Infertility in Women

Definition

A couple is considered infertile when they cannot conceive after a full year of regular, unprotected sex. About one-third of all cases are caused by female factors. An equal number are caused by factors in the male. In the remaining cases the cause is unknown or is due to problems with both partners.

Causes

Successful conception involves many steps. First, an egg must be released from the woman's ovaries (ovulation). The egg must then travel to the fallopian tubes and be fertilized by the man's sperm. If the egg is fertilized (conception), it then moves from the fallopian tubes to the uterus. It secures itself into the wall of the uterus and begins its 40-week period of fetal growth.
Most cases of female infertility are due either to problems with ovulation or problems with blocked or damaged fallopian tubes.
Problems with Ovulation 
If the egg is not released, it is not possible to conceive. Up to 40% of cases of female infertility are due to ovulation problems. Some factors that can cause problems with ovulation are:
  • Hormonal disorders
  • Polycystic ovarian syndrome
  • Ovulation disorder
  • Ovarian cysts
Problems with Fallopian Tubes
If the fallopian tubes are damaged or blocked, it is difficult for the egg to be fertilized or to travel to the uterus. Problems with fallopian tubes can be caused by:
  • Pelvic inflammatory disease
  • Endometriosis
  • Sexually transmitted diseases
  • Surgeries
  • Ectopic pregnancies
  • Congenital anomalies

Risk Factors

A risk factor is a something that increases your chance of getting a disease or condition.
  • Age: older than 35 years old
  • Very high or very low levels of body fat
  • Chronic diseases such as:
    • Diabetes
    • Lupus
    • Arthritis
    • Hypertension
    • Asthma
  • Excessive exercise
  • Smoking
  • Caffeine consumption
  • Alcohol intake
  • Occupational exposure to:
    • High temperatures
    • Toxic substances
    • Chemicals
    • Pesticides
    • Radiation
    • Constant stress
  • History of:
    • Pelvic inflammatory disease
    • Endometriosis
    • Polycystic ovaries
    • Ectopic pregnancy
    • Kidney failure
    • Cirrhosis
    • Pituitary tumors
    • Anorexia nervosa
    • Autoimmune hypothyroidism
    • Uterine fibroids
    • Uterine surgery
    • Ulcerative colitis
    • Crohn's disease
    • Epilepsy
    • Cushing's disease
    • Sickle cell anemia
    • HIV infection
    • Kidney disease
  • Medications, including:
    • Acetaminophen
    • Ibuprofen
    • Pain medications
    • Hormones
    • Antibiotics
    • Antidepressants

Symptoms

A couple should seek help for infertility if they are unable to conceive after one year of trying to conceive. They will both be evaluated to determine if the infertility is due to the male, the female, or a combination of both.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. During the initial consultation, both partners will be evaluated for fertility problems.
The following tests may be performed to see if ovulation is occurring:
Urine Test – to measure hormone levels
Basal Body Temperature – taking your temperature every day and recording it on a chart
Blood Test - to measure hormone levels
Endometrial Biopsy - to see if the changes in the uterus lining caused by ovulation are occurring
The following procedures may be performed to check if your uterus and fallopian tubes are normal:
Hysterosalpingography (HSG) - an x-ray of the uterus and fallopian tubes
Transvaginal Ultrasound – a device inserted into the vagina to take a "picture" of the pelvic organs
Hysteroscopy – a thin device inserted through the cervix to look inside the uterus
Laparoscopy – a small "camera" that allows examination of the fallopian tubes, ovaries, and uterus

Treatment

Treatment will depend on the cause of the infertility. Infertility treatments can be costly and lengthy. They often are not covered by insurance. Be sure to check with your health insurance provider.
Lifestyle Changes
Your provider may first ask you to make lifestyle changes such as:
  • Lose or gain weight.
  • Stop smoking.
  • Avoid caffeine and alcohol.
  • Avoid excessive exercise.
  • Plan sexual activity according to ovulation.
  • Manage stress and depression.
Medication
You may be given medications to cause ovulation to occur. The likelihood of multiple births is high with these medications.
Surgery
If the fallopian tubes are blocked, you may need surgery to open them. Surgery is also used to repair problems with organs or to remove cysts, fibroids, or scar tissue.
Assisted Reproductive Technologies (ART)
ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from the couple or can be donated. ART methods include:
Artificial Insemination – Semen is collected and processed in a lab and then inserted directly into the woman's cervix or uterus.
In Vitro Fertilization (IVF) – An egg is removed from the woman's body and mixed with sperm in a laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's uterus.
Gamete or Zygote Intrafallopian Transfer (GIFT or ZIFT) – An egg is removed from the woman's body and mixed with sperm in a laboratory. The egg and sperm mixture or a 2-3 day old embryo is then placed in the woman's fallopian tube.

Prevention

Not all causes of infertility can be prevented. The following steps may help:
  • Stop smoking.
  • Limit or avoid caffeine and alcohol.
  • Maintain a healthy body weight.
  • Prevent sexually transmitted diseases by using condoms and limiting the number of sexual partners.
  • Try stress management techniques.