Failure of Ovulation
Failure of ovulation represents 30% of infertility. In most cases anovulation is in related with Polycystic Ovarian Syndrome (PCO). This is best diagnosed by ultrasound scan, showing enlarged ovaries containing several small cysts. PCO is associated with elevated levels of Luteinizing Hormone and patients sometimes suffer from abnormal hair distribution and/or obesity. Clomiphene is a simple and effective therapy in 80% of cases.
Sometimes the origin of anovulation is the pituitary gland. Injections of Gonadotrophins or infusion of small pulses of a drug called LH-RH with an electric pump are both very effective treatments.
In rare cases, women do not ovulate because of premature menopause. Egg donation is the only effective treatment.
Blocked or Damaged Fallopian Tubes
Fallopian tubes can be damaged following pelvic inflammatory disease, endometriosis or after pelvic surgery. Laparoscopy will confirm the extent of the damage and whether tubal surgery or IVF is the best treatment option.
Hostile Cervical Mucus
A clear and abundant mucus is normally produced at the time of ovulation by the cervix, allowing sperm to penetrate the endometrial cavity. A post coital test will confirm normal sperm motility in cervical mucus.
Infertility related to hostile mucus can be overcome by Intra-uterine Insemination (IUI).
Endometriosis is defined as the presence of parts of endometrium outside of its normal location, ie the lining of the uterine cavity. Endometriosis is commonly noted on the ovaries, fallopian tubes or anywhere in the abdominal cavity. Endometriosis will bleed at the time of the period and small cysts filled with blood will be produced. Women experience painful periods. Sometimes a large endometrioma (a cyst containing old blood) can grow within the ovaries. Adhesions can occur as a consequence of endometriosis which is a major factor in infertility.
Fibroids are very common. They are defined as a fibrous growth within the uterine wall. They can cause infertility when they are very large and therefore distort the uterine cavity or when they develop inside the uterine cavity. In these cases they will need to be removed either by open surgery, laparoscopy or hysteroscopy.