Prevalence Along with Diagnostic Modalities and Treatment of Female Infertility Due to Female Genital Disorders

Introduction

Infertility is a medical condition in which a couple having consistent, unprotected mating within the time period of one or additional years but is unable to conceive [1]. Infertility in women is occurs due to female genital disorders i.e. PCOS, PID and endometriosis are discussed in this literature. Furthermore, medical histories and objective finding help to reveal the causes of female infertility. Previous studies have concluded that 37% of infertility factors are associated with female partner [2]. Globally, round about 72.4 million women (20-44yrs of age) have fertility problems from which approximately 40.5 million are pursuing infertility medical care and 32.6 million are not seeking infertility medical care [3]. PCOS is one of the major causes of ovulation disorders, premature ovarian failure (POF) & reduced ovarian reserve may occur. Chlamydial infections cause fallopian tubes (acute salpingitis) obstruction that leads to the failure of an ovum to pass through it and unite with the sperms resulting in infertility [4]. Erectile dysfunction, ejaculation problems, concentrated semen, atrophies after invasive procedures androgens and thyroxin imbalanced or vasectomy can lead to infertility or subfertility [5]. In endometriosis, pain during defecation and urination, ectopic growth of uterine tissue, dysmenorrhoea, dyspareunia & pelvic pain can occur [6]. Symptoms of estrogen deficiency develop in many, but not all, patients. These symptoms include vasomotor symptoms (hot flashes and night sweats), sleep disturbance, and dyspareunia related to vaginal dryness. However, not all patients have profound estrogen deficiency, and a vaginal examination often shows effects suggesting normal estrogen levels [7]. Semen analysis is done to analyse the sperm count, sperm shape, sperm motility as well as sperm dysfunction [8]. The ultrasonography (USG) and sonohysteroscopy is used to examine the pelvic cavity and organs located in it [9]. Gonadotropins are the hormones which induce ovulation [10].

Discussion

Infertility, defined as the inability of a sexually active couple to conceive after 1 year of regular intercourse without contraception, affects approximately 15% of couples, and male factors are the cause in 20% -50% of cases [11]. Higher prevalence has been seen from 25-34 years of age group and lesser rate of prevalence has been seen from age group greater than 45 years. According to a survey conducted (July 1988 – June 1989) in three regions of France. The main exaggerating causes of female infertility were ovulation disorders (32%) and tubal damage (almost 26%), and of male infertility oligo-terato-asthenozoospermia (approximately 21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%) [12]. Further studies provide an evidence of endometriosis insights into lethal ovarian carcinogenesis resulting in female infertility at the age of 25 to 40 years [13]. Secondary type of infertility is much more common than primary type of infertility. The incidence of varicocele is much higher factor in secondary infertility compared with primary infertility [14]. Higher prevalence rate has been seen from females suffering from PCOS. The prevalence of polycystic ovaries, ovarian size and morphology, menstrual history, features of androgen excess, fertility status, serum hormone levels should be assessed from each participant to check PCOS. Most of the studies shows that serum levels of oestradiol and FSH were similar in PCOS and non‐PCOS women, but LH was distributed around a higher median in PCOS women. Median testosterone and androstenedione levels were the same in PCOS and non‐PCOS women. Ovarian volume (each ovary separately) is mostly larger in women with PCOS irrespective of current OCP (oral contraceptive pill) usage. The prevalence of polycystic ovarian morphology is much high but it was accompanied by minimal clinical manifestations and superficially no deleterious effects on earlier fertility [15]. All the participants were diagnosed mainly via ultrasonography in order to check the pelvic cavity and cysts in ovaries. Tubal patency was checked via laparoscopy and endocrine tests included FSH, LH detection, progesterone, androgens etc. ultrasound is most common investigational modality for checking ovaries and for estimation of female infertility reasons [16].

The current common use of Doppler ultrasound technique to examine blood flow in the uterus and ovaries in infertile patients and during early female pregnancy. The overall basics of Doppler ultrasound and different techniques of measuring blood flow are also used from the viewpoint of the technician who may be unfamiliar with physics and terminology of Doppler. The normal values in menstrual cycle and the association of uterine and ovarian blood flow to infertility and to implantation following in- vitro fertilization can be presented by this technique. Normal standards for uterine blood flow in the first 16 weeks of pregnancy and effect of sex steroids and ovulation induction on their values can be described. The possible relationship of defective uterine blood flow and effect of drugs can be explored. Doppler blood flow studies also provide significant information about possible causes of some of disorders of infertility and early pregnancy and methods of treatment [17].

Ultrasound has become an important help for the judgement of infertility by demonstration of pelvic organs, growing ovarian follicles, of intra-follicular arrangements and the cyclic uterine endometrial changes. Ultrasonic discriminations of ovaries and their developments such as the ovarian artery can be described. By ultrasound, average ovarian blood flow can be measured. During hormone stimulated cycles, the overall ultrasonic examination is repeated through ovulation, induction and even subsequently. The average diameter of growing follicle is also measured. Femara (generic letrozole) and  Clomid  (having generic clomiphene) are fertility medications used for exciting ovulation. Combination drug therapies have been considered to improve pregnancy rates [18]. Previously, combinations of different hormonal therapies (anti-estrogen, tamoxifen with an androgen, testosterone undecanoate) in 212 patients with idiopathic oligozoospermia and the 82 normozoospermic men with female factor subfertility significantly enhanced sperm parameters and the spontaneous pregnancy rate [19]. Other smaller randomized trials using the combinations of hormonal therapy with antioxidants (anti-estrogen, clomiphene with an antioxidant, L-carnitine / vitamin E) have shown previously a beneficial effect on sperm considerations and pregnancy rates [20]. The antioxidants in combination had a helpful impact on overall pregnancy rates [21].

Conclusion

It is concluded from the study that the percentage prevalence of female infertility among ages was higher in age group (25-34) years (76%) and it was mostly secondary infertility (54%). The main pathological factor of female infertility in Sialkot city was PCOS, which was 52% of evaluated patients. Commonly used diagnostic tools were ultrasonography with prevalence of (100%) and endocrine tests (72%). In prescription trend, anti-obesity drugs, anti- oestrogen drugs and oral-contraceptives were commonly prescribed and other treatment interventions were also seen in few patients.