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The Woman

What does the female reproductive system do?

The female reproductive system plays an important rolethroughout in a woman’s life.The system includes fallopian tubes, uterus, ovaries, cervix, external genitalia and breasts. Each organ has a specific function and role. These organs are involved in producing hormones and female egg cells (ova) necessary for reproduction. They also facilitate fertilization of eggs by the sperm and support development of the embryo during pregnancy. Other structures such as breasts give the mother the ability to feed and nourish a baby after birth

The organs in the female reproductive system are found inside and outside the body.

The organs found inside the body include:

a. Ovaries

The ovaries are oval shaped and about the size of large grape. They are located close to the pelvic wall on each side of the uterus. It is a pair of ova-producing organs (they produce egg cells) and therefore, producing the important female hormones. Ovaries are the primary reproductive organs.

They produce and release two groups of sex hormones – estrogen and progesterone. These hormones are necessary to prepare the uterus for the implantation of the embryo. In case no pregnancy happens, the body will get rid of the prepared lining through the menstrual bleeding and the next cycle will start again.

b. Fallopian Tube

The fallopian tubes are narrow tubes leading from the uterus to the ovaries. They transport the sperm close to the ovary to allow fertilization of a released egg. After fertilization the tubes allow passage of the fertilized egg back to the uterus for the implantation.

Each fallopian tube is about 10 cm in length and 1 cm in diameter. In the distal portion the fallopian tube gets wider, this part is called the fimbria. The task of the fimbria is to collect the egg which is released by the ovary during ovulation.

c. Uterus (womb)

The uterus is a dynamic part of the female reproductive organ that is responsible for reproductive functions such as menses, implantation of the embryo, pregnancy and delivery. The uterus is a hollow, muscular pear-shaped organ placed in the female pelvis between the urinary bladder anteriorly and rectum posteriorly.

It is connected to the two fallopian tubes on its right and left side and to the vagina via the cervixon its inferor end. The average size isaround 8 cm long, 5 cm across and 4 cm thick with an average volume of between 80 until 120 ml. The uterus is also known as the womb, as it surrounds and supports the developing fetus in pregnancy.

d. Vagina

The vagina is a canal that connects the uterus to the outside of the body. It is ananelastic, muscular passage with a soft, flexible lining that provides lubrication and sensation when receiving the penis during sexual intercourse. The vagina also serves as the passageway for menstrual flow from the uterus and for the baby during birth (birth canal).

The organs found outside the body includes:

The external structure of the female reproductive systems includes some part of the vagina and the breasts. The labia, the clitoris and a number of glands are found externally. Togetherthese organs are known as the vulva.

Understanding Menstrual Cycle

Menstrual flow may occur every 26-35 days. That’s counting from the first day of theperiod to the day before the next. A menstrual cycle starts when red, normal flow menses is present (brown discharge does not count as menses). Although the average cycle is 28 days, it is also normal to have a cycle which is shorter or longer. As a woman gets older or reaching late 30’s to early 40’s, she may find that her cycle becomes shorter. Also the use of certain types of contraception such as birth control pills, hormone injections or intrauterine device can change the cycle.

The Menstrual Cycle

The Period
The first day of the cycle is the first day of the period (Day 1). The period might be regular or irregular, maybe light or heavy, painful or pain-free, long or short and still be considered as normal.

How does do the hormones work?
The menstrual cycle is under the control of a variety of hormones produced in different parts of the body:

  • Gonadotrophin-releasing hormone (GnRH): is produced in the hypothalamus, which is in the brain. It stimulates thepituitary gland to make and release follicle stimulating hormone (FSH) and luteinizing hormone (LH).GnRH is not secreted constantly in the same amount, there are fluctuations depending on the phase of the cycle.
  • Follicle stimulating hormone (FSH): is released by a part of the brain calledpituitary gland. FSH is carried by the bloodstream to the ovaries where it stimulates the ova to start growing.
  • Luteinising hormone hormone (LH): is also produced in the pituitary gland and is transported by the bloodstream to the ovaries. It stimulates the ovaries to release eggs (ovulation) and encourages the formation of a special group of cells called the corpus luteum (a yellow body, remainder of the follicle after ovulation which is left in the ovary).
  • Estrogen is produced by the growing ova. It has many roles in the body, including the changes in the body during puberty that takes a female from girl to womanhood. During the normal menstrual cycle due to the estrogens the lining (which is the inner layer of the uterus) will build up to prepare for a pregnancy that might happen in that cycle.
  • Progesterone: is mainly release by the corpus luteum. It works with estrogen to prepare the lining of your uterus for the implantation of fertlized egg.It also helps the breasts to produce milk.
  • Prolactin: which is also released in the pituitarygland helps in production of breast milk. During pregnany the level of prolactin increases by 10-20 times and stays high after the baby is born if the woman is breastfeeding. For non-breastfeeding women, the hormone will return to the normal level as soon as the woman give birth.
  • Human Chronic Gonadotrphin is produced during pregnancy. It helps in maintaining pregnancy and the development of the baby. The amount of this hormone increases early in pregnancy which can give information about the status on growth and development of the embryo.

FSH is produced by the pituitary gland in the beginning of each cycle. This simulates the ovaries to produce eggs. The ovaries have small fluid-filled cysts called follicles. Each follicles has an immature egg. The FSH causes many such follicles in the ovary to grow and mature.

At the same time specialised cells in the follicles begin to grow and produce the hormone estrogen. Estrogen levels are highest near ovulation (when egg is released from ovary for fertilisation) and lowest on the first day of the period.

Now, as these follicles develop and mature, one of them becomes “dominant”, and the egg growing inside it becomes mature. At this time, the estrogen level in the blood stream peaks, resulting in the thickening of the lining of the womb, so that it is able to support a pregnancy, if fertilisation happens.

Understanding Ovulation As the estrogen level in the body rises, there is a sudden and rapid increase in level of luteinising hormone – this is called “LH surge”. This causes the dominant follicle to rupture and release the mature egg. This mature egg then enters the fallopian tube and then travels towards the womb for fertilization. The egg can live upto 8 hours before being fertilised.

Meanwhile in the ovary, the empty follicle starts to collapse and forms the corpus luteum which produces progesterone. Progesterone acts on further thickening of the lining in the womb and increasing blood supply in preparation to receive the fertilized egg.

Preparing for the next period

If fertilization or embryo implantation does not take place, the estrogen and progesterone level will decrease and will result in breaking the lining of the uterus and stimulating the uterus to contract. At this point, the lining of the uterus begins to shed causing menstrual bleeding. This event marks the start of the next period and menstrual cycle.

What happens if fertilization takes place?

If the egg is fertilised in the fallopian tube, it will implant itself into the lining of the uterus. The journey from ovary to implanting into the uterus takes place about 5 days after the fertilisation.

Human chorionic Gonadotrophin (hCG) is the pregnancy hormone which will be produced as soon as implantation occurs. Other hormones – progerterone and estrogen levels remain high to prevent the lining of the womb from shedding. Their levels remain high until the placenta (the organ that supplies and contains all nutrients needed for the embryo to grow) is mature enough to support and maintain the pregnancy.

Factors Affecting the Menstrual Cycle

  • Gonadotrophin-releasing hormone (GnRH): is produced in the hypothalamus, which is in the brain. It stimulates thepituitary gland to make and release follicle stimulating hormone (FSH) and luteinizing hormone (LH).GnRH is not secreted constantly in the same amount, there are fluctuations depending on the phase of the cycle.
  • Follicle stimulating hormone (FSH): is released by a part of the brain calledpituitary gland. FSH is carried by the bloodstream to the ovaries where it stimulates the eggs to start growing
  • Luteinising hormone hormone (LH): is also produced in the pituitary gland and is transported by the bloodstream to the ovaries. It stimulates the ovaries to release eggs (ovulation) and encourages the formation of a special group of cells called the corpus luteum (a yellow body, remainder of the follicle after ovulation which is left in the ovary)
  • Estrogen: is produced by the growing eggs. It has many roles in the body, including the changes in the body during puberty that takes a female from girl to womanhood. During the normal menstrual cycle due to the estrogens the lining (which is the inner layer of the uterus) will build up to prepare for a pregnancy that might happen in that cycle.
  • Progesterone: is mainly release by the corpus luteum. It works with estrogen to prepare the lining of your uterus for the implantation of fertlized egg.It also helps the breasts to produce milk.
  • Prolactin: which is also released by the pituitarygland helps in the production of breast milk. During pregnancy the level of prolactin increases by 10-20 times and stays high after the baby is born if the woman is breastfeeding. For non-breastfeeding women, the hormone will return to the normal level as soon as the woman give birth.
  • Human Chronic Gonadotrophin is produced during pregnancy. It helps in maintaining pregnancy and the development of the baby. The amount of this hormone increases early in pregnancy which can give information about the status on growth and development of the embryo
  • Emotional Stress: e.g. Fear of pregnancy/phantom pregnancy, stressful work condition
  • Combined Oral Contraceptive Pill (COCP): This causes artificial period.
  • Breast-Feeding: can also delay the return of normal menstrual period due to elevlated levels of prolactin.
  • Rapid weight change: Increased or decreased body mass index (BMI).
  • Body weight below certain level: e.g. Eating disorder – anorexia nervosa
  • Body weight above certain level: Overweight or obesity can cause hormonal disturbances that lead to an irregular cycle.
  • Significant illness
  • Smoking, alcohol and coffeine abuse
  • Age
  • Hormonal inbalace (PCOS, reduces ovarain reseve, thyroid problems)
Female Infertility

Infertility

Infertility means difficulty of conceiving (becoming pregnant) even with regular intercourse when not using contraception. If a woman keeps on having miscarriage, it is also called infertility.

Female infertility can be caused by:

Physical Problems

  • Abnormal structure of the uterus
  • Previous surgery to ovaries, uterus, cervix and fallopian tube(s)
  • Previous infection that may cause scarring and damage in the fallopian tube and uterus. E.g. Pelvic inflammatory disease (PID), sexual transmitted diseases(STD)
  • Being underweight and overweight which may result to hormone imbalance and ovulation problem.
  • Long term (chronic) illness. E.g. Diabetes, cancer and kidney failure and the therefore existing changes in hormones may lead to anovulation (no ovulation occurs)
  • Endometrioses. This is a disease where cells of the lining implant outside the uterus next to the ovaries and fallopian tubes and will induce scarring and adhesions.
  • Gentic abnormalities
  • Reduced ovarain reseve

Hormonal Problems

  • Some women have problems with producing eggs or no ovulation occurs. For some, this is a permanent problem, however for some women it only happens from time to time.
  • Early menopause.

Lifestyle and environmental factors.

  • Excessive exercise can affect your hormone balance which can affect your ovulation.
  • Extreme stress. This can affect the libido or how often a couple has intercourse
  • Side effects of long term useof some medicines
  • Smoking and excess alcohol use

Idiopathic or unknown cause of infertility

  • The cause of infertility is unidentified, even after performing several infertility work up like checking the patency of fallopian tube, assesing if ovulation occurs, assessing hormone levels and evaluating the husband’s semen.
Assessing fertility Status

How do you know if you are fertile?

  • Track your menstual cycle: If the cycle is regular without using any pill to induce menstruation, the ovulation time frame should generally be the same each month. Normally ovualation takes place around 14 days before the period starts. In a 28 day cycle ovulation will take place around day 14, in a 30 day cycle ovulation is around day 14. This is a good way to know when there is the fertile time of your cycle.
  • Observe cervical mucus: Mucus can determine the most fertile days. If there is an increase in the amount of mucus, also it looks like egg white and is spinnable then it is the right time to have intercourse.

Test and Screening

Our experts may recommend infertility tests. This involves:

  • Physical exams and extensive review of medical and sexual history of the couple
  • Ovulation test for wife (mid luteal progesterone and LH kit)
  • Assessment of ovarian reserve by blood test and ultrasound
  • Assessment of uterus contour and tubal patency (hysterosalphingography)
  • Hysteroscopy to check the inside of cervix and womb with a specialised camera.
  • Laparoscopy to check in the abdomen to screen the ovaries, tubes and uterus. This invasive procedure should only be done in selected cases.

When it is possible to find the cause of infertility, treatments may include medicines, surgery, or assisted reproductive technologies.

Overcoming Infertility

Fertility is an ever increasing issue in the world today. It is a huge psychological stressor for a couple. For some, pregnancy is a miracle that just doesn’t happen. In the Middle East region, a lot of the couples are struggling with fertility issues and there are many reason behind it. This can be hereditary factors, environmental factors, lifestyle factors and exposure to chemicals and pollution and Vit D deficeincy.

Infertility can occur because of health changes from either man or woman and sometimes it is a combination of issues involving both of them. However many couples have been succesful at overcoming infertility naturally by changing their lifestyle.

Otherwise, if pregnancy doesn’t happen naturally, couples can overcome infertility with individual treatment like fertility-drugs, intrauterine insemination (IUI) and In-Vitro Fertilization (IVF).

Speak with IVI Middle East Fertility doctos, or get a Second Opinion

Our consultants are expert in regards to fertility problems. By filling up the below form, we will contact you within 48 hours to initiate determining the treatment approach that is right for you.

It can be very hard to figure out what you want or whether your treatment plan is suitable for you, IVIGCC Fertility can help you at variousopinions in making your decision.

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