Focus on women
- Average of 28 days
- Divided into two phases:
- Follicular phase: the egg cell matures
- Luteal phase: the uterus prepares for implantation of the egg
- Ovulation = transition point between these phases
- Hormonal control of the menstrual cycle
- Control centre: hypothalamus in the brain
- Release of the GnRH hormone serves as a signal for the pituitary gland
- The pituitary gland reacts by releasing FSH and LH
- Follicle rupture releases the mature egg cell (oocyte)
- A corpus luteum forms from the remains of the follicle
- The corpus luteum releases progesterone → Preparation of the uterine lining for implantation
- Point in the cycle: between the 14th and 16th day
- Fertile phase during the cycle: days 9 to 16
- Egg enters the fallopian tube
- Window for fertilisation: approx. 12-24 hours as it makes its way to the uterus
- In the absence of fertilisation, the egg cell dies, the corpus luteum regresses and the uterine lining is expelled.
- Menstrual bleeding starts → the new cycle begins.
Possible causes of female infertility
Unfortunately, it is not always possible to clearly determine the cause of infertility. In 15 to 30% of couples, the cause remains unknown.
- Hormonal imbalances (PCOS, thyroid diseases, diabetes, hyperprolactinemia)
- Fallopian tube disorders: inflammation, growths (endometriosis), adhesions (after surgery)
- Uterine changes due to inflammation/infection (sexually transmitted diseases), adhesions (after surgery) and growths (polyps, cysts, myoma, endometriosis)
- Congenital malformations of the genital organs
- Immunological dysfunctions
- Severe psychological/physical strain
- Alcohol
- Smoking
- Drugs
- Medication
- Being over/underweight
- Eating disorders and diets
The number of eggs that will later be available in the ovaries is determined before birth. Both the reserves of functioning egg cells and their quality decrease with age. This effect is particularly noticeable above the age of 35. However, modern life planning, often referred to as late fertility, increases the likelihood of a fertility disorder
Investigations for women
Questions about
- previous/current illnesses
- cycle disorders
- previous pregnancies
- surgical procedures
- lifestyle (alcohol, smoking, exercise, frequency of sexual intercourse)
- Hormone testing in the first and second half of the cycle (oestradiol, LH, FSH, progesterone) → Is the cycle regular and are follicles maturing?
- Ultrasound: recording follicle development and verifying ovulation
- Examination of the fallopian tubes and the uterus
- Examination to determine whether sperm can pass through the cervical mucus
- Timing of test: at ovulation, after sexual intercourse
- Sperm motility and quality of cervical mucus are recorded
- Uteroscopy (hysteroscopy)
- Abdominaloscopy (laparoscopy)
