FEMALE INFERTILITY
refers Infertility in female humans. It affects an estimated 48 million women with the highest prevalence of infertility affecting people in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia.
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Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the NIGERIA. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery. Infertility results from female factors about one-third of the time and malefactors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
CAUSES OF INFERTILITY
Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.
Acquired[
According to the American Society for Reproductive Medicine (ASRM), Age, Smoking, Sexually Transmitted Infections, and Being Overweight or Underweight can all affect fertility.
In broad sense, acquired factors practically include any factor that is not based on a genetic mutation, including any intrauterine exposure to toxins during fetal development, which may present as infertility many years later as an adult.
Age
A woman's fertility is affected by her age. A woman's fertility peaks in the early and mid 20s, after which it starts to decline, with this decline being accelerated after age 35. The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of a woman and the fertility of the male partner.
Tobacco smoking
Tobacco Including shisha is harmful to the ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates the growth of follicle and ovulation.
Sexually transmitted infections
Sexually transmitted infections are a leading cause of infertility. They often display few, if any visible symptoms, with the risk of failing to seek proper treatment in time to prevent decreased fertility.

Overweight or underweight
Twelve percent of all infertility cases are a result of a woman either being underweight or overweight. Fat cells produce estrogen, in addition to the primary sex organs.
Too much body fat causes the production of too much estrogen and the body begins to react as if it is on birth control, limiting the odds of getting pregnant.
Too little body fat causes insufficient production of estrogen and disruption of the menstrual cycle. Both under and overweight women have irregular cycles in which ovulation does not occur or is inadequate.
Proper nutrition in early life is also a major factor for later fertility.

Other acquired factors
• Adhesions secondary to surgery in the peritoneal cavity is the leading cause of acquired infertility.
• Diabetes mellitus. a review of type 1 diabetes came to the result that, despite modern treatment, women with diabetes are at increased risk of female infertility
• cannabis smoking, such as of marijuana causes disturbances in the endocannabinoid system, potentially causing infertility
• Radiation, such as in radiation therapy. After total body irradiation, recovery of gonadal function occurs in 10−14% of cases.
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COMMON SIGN OF INFERTILITY

1.Irregular period
An Average woman’s cycle is 28 days long. But anything within a few days of that can be considered normal, as long as those cycles are consistent. For example, a woman who has a 33-day cycle one month, a 31-day cycle the next, and a 35-day cycle after that, is probably having “normal” periods.
But a woman whose cycles vary so greatly that she can’t even begin to estimate when her period might arrive is experiencing irregular periods. This can be related to hormone issues, or to polycystic ovarian syndrome (PCOS). Both of these can contribute to infertility.
2. Painful or heavy periods
Most women experience cramps with their periods. But painful periods that interfere with your daily life may be a symptom of endometriosis.
3. No periods
It’s not uncommon for women to have an off month here and there. Factors like stress or heavy workouts can cause your period to temporarily disappear. But if you haven’t had a period in months, it’s time to get your fertility checked.
4. Symptoms of hormone fluctuations
Signs of hormone fluctuations in women could indicate potential issues with fertility. Talk to your doctor if you experience the following:
• skin issues
• reduced sex drive
• facial hair growth
• thinning hair
• weight gain
5. Pain during sex
Some women have experienced painful sex their entire lives, so they’ve convinced themselves its normal. But it’s not. It could be related to hormone issues, to endometriosis, or to other underlying conditions that could also be contributing to infertility.

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Endometriosis
Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.
Symptoms
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that's far worse than usual. They also tend to report that the pain increases over time.
Common signs and symptoms of endometriosis may include:
• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
• Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
• Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
When to see a doctor
See your doctor if you have signs and symptoms that may indicate endometriosis.
Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Causes
Although the exact cause of endometriosis is not certain, possible explanations include:
• Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
• Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote a transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
• Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
• Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
• Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
• Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.
Risk factors
Several factors place you at greater risk of developing endometriosis, such as:
• Never giving birth
• Starting your period at an early age
• Going through menopause at an older age
• Short menstrual cycles — for instance, less than 27 days
• Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
• Low body mass index
• Alcohol consumption
• One or more relatives (mother, aunt or sister) with endometriosis
• Any medical condition that prevents the normal passage of menstrual flow out of the body
• Uterine abnormalities
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause unless you're taking estrogen.
Complications

Fertilization and implantation
Infertility
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis has difficulty getting pregnant.
For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.
Ovarian cancer
Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low, to begin with. Some studies suggest that endometriosis increases that risk, but it's still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

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