blood sugars to rule out undiagnosed diabetes mellitus and if present good glycaemic control should be the aim. Avoid recurrent courses of broad spectrum antibiotics. The treatment of vulvovaginal candidiasis can be based on whether the infection is uncomplicated, complicated or severe and recurrent.

Azoles/imidazoles are the mainstay of the treatment. They can either be used either as a local topical application (pessaries/creams) or oral preparations. There are several types of imidazoles with similar efficacy with a cure rate of over 80 per cent. The treatment is usually based on the preference of the physician, local availability and costs. The common imidazoles are clotrimazole, econazole and miconazole. Other antifungals, such as nystatin cream or pessary, can also be used. The medication can be taken as a single pessary treatment or a course of pessaries for a few days at a lower dose. The commonly prescribed medication is clotrimazole, which can be taken as single 500 mg pessary or a course of a 100 mg pessary over 6 days. Oral imidazoles, such as fluconazole, are given as a single dose at 150 mg or itraconazole 200 mg twice a day for 1 day. However, these are contraindicated in pregnancy.

There is no evidence to treat the asymptomatic male partner.