Infertility in Women
Approximately 10% of all women of reproductive age have trouble getting pregnant or maintaining a pregnancy. Female infertility contributes to around 33% of all cases. Thanks to modern technology and advances in medical diagnostics, couples now have options for conception.
What are the risk factors for female infertility?
The risks factors for infertility in women include:
- Age – After a woman reaches age 35, fertility begins to decline.
- Weight – Extreme weight gain or loss contributes to infertility.
- Smoking – Cigarette smoking is known to impair fertility in women.
What are the known causes of infertility in women?
Infertility can be the result of an underlying health condition that interferes with ovulation, damages the fallopian tubes, or causes hormone imbalances. Common causes of female infertility include:
- Ovulation problems – The two main problems with ovulation include polycystic ovarian syndrome (PCOS) and premature ovarian failure (POF). With PCOS, a woman does not ovulate regularly and produces excessive male hormones (androgens). This alters the hormone levels that are involved with egg production. With premature ovarian failure (early menopause), there is a depletion of follicles before age 40 years. Certain conditions contribute to this problem, particularly diseases that affect the thyroid, adrenal, and/or pituitary glands.
- Blocked fallopian tubes – The tubes become scarred and blocked due to endometriosis or pelvic inflammatory disease (PID). With PID, chronic reproductive tract infection leads to inflammation of the tubes and scarring. Endometriosis involves growth of uterine cells outside the uterus, causing the tissue to become inflamed from hormonal changes. With blocked fallopian tubes, the egg cannot progress to become fertilized or to implant if fertilization does occur.
- Uterine abnormalities – Adhesions can form following pelvic surgery, restricting the movement of the fallopian tubes and ovaries. In addition, uterine fibroids often block the fallopian tubes or distort the shape of the uterine cavity.
- Elevated prolactin levels – Prolactin is produced by the pituitary gland, and this hormone stimulates milk production after pregnancy. With high levels, gonadotropin hormones are suppressed, which inhibits ovulation.
- Egg quality – The quality and number of eggs decrease as a woman ages. Certain medical conditions can impair the ovaries. In addition, radiation/chemotherapy treatments often damage the ovaries, which affects egg development and quality.
How is female infertility diagnosed?
When a couple cannot conceive after one year of unprotected sex, infertility can be diagnosed. Testing involves finding the underlying cause of infertility. Before the woman undergoes invasive testing, the male partner should have a semen analysis.
- Medical history/physical examination – The first step in a workup for female infertility is the medical history and physical examination. The doctor will ask questions about lifestyle issues, menstrual history, and current medications, as well as conduct a thorough examination.
- Laboratory tests – this involves evaluation of hormone levels and ovarian reserve. With the Clomid challenge test, the doctor measures FSH, has the woman take Clomid, and then measures FSH again, assessing for sufficient levels. Tissues samples often are taken to assess for premature ovarian failure.
- Diagnostic testing – Extensive diagnostic tests help reveal abnormal uterine or tube findings. These include ultrasound, hysteroscopy, hysterosalpingography, and laparoscopy.
How is female infertility treated?
Treatment for infertility in women should address the actual medical condition or cause of the fertility problem. Approaches for treatment are:
- Lifestyle measures – This includes quitting smoking, maintaining a healthy weight, and avoiding alcohol.
- Rhythm method – To increase chances of conception, the couple can time sexual activity according to ovulation.
- Assisted reproductive technologies (ART) – These include in vitro fertilization, use of egg and/or sperm donors, and intracytoplasmic sperm injection.
- Medications – Drugs can induce ovulation, such as gonadotrophins.
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