Female Factors of Infertility in a Couple


Iryna Ventskivs’ka
Oleksandra Zahorodnia


The problem of infertility is relevant to the whole world, that is explaned both by the prevalence (at least 50 million couples on the planet are diagnosed) and by the enormous medical, ecoomic, social and psychological significance. Another important aspect of infertility is the heterogeneity of its causes – about 40% of infertile marriages are caused by the female factor, 35% – male, 20% – a combination of male and female factors and 5% – have no identified factor.

In 2019, the American Collegue of Obstetricians and Gynecologists updated the guidelines for the timing and scope of examinations of infertile couples. In particular, if a woman is 35–40 years old, examination and elimination of the probable factor of infertility should be started after 6 months of non-pregnancy, and in the case of age older than 40 years – immediately after the couple’s accost. The expected tactics should not be used if the patient has oligo- or amenorrhea, known uterine and fallopian tube abnormalities, grade III or IV severity of endometriosis, and the couple has known male infertility factors.

Ovulation disorders as a factor of infertility include hypothalamic syndrome, polycystic ovary syndrome, premature ovarian failure and hyperprolactinemia, which differ in the content of gonadotropic hormones and ovarian hormones. The adhesion process of the pelvic organs, which restricts the transport of sperm and fertilized egg through the fallopian tubes, is a consequence of endometriosis and inflammatory diseases caused mainly by sexually transmitted pathogens. Endometriosis, in addition to the formation of adhesions in the pelvic cavity, which is characteristic of stage III and IV of the disease, is also a factor in infertility due to elevated concentrations of prostaglandins and proinflammatory cytokines, failed endometrial reciprocity. Among the uterus abnormalities in the violation of fertility are the uterine membrane, leiomyoma with submucosal localization of the node and uterine synechiae.

As part of a comprehensive examination of patients with infertility, it is necessary to take into account the study of thyroid function.


Distance learning
Author Biographies

Iryna Ventskivs’ka, Bogomolets National Medical University

Iryna B. Ventskivs’ka,

Head of Department of Obstetrics and Gynecology No 1


Oleksandra Zahorodnia, Bogomolets National Medical University

Oleksandra S. Zahorodnia,

Department of Obstetrics and Gynecology No 1


Inhorn M, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum. Reprod. Update. 2015;21(4):411–26.

Elhussein OG, Ahmed MA, Suliman SO et al. Epidemiology of infertility and char-acteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan. Fertil Res and Pract. 2019;5:345-9. Available from: https://doi.org/10.1186/s40738-019-0060-1

Wasilewski T, Łukaszewicz-Zając M, Wasilewska J, Mroczko F. Biochemistry of infertility. Clinica Chimica Acta. 2020;508:185-90. Available from: https://doi.org/10.1016/j.cca.2020.05.039

Hladchuk IZ, Doshchechkin VV. Subfertylnost: fylosofyia y metodolohycheskye problemy. Chast I. Reproduktyvna endokrynolohiia. 2018;3(41):25–31.

Infertility Workup for the Women’s Health Specialist, Obstetrics & Gynecology: 2019;133(6):e377-e384 DOI: 10.1097/AOG.0000000000003271

Matthew H, Walker K, Tobler J. Female Infertility. StatPearls Publishing. 2020:566.

Ackerman K, Patel KT, Guereca G, Pierce L, Herzog DB, Misra M. Cortisol secretory parameters in young exercisers in relation to LH secretion and bone parameters. Clin Endocrinol (Oxf). 2013;78(1):114–9.

Li Y, Chen C, Ma J. et al. Multi-system reproductive metabolic disorder: significance for the pathogenesis and therapy of polycystic ovary syndrome (PCOS). Life Sci. 2019;228:167–75. 10.1016/j.lfs.2019.04.046

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7.

Fauser BC, Van Heusden AM. Manipulation of human ovarian function: physiological concepts and clinical consequences. Endocr Rev. 1997;18(1):71–106.

Zahorodnia OS, Ventskivska IB, Kazak AV. Premature ovarian insufficiency – to treat or not to treat? Reproductive Endocrinology. 2019;50:12–6.

Ventskivska IB, Zagorodnya OS, Narytnik TT. Early termination of menstrual function: Modern views on pathogenesis and consequences. Reproductive Endocrinology. 2019;48:8–12.

Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535–49.

Ravel A. Defective endometrial receptivity. Fertility and sterility.2012;97(5):1028–32.

Brunham R, Gottlieb S, Paavonen J. Pelvic inflammatory disease N Engl J Med. 2015;372:2039–48.

Van Voorhis B, Mejia R, Schlaff W, Hurst B. Is removal of hydrosal pinges prior to in vitro fertilization the standard of care? Fertil Steril. 2019;111(4):652–56.

Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv. 2001;56(8):483–91.

Carranza-Mamane B, Havelock J, Hemmings R. The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can. 2015;37(3):277–85. DOI: 10.1016/S1701-2163(15)30318-2

Chan Y, Jayaprakasan K, Zamora J. et al.The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761–71. DOI: 10.1093/humupd/dmr028

Grimbizis G, Camus M, Tarlatzis B. et al. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161–74. DOI: 10.1093/humupd/7.2.161

Chan Y, Jayaprakasan K, Tan A et al. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol.2011;38:371–82.

Myers E, Hurst B. Comprehensive management of severe Asherman syndrome and amenorrhea. Fertil Steril.2012;97:160–64.

Check J, Cohen R. Live fetus following embryo transfer in a woman with diminished egg reserve whose maximal endometrial thickness was less than 4 mm. Clin Exp Obstet Gynecol. 2011;38:330–32.

Casper R. It’s time to pay attention to the endometrium.Fertil Steril.2011.96:519–21.

Eldar-Geva T, Shoham M, Rosler A. et al. Subclinical hypothyroidism in infertile women: the importance of continuous monitoring and the role of the thyrotropin-releasing hormone stimulation test, Gynecol. Endocrinol. 2007;23:332–37. https://doi.org/10.1080/09513590701267651

Ludwig M, Banz C, Katalinic A. et al. The usefulness of a thyrotropin-releasing hormone stimulation test in subfertile female patients. Gynecol. Endocrinol.2007;23: 226–30. https://doi.org/10.1080/09513590701259658

Abalovich M, Gutierrez S, Alcaraz G. et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002:63-8. https://doi.org/10.1089/105072502753451986

Trummer H, Ramschak-Schwarzer S, Haas J. Value of intensive thyroid assessment in male infertility. Acta Med. Austriaca.2003;30:103–4.

Tersigni C, Castellani R, de Waure C. et al. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod. Update. 2014;20:582-93. https://doi.org/10.1093/humupd/dmu007

Di Simone N, De Spirito M, Di Nicuolo D. et al. Potential new mechanisms of placental damage in celiac disease: anti-transglutaminase antibodies impair human endometrial angiogenesis. Biol. Reprod. 2013;89:88. https://doi.org/10.1095/biolreprod.113.109637

Pellicano R, Astegiano M, Bruno M. et al. Women and celiac disease: association with unexplained infertility. Minerva Med. 2007;19:217–9.

Revel A, Achache H, Stevens J, Smith Y, Reich R. MicroRNAs are associated with human embryo implantation defects. Hum Reprod. 2011;26:2830–40.

Madhurima D, Vaijayanti K. Extracellular vesicles: Mediators of embryo-maternal crosstalk during pregnancy and a new weapon to fight against infertility. European Journal of Cell Biology. 2020;99(8):125–51. https://doi.org/10.1016/j.ejcb.2020.151125