Female Infertility

What is infertility?

Infertility is usually defined as not being able to get pregnant despite trying for 1 year. It is a problem for 1 of every 6 couples. It can be caused by problems in a man's or woman's reproductive system. Problems in the woman's body are responsible for about half of the cases of infertility.

How does it occur?

Often the reason a woman is infertile is that her ovaries are not releasing eggs. For example, when a woman gets older, the ability of the ovaries to produce eggs declines, especially after age 35. Other things that may affect the release of eggs (ovulation) are:

• hormone imbalance
• overweight
• too much stress
• ovarian tumors or cysts
• weight loss for various reasons, including eating disorders such as anorexia and bulimia
• intense exercise, such as long distance running, which causes loss of body fat
• abuse of alcohol or drugs
• thyroid or adrenal gland problems
• tumors in the pituitary gland
• chronic illness, such as diabetes
• some medicines.

An abnormal or damaged uterus or fallopian tube can also cause infertility. These female organs may be damaged from:

• an infection, such as a sexually transmitted disease
• a birth defect in the female organs
• growths in the uterus, such as polyps or fibroids
• scar tissue from surgery (called adhesions)
• endometriosis (tissue from the uterus growing outside the uterus)
• adhesions (scar tissue) inside the uterus or in the pelvis
• DES syndrome, which you may have if your mother took the medicine DES when she was pregnant with you
• chronic illness.

You may have problems with your cervix, such as:

• cervical stenosis (a cervix that is very narrow or closed)
• abnormal cervical mucus
• cervicitis, which is inflammation or infection of the cervix.

In rare cases, a woman's body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility.

Thirty percent of infertility cases have no known cause.

How is it diagnosed?

You and your partner will have thorough physical exams. You will be asked about:

• your sexual history, including previous pregnancy, miscarriage, or abortion
• your medical history
• your family history
• your use of drugs and alcohol
• your sexual intercourse practices, such as how often you have sex and whether you use lubricants.

Tests that may be done are:

• urine and blood tests to check for infections and a hormone imbalance
• tests of samples of cervical mucus and tissue from the lining of your uterus
• tests of your partner's semen to check the number and quality of sperm in the semen
• ultrasound scans.

Your health care provider may tell you how to take and chart your body temperature each morning. A woman's temperature rises after ovulation. The chart helps check for ovulation.

You may have the following procedures to check for a blockage in your tubes or uterus or for scar tissue:

• D&C (dilation and curettage), which is a stretching of the cervix followed by scraping or suctioning of tissue from the uterus
• hysteroscopy (putting a scope into the vagina and through the cervix to examine the inside of the uterus)
• laparoscopy (inserting a scope into your abdomen through a small cut to examine the organs in your abdomen)
• hysterosalpingogram (x-ray of the uterus and fallopian tubes after injection of a dye through the cervix and into the uterus and fallopian tubes).

How is it treated?

Your provider will try to find the cause of the infertility and, if a cause is found, treat the cause. The treatment may include medicine (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments for both partners is necessary. Examples of treatments for women are:

• Taking hormones for a hormone imbalance, endometriosis, or short menstrual cycle.
• Taking drugs to stimulate ovulation. (Sometimes with this treatment you may become pregnant with more than 1 baby.)
• Having surgery to remove blockage or scar tissue from the fallopian tubes, uterus, cervix, or pelvis.
• Having surgery to remove polyps or fibroids from the uterus.

You may be asked to keep a record of your daily temperature to track ovulation. This will help predict when you are most fertile or if the drugs you are taking stimulate egg production.

If your partner's sperm count is low, artificial insemination may be an option. Semen is collected at several different times and stored until there are enough sperm. The semen is then placed in your uterus or fallopian tubes during the most fertile time of your menstrual cycle. This procedure has varying success. Another choice is to use sperm donated by another man.

In vitro fertilization is another option. In this procedure eggs are removed from your body and fertilized with sperm in the lab. The fertilized eggs are then put into your uterus or fallopian tubes. This procedure may be done if your partner's sperm count is low or your fallopian tubes are blocked or damaged. In vitro fertilization is expensive and success rates are often low. You may become pregnant with more than 1 baby at a time.

Looking for and treating causes of infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through difficult times.

How can I help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or an illness. However, you can do the following to reduce the risk of infertility:

• Prevent sexually transmitted diseases by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Limit the amount of alcohol you drink to no more than 1 or 2 drinks a week.
• Avoid the use of street drugs (such as heroin) and overuse of prescription and nonprescription drugs.
• Do not smoke.
• Maintain good personal hygiene and health practices.
• Do not use lubricant during sexual intercourse because it can make it harder for the sperm to reach the egg.

Contact your health care provider about any signs of infection or hormonal change, such as:

• unusual discharge from the vagina
• abdominal pain
• fever
• abnormal bleeding
• a change in your menstrual periods
• discomfort during intercourse
• sores and itching in the vagina or rectal area.