What is the major cause of female infertility?

An investigational drug that helps insulin function more efficiently also appears to assist in treating infertility in women with polycystic ovary syndrome (PCOS). PCOS is the most common cause of female infertility. The drug, D-chiro-inositol occurs naturally in fruits and vegetables and appears to have no side effects in the small number of women with PCOS who took part in the trial.

PCOS affects 5-10% of American women of reproductive age. The ovaries of women with PCOS appear to be filled with numerous small cysts. The cyst-like appearance results from accumulation of immature ovarian follicles, the bubble-like structures that, upon maturation, rupture and give rise to the egg cell.

PCOS may cause those women who fail to ovulate or menstruate to have abnormally high insulin levels, obesity, high blood pressure, hardening of the arteries, or high triglyceride levels. PCOS patients have high levels of testosterone, which may cause them to grow excess facial hair or body hair.

Current findings of the study suggest that PCOS results from failure to use insulin properly. Dr. John E. Nestler, Chairman of Endocrinology at University of Virginia Medical College in Virginia, believes this failure causes insulin to rise. The high testosterone levels will halt egg maturation and interfere with menstrual cycles.

Researchers followed 44 obese women with PCOS; half received D-chiro-inositiol and half received a placebo. Of the 22 women who received the drug, 86% ovulated, compared with only 27% in the placebo group. Women receiving the drug also saw improvements in their insulin levels, blood sugar, blood pressure, testosterone, and triglyceride levels.

For pregnancy to occur, several things must happen: an egg must develop and ovulate properly each month, and a sperm must fertilize the ovulated egg. The resulting embryo must be transported to the uterus and implanted.

If any of these events does not occur or is disrupted, infertility will result. Some women are unable to produce eggs. Others produce eggs, but do not ovulate. In others, conception cannot occur due to blockage of the fallopian tubes, scarring of the uterus, or the inability to produce cervical mucous of sufficient quantity or quality. These problems account for just over half of all infertility.

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How is female infertility treated?
Many treatments are available, depending on the cause of the infertility, and it is always important to investigate both partners. Fertility drugs such as clomiphene citrate or recombinant human FSH (follicle stimulating hormone) may bring about ovulation in women. Insemination directly into the uterus can manage infertility related to problems in the cervical mucous. Blocked fallopian tubes can sometimes be surgically repaired. In-vitro fertilization, with a surrogate mother and related assisted reproductive technologies are the most dramatic treatments for female infertility. Although these techniques may be time-consuming and costly, they offer hope to many women who previously were unable to conceive.