Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.
Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.
The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
Ovulation problems may be caused by one or more of the following:
Damage to the fallopian tubes or uterus can be caused by one or more of the following:
Abnormal cervical mucus can also cause infertility. Abnormal cervical mucus can prevent the sperm from reaching the egg or make it more difficult for the sperm to penetrate the egg.
Potential female infertility is assessed as part of a thorough physical exam. The exam will include a medical history regarding potential factors that could contribute to infertility.
Healthcare providers may use one or more of the following tests/exams to evaluate fertility:
Tracking your ovulation through fertility awareness will also help your healthcare provider assess your fertility status.
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There may be no other outward signs or symptoms.
When to seek help sometimes depends on your age:
Your doctor may also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.
Many of the risk factors for both male and female infertility are the same. These include:
A woman's age can affect her fertility. By age 40, a woman's chance of pregnancy has decreased from 90 percent to 67 percent. By age 45, the chance of becoming pregnant declines to 15 percent. Infertility in older women may be due to a higher risk of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also is much greater for older women
Depression and stress may have a direct effect on the hormones that regulate reproduction and affect sperm production or ovulation.
Studies suggest that prolonged exposure to high mental stress, high temperatures, chemicals, radiation, or heavy electromagnetic or microwave emissions may reduce fertility in both men and women
Smoking may increase the risk of infertility in women and may reduce sperm production in men.
Even moderate alcohol intake - as few as five drinks a week - can impair conception.
Body fat levels that are 10 percent to 15 percent above normal can overload the body with estrogen, throwing off the reproductive cycle.
Body fat levels 10 percent to 15 percent below normal can completely shut down the reproductive process. Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women on a very low-calorie or restrictive diet. Strict vegetarians also may experience infertility problems due to a lack of important nutrients such as vitamin B-12, zinc, iron and folic acid. Marathon runners, dancers and others who exercise very intensely are more prone to menstrual irregularities and infertility.
To diagnose infertility, doctors generally check the following areas: the female hormone system and ovarian reserve, the female pelvis, the vagina and cervix, and the semen.
Endocrine System Tests
The endocrine system includes all the hormone-producing glands in the body that regulate the body’s growth, metabolism and sexual development. Sometimes infertility is due to problems in the endocrine system, and the fertility specialist may perform various tests, which include:
BBT charts help predict the time of ovulation. They can also indicate whether or not there are problems with ovulation. Higher levels of progesterone cause the body temperature to increase slightly (about 0.5F to 1F). To create a BBT chart, a woman must record her temperature every morning before getting out of bed.
There are many tests that help identify the timing of ovulation, such as Ovulation Predictor Kits (OPK) which are usually Urinary Luteinizing Hormone (uLH) tests. As a result, BBT charts are much less commonly used today than OPKs.
A specialist takes a sample of the cells lining the uterus (endometrium) after ovulation occurs. They then test the sample to look for signs of inflammation, changes in the endometrium (due to ovulation), and a change in hormones. This test is usually performed about 7 to 12 days after ovulation. Today, this procedure is much less commonly performed, because it has limited ability to help with infertility diagnosis and treatment.
Ovulation Predictor Kits (OPKs) detect the ovulation-triggering hormone, lutenizing hormone (LH), in the urine. Levels of LH reflect the presence or absence of ovulation. It can help a specialist time diagnostic procedures and inseminations and intercourse. OPKs are generally effective about 90% or more of the time.
Ultrasonography uses sound waves to image and closely examine the uterus, ovaries, endometrium and ovarian follicles. The imaging test can be performed via the woman’s abdomen or vagina.
Fertility doctors may use a combination of the following tests to check the health of a woman’s ovaries and the ‘supply’ of eggs (ovarian reserve):
Laparoscopy is a surgical procedure that uses a thin, lighted tube (a laparoscope) to see and closely examine the uterus, fallopian tubes, ovaries and pelvic surfaces. A common sign of ovulation is the appearance of follicular cysts, which are non-harmful, fluid-filled sacs that appear on the ovaries. Follicular cysts suggest that ovulation is occurring. Laparoscopy can be very helpful in diagnosing infertility in women.
Testing the levels of other endocrine hormones can help indicate the causes of infertility.
Tests for Pelvic Disorders
Your fertility doctor may suspect a problem within the pelvis or the tissue that lines the abdomen, uterus, bladder and rectum (peritoneum). One or more of the following diagnostic tests are likely to be used:
Ultrasonography is an ultrasound-based imaging technique that helps doctors visualize the structure of organs. It is useful in detecting abnormalities in the pelvic region often associated with infertility. For example, ultrasonography can diagnose a condition called hydrosalpinges, in which the fallopian tubes are blocked by scarring (often due to previous pelvic infection). Problems in the pelvis and ovaries can also be detected using a similar technique called sonohysterography, which is a special ultrasound technique to check the inside of the uterus for abnormalities such as scar tissue, fibroids or polyps (growths attached to the inner wall of the uterus).
Hysterosalpingogram is a radiology procedure that examines the health of the uterus and fallopian tubes. A radio-opaque fluid is injected into the uterus and fallopian tubes and photographed via x-rays to check the shape of the uterus for fibroids, and scar tissue, and whether the tubes are blocked. It is relatively safe, simple, inexpensive and reliable test. It can cause cramping in some women.
Hysteroscopy is a minimally invasive procedure in which a fiberoptic ‘telescope’ is passed through the vagina into the uterus to examine and check for abnormalities. It can be used to find polyps, fibroids, scar tissue or other abnormalities inside the uterus.
Magnetic resonance imaging is an imaging technique that uses a magnetic field and radio waves to develop pictures of organs inside the body. MRIs can be helpful in some situations, such as identifying lesions or rare abnormalities inside the pelvis and uterus.
Laparoscopy is an out-patient surgical procedure that uses a thin, lighted tube (a laparoscope). It can also be used to look for abnormalities inside the pelvis. It is generally accurate in diagnosing infertility. It can be used to treat problems that cause infertility such as scar tissue, endometriosis, ovarian cysts, fibroids and endometriosis, a condition in which uterine lining tissue grows outside the uterus.
Tests Related to the Cervix
Very occasionally infertility in women is related to difficulty the sperm has getting from the vagina to the inside of the uterus and fallopian tubes. This can occur because the woman’s cervical mucus (which is a sticky fluid made by the endocervical canal that connects the vagina to the inside of the uterus) may not function normally as a result of surgery or other problem, or that not enough sperm are deposited at the cervix by intercourse at the right time to get pregnant.
Once a woman is diagnosed with infertility, the overall likelihood for successful treatment is 50%.
Whether a treatment is successful depends on the:
Fertility treatments are most likely to benefit women whose infertility is due to problems with ovulation. Treatment is least likely to benefit infertility caused by damage to the fallopian tubes or severe endometriosis.
The first step of treating infertility in many cases is to treat the underlying cause of infertility. For example, in cases where thyroid disease causes hormone imbalances, medication for thyroid disease may be able to restore fertility.
Fertility treatments for women fall into the following categories:
Medication Treatments for Female Infertility
The most common medications used to treat infertility help stimulate ovulation. Examples of these types of medications include:
Clomiphene is a medication patients take by mouth (orally). It causes the body to make more of the hormones that cause the eggs to mature in the ovaries. If a woman does not become pregnant after taking clomiphene for six menstrual cycles, a health care provider may prescribe other fertility treatments.
Gonadotropins are hormones that are injected in a woman to directly stimulate eggs to grow in the ovaries, leading to ovulation. Health care providers normally prescribe gonadotropins when a woman does not respond to clomiphene or to stimulate follicle growth for ART.
hCG is a hormone similar to luteinizing hormone that can be used to trigger release of the egg after the follicles have developed.
Bromocriptine and cabergoline are pills taken orally to treat abnormally high levels of the hormone prolactin, which can stop ovulation.Certain medications, kidney disease, and thyroid disease can cause high levels of prolactin.
Surgical Treatments for Female Infertility
If disease of the fallopian tubes is the cause of infertility, surgery can repair the tubes or remove blockages in the tubes. Success rates of these types of surgery, however, are low. These surgeries involving the fallopian tubes also increase the risk of ectopic (pronounced ek-TOP-ik) pregnancy, which is a pregnancy that occurs outside of the uterus.1 Ectopic pregnancies are also called "tubal pregnancies" because they most often occur in a fallopian tube.
Surgery to remove patches of endometriosis has been found to double the chances for pregnancy. Surgery can also remove uterine fibroids, polyps, or scarring, which can affect fertility.
Sources: webmd, americanpregnancy.org, mayoclinic.org, arcfertility, nichd.nih.gov