Infertility in Women

Definition

A couple is considered infertile when they cannot conceive after a full year of regular, unprotected intercourse. 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 down 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.

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 (resulting in lack of ovulation)
• Chronic diseases such as:
  
  • Diabetes
  • Lupus
  • Arthritis
  • Hypertension
  • Asthma
• Excessive exercise (causing to severe a loss of body fat)
• 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. Each partner will be evaluated to determine if the infertility is due to the male , the female, a combination of both, or due to unknown causes.

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 in women to see if ovulation is occurring:

• Urine test—to measure hormone levels
• Basal body temperature—rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy. You can take your temperature every day and record 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 telescopic device inserted through a small incision in the abdominal wall 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.

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.