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5.1.2 INFERTILITY IN WOMEN
As mentioned above the cause of a couple's infertility may lie with the man or the woman, or both. If medical tests prove the man to be fertile the examining physician will start a new series of tests on the woman. She may be sterile because of certain congenital defects (see "Genetic Defects" and Sexual Malformations"), or as a result of certain internal infections especially gonorrhea (see "Venereal Diseases"). Such infections may have led to a permanent blocking of the Fallopian tubes, thus making fertilization impossible. In some cases of infertility, there simply is no egg to be fertilized because there is no ovulation. In other cases, fertilization does take place but the fertilized egg invariably fails to attach itself to the uterine wall. In still other instances, both fertilization and implantation occur, only to be followed by early spontaneous abortions (miscarriages). The reason for this may be some abnormality of the uterus or the cervix. In certain women, the cervical mucus is too thick to be penetrated by sperm; in others, the cervical or vaginal fluids are hostile to the sperm and kill it. Sometimes women develop antibodies which appear in the vagina and produce an immunity to all sperm or to the sperm of a particular man.
Since the possible causes of female infertility are so varied and numerous, treatment may sometimes be difficult, and it may involve any number of measures from hormone replacement to surgery. However, in recent decades an increasing number of formerly hopeless fertility problems have been overcome with the help of artificial insemination.
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