Men and women of childbearing age who, after getting married, have normal male fertility and do not use contraception but still fail to conceive after two or more years are considered to have infertility. Those who have never conceived after marriage are diagnosed with primary infertility; those who have had a pregnancy but subsequently fail to conceive again without contraception are diagnosed with secondary infertility; those who remain unable to conceive despite various treatments are diagnosed with lifelong infertility; and those who have the potential to conceive but fail to do so naturally but can conceive after treatment are diagnosed with relative infertility. Cases where conception is impossible, such as congenital abnormalities like the absence of a uterus or vagina, are termed absolute infertility, also known as permanent infertility. The causes of infertility are numerous. Aside from male factors, female factors alone include abnormalities in the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries that affect conception. Malformations, defects, developmental disorders, diseases, or blockages in these organs can interfere with normal sexual activity, sperm passage, egg development, fertilization, and implantation, leading to infertility. Endocrine disorders and certain congenital conditions can also cause infertility.

bubble_chart Etiology

The causes of female infertility can be mainly divided into maternal factors, fetal factors, and blood type incompatibility between mother and child, among which maternal factors play a significant role. Maternal causes include reproductive organ diseases, endocrine disorders, and other pathological conditions.

1. Ovarian infertility: Manifested as menstrual cycle disorders without ovulation but accompanied by luteal phase defects. Ovarian factors are a relatively common cause of female infertility, accounting for approximately 40% of cases.
2. Tubal infertility: Clinically, a few cases are due to congenital tubal dysplasia or malformations, but most are caused by reproductive tract infections, especially long-term chronic inflammation with acute recurrent episodes, which injure and damage the tubal epithelium, leading to tubal blockage and pelvic adhesions. This accounts for over 30% of female infertility cases.
3. Uterine infertility:
   1. Congenital uterine malformations or underdevelopment can lead to late miscarriage. Uterine positional abnormalities, if corrected, may allow conception, though such cases are clinically rare.
   2. Cervical infertility: Infections of the cervical canal.
4. Estrogen deficiency: Also an important factor contributing to infertility.
5. Vaginal infertility: This condition is clinically uncommon, but severe vaginitis can shorten sperm survival time and affect conception.
6. Unexplained infertility and immune infertility

bubble_chart Diagnosis

Physical Examination

Pay attention to overall development, nutritional status, and the development of secondary sexual characteristics, including breast development, fat distribution, hair growth, pubic hair distribution, and any signs of masculinization. Check for milk regurgitation when squeezing the breasts and for thyroid enlargement. Note any body shape variations or abnormal skin pigmentation caused by endocrine disorders in organs such as the pituitary gland, adrenal glands, or thyroid.

Gynecological Examination

Includes the development of external genitalia, any deformities or inflammation; the thickness of the hymen, and whether the hymen and vaginal opening are narrow or unusually sensitive; vaginal depth and tightness, any vaginal atresia, and whether the mucosal color is normal. Also measure the pH of vaginal secretions; check for cervical stenosis, inflammation, or erosion, and if necessary, perform a smear test for pathogens or cultures for gonorrhea, mycoplasma, or chlamydia. Examine uterine development for any deformities, normal uterine position, or suspected fibroids; check for enlarged or hardened adnexa and tenderness; palpate for nodules or scar-like thickening in the rectouterine pouch and uterosacral ligaments, and note any pain when lifting the cervix forward. Measure uterine cavity depth and curvature direction, check for smooth uterine walls, the ratio of cervix to uterine body, and any deformities such as a septum or unicornuate uterus.

It should be noted that hospital examinations should not be conducted during menstruation, as the cervical opening is dilated and prone to infection. During a bimanual examination, menstrual blood and fragments of the endometrial lining may reflux into the fallopian tubes or even the pelvic cavity, leading to endometriosis. Bleeding also makes it inconvenient to collect leucorrhea for testing or cervical secretions for examination.

1. Sexual knowledge guidance.
2. Targeted treatment for disease causes, including surgery for certain reproductive organ deformities, treatment of genital inflammation and endometriosis. For those with anovulation, treatments such as clomiphene, chorionic gonadotropin, luteinizing hormone-releasing hormone, progesterone injections, and Chinese medicinals can be used.
3. Artificial insemination and test-tube babies.