Some of the common causes of infertility in women, other than endocrine factors, are the following:
Tubal disease affects approximately 25 per cent of infertile couples, and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is commonly surgery and, owing to improvement in microsurgery and laser technology, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30 per cent with certain procedures having success rates up to 65 per cent. The development in IVF has now made it a suitable alternative to tubal surgery.
The main causes of tubal damage include:
Previous surgical operations are also causes of tubal disease and damage. Pelvic or abdominal surgery, such as appendectomy for someone with appendicitis can result in adhesions that alter the tubes in such a way that those eggs cannot travel through them.
Approximately 10 per cent of infertile couples are affected by endometriosis. Endometriosis affects five million women in the US and six or seven per cent of all females. It has been linked to late marriage due to prior occupation with the busy schedule of work by these women, who delay having children till the late mid 30s or early 40s. In fact, 30-40 per cent of patients with endometriosis are infertile. This is two to three times the rate of infertility in the general population. For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36 per cent.
The long term cumulative pregnancy rates are normal in patients with minimal endometriosis and normal anatomy. Current studies demonstrate that pregnancy rates are not improved by treating minimal endometriosis.
Environmental and occupational factors