What are the signs of infertility in females?

We are talking about infertility when the couple is trying to conceive for more than one year. Trying to concieve means that they have regular intercourses without any contraception.
How many women have fertility problems?
Actually the frequency of this depends on the country, social position of the couple, probably traditions and so on. Modern lifestyles delay child bearing to advanced age, obesity pandemic, some ecological problems lead to increasing couples with the problem. In western countries, the frequency of infertility is about 20% and it is well known that fertility depends on female age mainly and delaying of pregnancy to the age after 35 or 40 years old faces us to growing amount of gynecological problems, somatic disorders and genetic reasons of both conceptions failures and also pregnancy loss. We hope that our patients will be younger but we see that patients become older and older. We are trying to find out any possible methods to help them.

Unfortunately we are not very efficient as a species. The odds of a 20 year old lady or the odds of any lady who’s trying for a baby when they are young – in the late 20s or 20s and early 30s up to 35, the odds of conceiving every month is approximately one in four so approximately 25 % of the times when ladies try to aim at having intercourse at the right time, when they are in their 20s or early 30s that will end up in conception. Unfortunately that starts getting lower and lower after a specific time. There’s a very old study that tried to give us an idea what are the chances after trying for one year, although, statistically speaking we try to think about these months as mutually exclusive by that I mean, we try to always think that the probability of getting pregnant the first month is going to be 25 percent, the second month being 25 but unfortunately in the human body there’s nothing called mutually exclusive. There might be a reason behind all of these months while ladies are not getting pregnant and the odds will drop to approximately 5 % every month after trying for one year and at that point in time it warrants a visit to a doctor. The doctor will start by doing basic investigations, like checking the ovarian reserve, checking the uterus, checking the tubes and checking a semen for a semen analysis if a lady have been trying with a heterosexual partner for quite some time.

I think again there would be things to be aware of particularly in terms of perhaps previous medical history. So, I think erratic periods are always very high up on that list and that may be associated with other things, for example, high BMI, issues with the skin and hirsutism and things like that. So, issues that might point towards Polycystic Ovarian Syndrome which is incredibly common and again, that’s a group of ladies where you need to make that diagnosis because often those ladies need significant intervention to help them conceive – they may not be completely anovulatory but they may only ovulate literally a few times a year. Those kinds of features again in primary care, be aware of those, that’s the kind of thing the GP should be picking up just during the conversation with that lady and flagging those things. Again the weight side, the BMI side, hugely important because in all areas within the UK, if your BMI is over 30, although you can be investigated for infertility, you cannot be treated on the NHS. So, it’s a really good thing for the GP to pick up, it’s important in terms of general health as well, risk of diabetes, etc., but flag up to the lady and the couple perhaps that it may be a significant factor and again use that as a trigger to start doing the basic investigations in terms of underlying reasons. I think the other factors might well be that ladies might be aware if they’ve had a previous history of, for example, abdominal surgery, perhaps they had a perforated appendix in their teens and that may have led to intra-abdominal adhesions which might block the tube. Commonly, pelvic infection and unfortunately sometimes in ladies that can be relatively asymptomatic and it may well be that a lady’s been aware that there was some infection, she perhaps had some antibiotics a few years ago but no obvious consequences at the time but in fact what’s happened there is she’s ended up with infection within the pelvis and that’s caused some degree of tubular occlusion so, those kind of things. It’s important that if people are thinking about conception, that they’re aware, that there are things that may have happened to them in the past that are highly relevant to the chance of them getting pregnant and on the man’s side again, as I alluded to previously infection, perhaps testicular trauma (sport related ) or rarely these days but sometimes occupational issues, certainly historically have been a factor in terms of heat and solvent exposure and things like that.
There are a lot of things and there may be things, not that it doesn’t form a large part of it, but there may be some genetic factors that might come in, but again in terms of physical appearance, it may well be that the primary care physician is aware of an underlying genetic problem (that’s already been diagnosed) or they may look at somebody and wonder about genetic abnormality which might mean that there’s an impairment of fertility on either side of the equation really. So, I think, for many people, there aren’t particular features. Majority of people we see probably aren’t in any of these particular areas but I think, where there are deviations from the overall norm in terms of all these different parameters, then be aware they may give a clue as to the underlying reason really.

I would say that basic signs are disorders in the cycles. Woman who has a normal cycle, let’s say when she was 21 years old, has a cycle of 28 days, lasting 5-6 days without any serious problems. In the last 6 months, the cycles are beginning to be much shorter like 22-25 days or the opposite much longer so 30-35 days – this is something that should make us suspect that something is going wrong.
Usually when we have a very short cycle, it might be linked to low ovarian reserve – quickly diminishing ovarian reserve. On the other hand when we have a very long cycle it is more linked to PCO syndrome. These are the main signs as far as the frequency and the sequence are concerned.
If a woman in her reproductive years feels that her menstruation becomes more painful, creating many problems then in those cases she should also be suspect of endometriosis and other diseases that are regarding the function of ovaries, the tubes and the uterus.
Summarize: one I would say is frequency and duration of the cycle, two pain during the cycle; these are the basic signs that one woman should be aware that there are changes in her body.

I think that it goes back to what the causes are and I think that there will be signs of some of the causes. If you look at a woman with polycystic ovaries, for example, if you’ve got particularly long irregular cycles – that will suggest that you probably aren’t ovulating and you should probably get that investigated and confirmed, so what you need to do when the time comes that you want to get pregnant. If you’ve got a consistent history of painful periods, painful intercourse – could that integrate something like endometriosis that could impact on things. Now treating endometriosis doesn’t always necessarily improve fertility. It clearly will improve the symptoms, so again, that should be a trigger to perhaps get that looked at. If your cycles are shortening and classically one of the first things that happens in women as their regular reserve goes down is, that cycles begin to get closer together before you start missing cycles and before you start perhaps going into the menopause, so if your cycles are getting shorter together and closer together – that may be something, that may trigger an investigation into egg reserve. Those are the classic things that are worth looking at.