These are the most common of the benign functional cysts (functional meaning in response to a normal menstrual cycle). Each time an egg is produced by the ovary a small cyst forms. The cyst is usually very small and ruptures when releasing the egg during ovulation. If the cysts don’t rupture they may continue to grow; however, as they rarely grow larger than 8 centimeters and normally shrink after ovulation, surgery is usually not required. If rupture occurs, pelvic pain may result and last 24-48 hours. The pain is due to a small amount of bleeding which is irritating to the abdominal cavity. Surgery may be indicated in cases when bleeding continues or is excessive.They can occur as a single tumor but often are multiple; their consistency ranges from hard and stoney to soft and rubbery.

Symptoms of Tumor or Cyst

Symptoms vary greatly. Some women are fortunate enough to be completely asymptomatic, but their fibroids are usually insignificant in size. Most women experience at least one of the following complaints or side effects:

• Pelvic Pain
• Increased menstrual cramps
• Increased menstrual flow
• Clots
• Irregular or painful periods
• Increased urinary frequency
• Constipation
• Bloating

The uterus is another important component in the female reproductive system. It is the site where the fertilized egg will implant and continue to grow for nine months. Abnormalities in the uterus can also be a common cause for infertility. Fibroids are benign tumors of the uterus, which can grow substantially in size leading to infertility. Endometriosis is different conditions, which affect the lining of the uterus. In these conditions scar tissue can form which can effect the implantation and thus be a cause for infertility.

Uterine fibroids are non-cancerous tumors that develop within or attach to the wall of the uterus, a female reproductive organ. Uterine fibroids are the most common pelvic tumor. The cause of uterine fibroid tumors is unknown. Oral contraceptives and pregnancy lower the risk of developing new fibroid tumors. Fibroids may be present in 15 – 20% of women in their reproductive years — the time after starting menstruation for the first time and before menopause. Fibroids may affect 30 – 40% of women over age 30. Fibroids range in size from very small (coin sized) to larger than a melon. A very large uterine fibroid can cause the uterus to expand to the size of a six or seven-month pregnancy. There can either be one dominant fibroid or a cluster of many small fibroids.
The growth of a fibroid seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, the fibroids will probably continue to grow, usually slowly. Fibroids are a common problem among many women, but you may hardly realize it since they often produce no symptoms.

Symptoms of Uterine fibroids
• Very heavy and prolonged menstrual periods
• Pain in the back of the legs
• Pelvic pain or pressure
• Pain during sexual intercourse
• Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to
empty the bladder
• Constipation
• An enlarged abdomen which may be mistaken for weight gain or pregnancy
Complications of uterine fibroids
Uterine fibroids are not very dangerous and are not a major health concern. But it can put you through some difficulties. For example, severe and heavy bleeding during your period can make you Anemic. On some occasions, if the fibroid grows out of your Uterus in a peculiar stalk-like projection, you may feel extreme pain when it twists on this stalk. Under these conditions, the fibroid will have to be surgically removed.

Pregnancy and fibroids

In most cases, fibroids do not interfere with pregnancy and treatment is not necessary. By and large they do not hinder the process of getting pregnant or with your bodily changes during pregnancy, but fibroids can rarely cause infertility. Some of the ways fibroids can cause infertility are by
• blocking your fallopian tubes,
• interfering with Sperm movement and
• Preventing implantation and growth of an Embryo.
A more common complication of fibroids in pregnancy is localized pain, usually between the first and second trimesters. This can be easily treated with pain relievers.

This presents a rare and as of yet unexplainable cause of an ovulation. Some women cease menstruation and begin menopause before normal age. It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise.There is also a genetic possibility for this condition. Premature ovarian failure is a condition that decline in normal functioning of the ovaries in a woman younger than 40 years of age.

Symptoms of Premature Ovarian Failure
• Irregular menstrual period
• Infertility
• Hot flashes, night sweats
• Irritability, poor concentration
• Decreased libido
• Vaginal dryness

Premature ovarian failure to describe a stop in normal functioning of the ovaries in a woman under the age of 40. Many women naturally experience a decline in fertility at age 40, this age may also mark the beginning of irregularities in their menstrual cycles that signal the onset of menopause. for women with POF, the fertility decline and menstrual irregularities occur before age 40, sometimes even in the teens.

A woman with POF is much more likely to have periods, even though they might not come regularly. There is virtually no chance for a woman who has gone through menopause naturally to get pregnant. Premature Ovarian Failure results in Infertility, the most discussed problem about women. There are some additional implications on the health of woman caused by this problem like ‘Osteoporosis’ (decreased bone density) is very likely to affect all women early menopause because of the estrogen insufficiency. Also, it has been found that there is a high risk of heart disease, hypothyroidism and other auto-immune disorders.

Causes Of Premature Ovarian Failure (POF)
Unfortunately, for most women the cause is unknown. There are, however, some causes that may be identified which include:

• Autoimmune disorder
• Genetics
• The end of a treatment for cancer with radiation or chemotherapy
• Hysterectomy with both ovaries removed
• Thyroid dysfunction
• Turner syndrome
• Viral infection
• Inadequate gondaotropin secretion or action
• Eating Disorders

Is there a difference between Premature Ovarian Failure (POF) and Menopause?

Menopause usually occurs on average around age 51. Premature ovarian failure can occur at any age before 40, usually on average around age 27. When a woman experiences menopause, she no longer has follicles to produce into eggs and therefore no longer gets her menstrual period.
A woman with premature ovarian failure, or premature menopause, may still have follicles, but there may be a depletion or dysfunction of these. Therefore, she can still get her period; however, most of the time her period is irregular. Irregular periods are one of the signs for POF. Keep in mind that there may be other explanations for an irregular period. Always discuss any irregularity in your menstrual cycle with your healthcare provider.

Common signs and symptoms include
• Irregular menstrual cycles
• Excess hair growth on the face and body
• Infertility (due primarily to lack of ovulation)
• Excess weight (especially at the waist)
• Sleep Apnoea

Polycystic ovary syndrome is not a well understood condition but the theory behind the cause is that it is an imbalance of hormones that produces cysts on the ovary’s. The cysts are fluid filled sacs that disrupt the production of hormones even further.
Normally, a woman’s ovaries and adrenals produce small amounts of male hormones (androgens), but women with polycystic ovary syndrome have increased androgen levels. Higher levels of androgens lead to an imbalance in the hormones that regulate ovulation and normal egg development. Obesity, which is common in women with PCOS, contributes to infertility. Thus, weight loss, if needed, and treatment for polycystic ovary syndrome with medications can restore ovulation. It is believed that polycystic ovary syndrome is hereditary. Daughters and sisters of those with Polycystic ovary syndrome have 50% more chance of developing the condition.
Polycystic ovary syndrome is diagnosed by an ultrasound of the ovaries, blood tests for hormones, menstrual difficulties and the symptoms mentioned above. As you can see from this ultrasound, there are multiple cysts.
Women with polycystic ovarian syndrome may complain of abnormal bleeding, extreme weight gain, depression, tiredness, hair loss, thyroid problems, headaches, sleeping disorders, high cholesterol, poor memory, panic attacks, constant thirst, dizzy spells, insulin resistance, extreme cravings, cystic ovaries, cystic acne, an ovulatory menstrual cycles (cycles without ovulation), irregular periods, mood swings, high levels of testosterone, infertility, extreme hair growth on face and body.

Ovarian causes of infertility can be divided in to primary and secondary. Primary conditions are often diagnosed in the early adolescent years when patients fail to menstruate. This may be due to nonfunctional ovaries as in Turners syndrome, or the absence of internal reproductive structures altogether (gonadal dysgenisis). These cases are rare, but need to be evaluated with chromosome analysis. Secondary causes can be due to hormonal abnormalities such as thyroid dysfunction, advanced maternal age i.e. over 35 and disease of the ovaries such as ovarian cancer and polycystic ovarian disease. In such cases a full endocrine work up needs to be done, to check hormone levels within the blood. If ovarian disease is suspected a pelvic ultrasound will be needed in addition to more specific and more invasive procedures to establish a specific ovarian cause.

The cause of endometriosis is unknown. The diagnosis is frequently made because of the technical ease of modern videolaparoscopy. The glib explanation is that endometriosis follows retrograde menstruation, but much laboratory and clinical evidence suggests that endometriosis is more complex than this. We have recently suggested that endometriosis is a disease of angiogenesis since in endometriosis, the endometrium, as well as endometriotic plaques, seems to have greater angiogenic activity than does the endometrium of normal women.

Endometriosis can affect many organs surrounding the uterus, fallopian tubes and ovaries. This sometimes includes the bladder and bowels. Endometriosis can interfere with conception and be a factor in infertility.
Approximately 10% of infertile couples are affected by endometriosis. 30-40% 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%. This condition is characterized by excessive growth of the lining of the uterus, called the endometrial. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum. A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms. 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.
Treatment of endometriosis is either medical (using drug therapy) or surgical (using laparoscopy or open surgery), depending on the extent of the disease. IVF is an appropriate treatment for endometriosis-induced infertility when other methods have failed.

Symptoms of PID
For women who have them, symptoms can range from mild to severe. The most common symptom of PID is pain in your lower abdomen (stomach area). Other symptoms include:
• Fever
• Vaginal discharge that may smell foul
• Painful sex
• Painful urination
• Irregular periods (monthly bleeding)
• Pain in the upper right abdomen

Causes of PID
• Have had an STI
• Are under 25 years of age and are having sex
• Have more than 1 sex partner
• Douche. Douching can push bacteria into the pelvic organs and cause infection. It can also hide the
signs of an infection.
• Have an intrauterine device (IUD). You should get tested and treated for any infections before getting
an IUD. This will lower your risk of getting PID.

What are the risk factors for PID?
The same things that put you at risk for STIs also put you at risk for PID. Risk factors for PID include:

• Being a sexually active woman younger than 25 years of age.
• Having multiple sexual partners.
• Having unsafe sexual habits.
• Douching regularly (which can flush the bacteria up into your genital tract).

How do I practice safe sex?
Avoid sexual contact with people who are at risk of infection. If you decide to have sex, first ask your partner if he or she has any risks for infection. Both men and women can carry STIs and not have any symptoms, which is why regular screening for STIs is important. A male partner should always wear a condom during sexual activity. Even though the condom will not prevent 100% of STIs, it will greatly reduce your chances of getting infected. Remember, only a condom can provide some protection against STIs. Other forms of birth control don’t provide this protection.

What can happen to my body if I get PID?
Early and complete treatment can help prevent complications of PID. However, if PID isn’t treated, it can cause permanent damage to your internal organs. Scar tissue can form in the fallopian tubes and around the abdomen. This tissue can prevent pregnancy or cause the pregnancy to form outside the uterus (called a tubal or ectopic pregnancy). Scarring can cause pain that lasts for months or even years. Occasionally, the effects of PID can be so severe that surgery is required to remove pus, get rid of scar tissue or remove damaged organs.
PID is more likely to come back if you are exposed to STIs again. Each time you have PID causes more damage and a greater possibility of complications.

Causes of unexplained Infertility
• Abnormal Fallopian tubes
• Abnormal eggs
• Abnormal Luteal Phase
• Immune Problems
• Infections
• Weak Sperm
• Psychological Factors

Cervical mucus is a substance secreted within the vagina in response to various hormones within the blood. The characteristics of this substance change in response to reproductive hormones such as oestrogen. Inappropriate changes in the cervical mucus can lead to a hostile environment for the sperm. Cervical mucus incompatibility accounts for approximately 5% of female infertility. A post-coital test is done hours after intercourse and can help assess weather the cause of infertility is related to cervical mucus incompatibility. This test analyses the mucus for volume, consistency, PH and viscosity. If the PH is too acidic as in bacterial and yeast infections, the sperm will die off prematurely. If the cervical mucus is highly viscous then the sperm will have a difficult time penetrating their way to the egg.
Cervical mucus hostility is the inability of sperm to penetrate the cervical mucus, therefore preventing migration through the cervical canal. It may be possible to bypass hostile mucus by intrauterine insemination (IUI).
The cervical glands secrete cervical fluid, which serves as a media for sperm transport. Sperm are deposited in the vagina and swim in the cervical fluid through the cervix and into the uterus. The cervical fluid is rich in nutrients and must have the correct consistency to support sperm transport. If the cervical mucus is too “thick or sticky”, the sperm cannot reach the uterus resulting in infertility.
The cervical mucus must also be free of antisperm antibodies. These antibodies are sometimes mistakenly made by the female’s immune system and can destroy sperm. The antibodies recognize sperm as invading pathogens, such as virus or bacteria, and seek to destroy them. The male may rarely make antibodies to his own sperm, as can be seen with vasectomy reversal.
When female antisperm antibodies are present, or if the cervical mucus is inadequate, intrauterine insemination (IUI) is often the treatment of choice. In IUI, the sperm are washed and concentrated and then placed directly into the uterus using a small catheter, thus avoiding sperm contact with the cervical mucus.

Cervical causes

• Infections
• Hostile mucus
• Hypoplastic cervix
• Cervical anomalies