Childlessness due to physical problems in women

1. Hormonal Imbalance
2. Obstructed Fallopian Tubes
3. Endometriosis
4. Genetic Diseases
5. Ovarian Insufficiency and Premature Ovarian Failure (POF)
6. Malignant diseases

1. Hormonal Imbalance

A woman’s menstrual cycle is controlled by many different hormones. Hormonal imbalance can result in a variety of disorders. The various underlying causes can be the reason for failure of oocyte maturation (oogenesis), follicle maturation or the absence of ovulation. If the level of the yellow-body (corpus luteum) hormone (progesterone) is insufficient, pregnancy cannot be achieved (corpus luteum insufficiency). Other decisive factors to take into account are e.g. hypothyroidism or hyperthyroidism, elevated prolactin levels, an excessive level of testosterone (polycystic ovary syndrome (PCOS)), extreme physical stress, other stress factors, severe underweight (anorexia, bulimia) or overweight as well as tumors (which is indeed very rare).

Example: Corpus luteum insufficiency
Corpus luteum insufficiency that can be observed in some women occurs when the yellow body that developed from the remnants of the follicle cannot produce enough progesterone in order to prepare the inner lining for a successful implantation of the embryo and maintenance of pregnancy. A drop in the progesterone level will prompt the shed of the inner lining and thus the onset of the menstruation period.

This hormonal disorder can be assessed by doing a hormone analysis in the second half of the menstrual cycle or the subsequent days. Too low hormone levels in the days after ovulation indicate such a corpus luteum insufficiency. In these cases a progesterone supplementation may be helpful. Progesterone can be administered orally, vaginally or by an intramuscular injection.

Moreover, it is possible that the corpus luteum doesn’t properly respond to the signals produced by the embryo. This disorder can’t be detected with the help of a hormone analysis. In this case, however, the yellow body can only be prevented from disintegrating by repeated intramuscular injections of HCG.

During follicular puncture performed by aspirating the follicles many of the granulosa cells (which normally develop into the yellow body) are removed, too. This is why an IVF /ICSI / IMSI treatment naturally results in a corpus luteum insufficiency. Here, however, administering progesterone can remedy the situation.

We would like to emphasize that progesterone administered only orally or by vaginal suppositories often provides progesterone levels that are insufficient and interfere with the development of the endometrium. If need be, this way of administering progesterone may be chosen after the 6th week of pregnancy, since at this time the placenta also produces progesterone adding to the dosage provided by suppositories or tablets.

Fertilization occurs in the fallopian tubes. Subsequently the fertilized ovum (zygote) now referred to as the embryo is transported through the fallopian tubes towards the uterus. Poorly functioning fallopian tubes can result from a variety of causes.

In the worst case, the fallopian tubes are completely blocked. This can occur as a result of previous surgery causing adhesions and tubal scar tissue, of genital infections (e.g. chlamydia) or as a result of a tubal pregnancy (ectopic pregnancy), tubal ligation (sterilization) or endometriosis.

About 15 % of all women are suffering from endometriosis. Endometriosis is a condition in which endometrial tissue, normally found in the inner lining of the uterus grows outside the uterine cavity.

The sites where endometriosis occurs are the urinary bladder, the intestines, the fallopian tubes, the ovaries or the abdomen. Women in the reproductive age diagnosed with endometriosis often suffer from intense pain in the course of each menstrual period.

Moreover, these endometriosis nodules may cause adhesions and result in malfunction of the fallopian tubes. Furthermore, they secrete substances which serve as chemical messengers and may have a negative effect on pregnancy. The development of endometriosis and the fact that it interferes with the chances of conceiving naturally have not been completely clarified.

Particularly when couples know that they are carriers of genetic disorders (e.g. down-syndrome, cystic fibrosis, thalassemia or a family history of cancer) or if they have already given birth to a child suffering from a genetically-caused disease (maybe by spontaneous mutation) or when they have suffered multiple miscarriages, or if there is a case of mental disability within the family or if the partners are blood relatives the preimplantation genetic diagnosis may help, in many cases, to prevent the passing from parents to offspring.

www.en.wikipedia.org/Premature_ovarian_failure
www.fertility-preservation.eu

Patients suffering from malignant diseases need individually adjusted therapeutic treatment, e.g. radical surgeries and/or chemotherapy, radiation etc. All these treatments may cause infertility in young women and men.

There are different methods to preserve fertility such as cryopreservation of sperm or testicular tissue for subsequent transplantation or oocyte cryopreservation.

Our biologists are internationally recognized experts in the field of freezing techniques.