Age plays a vital role in woman’s ability to gestate and fertilize successfully. Woman’s fertility peak is at the age of 20 to 25 years old, but by the age of 35 and after the genetic dynamics of the reproductive system start to decline. This phenomenon encompasses a low quality ovum increasing the risk the embryo will demonstrate chromosomal abnormalities (Down syndrome is the most common chromosomal birth defect), perinatal problems by causing detrimental effects to the placental maturation as well as the odds of negative outcomes of pregnancy are higher such as low birth weight, pre-term labor or un-explained fetal death. Additionally, it is important to mention that in some cases the biological age of the ovaries are not in accordance to the mother’s age, so despite the young age of a woman, her ovaries can be older. The loss of function of the ovaries in young age called Premature Ovarian Failure (POF).
There are many young women, who are afflicted by endometriosis. This disorder is often painful due to the tissue that grows outside the uterus instead of lining to its inner side known as endometrium. Endometriosis can be spread to ovaries, fallopian tubes, pelvic floor, uterine ligaments (like the broad/round ligament of the uterus) cervix and vagina or to sites of a surgical abdominal incision. The exact cause of endometriosis remains unknown, but possible explanations may be:
- the retrograde menstruation,
- transformation of the peritoneal cells,
- embryonic cells transformation,
- surgical scar implantation,
- endometrial cells transport or
- immune system disorder
The symptoms of endometriosis can be revealed by:
- acute pelvic pain
- painful menstruation (Dysmenorrhea)
- dyspareunia during intercourse
- excessive bleeding during periods
Common signs and symptoms can be look alike with pelvic inflammatory disease (PID) or ovarian cysts. Diagnosis and treatment must be done as soon as possible, Medicinal and surgical interventions have pain-relief benefits. Laparoscopy is more effective than medical treatment, capable to preserve ovaries without damaging normal tissue and avoid any implications to the ovaries function.
Pelvic inflammatory disease or pelvic inflammatory disorder (PID)
The usual sites of infection in pelvic inflammatory disease are in uterus, fallopian tubes, and ovaries, inside the pelvis. It is difficult to be diagnosed due to the variety of symptoms that scale from none to severe ones. It’s an infection of the upper part of the female reproductive system and it is usually associated with infertility as well as ectopic pregnancy when it’s untreated. Usually, there can be no signs or symptoms but when symptoms are present, they can cause endometritis, salpingitis, etc. Diagnosis of pelvic inflammatory disease can be underwent with Hysteroscopy; a surgical method that can detect adhesions and proceed to biopsy of the uterine cavity. Furthermore, pelvic and vaginal ultrasounds, hysterosalpingography and blood test investigations can also help to identify the presence of the infection. It must be stressed out that hysterosalpingography constitutes a non-invasive process to check the translucency of the fallopian tubes and not only their ability to function. There are many bacterial factors that are involved and cause the PID such as Chlamydia trachomatis and Neisseria gonorrhea. If any of these symptoms appear you should visit your doctor immediately.
Ovarian surgeries are made, most of the times, due to the presence of cysts. Laparoscopy, an invasive method technique, is usually used for removing the cysts, in one or even both the ovaries. The cysts in the ovaries must carefully removed and the purpose of it is to avoid any damage to the ovaries that can affect the oocyte production. Moreover equally important is the attention of diathermy, which is capable to destroy a large number of oocytes. Surgeries concerning the removal of a Fallopian tube (salpingectomy) or fibroids (Myomectomy) can affect the ovarian blood flow as a consequence the insufficiency and functionality to produce oocytes or incapability to respond to drugs stimulation for forming oocytes.
Premature Ovarian Failure
Time constitutes an enemy for a woman’s reproductive system, since age can affect her ovaries and the quality of the oocytes (decreased number of the eggs, menstrual disorders with periods lasting longer or indicating a shorter duration, cycles in which the amount of blood loss may be less or heavier). Menopause can be a result either of time or it can be hereditary. During menopause women are experiencing symptoms of hot flashes, sweating, vagina dryness, mood swings, hormone levels begin to fluctuate and absence of ovulation. Premature ovarian failure is a malfunction of the ovaries before the age of 40. Primary ovarian insufficiency means that the ovaries fail to produce normal amounts of the hormone estrogen or release eggs; a situation from which infertility results, especially in young ages. Restoring estrogens levels under a hormonal therapy, complications will be prevented. Women having a family history or have any of the symptoms mentioned earlier, they should make an ultrasound in order to check the size as well as the number of oocytes in the ovaries and in combination with the results of the hormonal blood investigations (Follicle-Stimulating Hormone (FSH) test, Estradiol test, Prolactin test, Karyotype, FMR1 gene testing, AMH levels) the diagnosis will be able to be made.
Uterine Malformations (Bicornuate uterus Septated uterus. Arcuate uterus DES uterus (T-shaped uterus)
Congenital uterine abnormalities are malformations of the uterus, resulting from the abnormal development of the mullerian ducts that evolve during embryogenesis. These abnormalities pertain to diversification of the uterine structure and function under an interior and/or exterior substance. Uterine malformations may affect fertility and most of the times are easily distinguished and determined with gynecologic transvaginal ultrasonography, pelvic MRI, or hysterosalpingography. Moreover, the procedures of Laparoscopy and h may be indicated because the results are more accurate. The types of malformations can be found in a variety of sizes and shapes and each one of them can affect a woman’s life in a unique way.
Salpingitis is a fallopian tube disorder; in other words it constitutes an infection/ inflammation in the fallopian tubes. Salpingitis can also lead to infertility. In case of malfunction or destruction of uterine tubes, after ovulation the sperm will be incapable to reach the ovum, thus damaged oviducts increase the risk of ectopic pregnancy. The causes for tubal damage are salpingitis usually created by Chlamydia trachomatis and ectopic pregnancies are due to a salpingitis infection.
The menstrual cycle is the key for pregnancy since, every month, your body prepares for pregnancy. Due to the rise and fall of hormonal changes, the growth of an egg and the thickening of uterine lining (endometrium) are occurred. The thicken endometrium is necessary for embryo’s implantation because provides nutrients and the appropriate environment for its development. The usual length of time between the first day of one period and the first day of the next is an average of 28 days, thus around the 9th until 14th day ovulation occurs. It’s important to mention that every woman may experience different ways of menstruation based on cycle regularity, Frequency of menstruation, duration and volume of menstrual flow. The most frequent causes for the irregularity of menstrual cycles are:
- Polycystic ovary syndrome (PCOS), occurs when women with excessive androgens (male sex hormones) are released by the ovaries.
- Eating disorders, extreme weight loss or excessive exercising
- Prolactinomas (adenomas of the hypophysis)
- Uterine fibroids can cause heavy menstrual periods and prolonged menstrual periods
- Pelvic inflammatory disease (PID) can cause irregular menstrual bleeding.
- Premature ovarian failure. Causes the loss of normal ovarian function before age of 40.
The irregularity and abnormality of menstruation causes barriers to conception and fertilization as a result the rising of infertility. Detect and evaluate your menstrual cycle can help you find out what’s normal for you and what isn’t. Start by keeping a record with notes of your menstrual cycle on a calendar. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods.