Female Infertility

Infertility is a condition that affects approximately one out of every six couples. When the problem exists within the female partner, it is referred to as female infertility and female infertility factors contribute to approximately 35% to 45% of all infertility cases.

For a man and a woman of typical child bearing age who are having sexual intercourse without using any birth control, the average amount of time that it takes to conceive is approximately six months. Most couples are able to achieve a pregnancy within one year if they have intercourse twice per week or more often. Between 10% and 15% of couples will continue to have difficulty conceiving after one year of trying. When pregnancy is this slow to occur, the man and woman are diagnosed as infertile.

Infertility can be caused by health problems in the man, the woman or both partners. In some infertile couples, no cause can be found to explain the problem. In approximately 20% of couples, more than one cause of the infertility is found.  When a couple's difficulty in getting pregnant is caused by a fertility problem in the woman, an explanation for her infertility can be found about 80% of the time.

The following information can help you understand female infertility.  Information is available on a different page of male infertility.  For the definitions of infertility terms visit Terms and definitions.

Many things can affect a woman's ability to have a baby. These include such things as:

age
stress
poor diet
athletic training
being overweight or underweight
tobacco smoking
alcohol
sexually transmitted diseases (STD's)
health problems that cause hormonal changes

Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:

irregular periods or no menstrual periods
very painful periods
endometriosis
pelvic inflammatory disease
more than one miscarriage

Female infertility usually occurs when there is a problem with ovulation, a damaged fallopian tube or uterus, there is a problem with the cervix, or age is an issue since as a women ages, her fertility decreases.

Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems (egg release from the ovary) accounts for approximately 20% of female infertility problems. If your ovulation is infrequent, your periods will be spaced apart by longer than a month, or they will be absent. Common causes of infrequent ovulation include body stresses such as eating disorders, unusually ambitious exercise training, rapid weight loss, low body weight, stress, hormone imbalance, alcohol and drug use, and obesity. Some hormonal abnormalities such as thyroid problems, pituitary-gland problems, adrenal-gland problems and polycystic ovary syndrome can delay or prevent the ovaries from releasing an egg.

Damage to, and scaring in, the fallopian tubes can prevent pregnancy because it stops the egg from traveling into the uterus. Fallopian-tube problems are the cause in approximately 30% of female infertility problems. Damage can be from a previous surgery, a previous ectopic (tubal) pregnancy, from endometriosis or from pelvic inflammatory disease (a bacterial infection in the pelvis caused by sexually transmitted bacteria such as gonorrhea or chlamydia), or from a birth defect or genetic factor.

Abnormalities in the shape or lining of the uterus account for approximately 20% of female infertility problems. Fibroid tumors or uterine polyps sometimes result in heavy menstrual bleeding, pelvic pain or enlargement of the uterus. Scar tissue can develop within the uterine cavity as a complication of uterine infections, miscarriages, abortions, or surgical procedures such as a dilation and curettage (D&C).

Abnormal cervical mucus can be the cause of infertility. Abnormal cervical mucus may prevent the sperm from reaching the egg or make it more challenging for the sperm to penetrate the egg.

Normal aging reduces a woman's ability to become pregnant. Ovulation, the process of forming and releasing an egg, becomes slower and less effective. Aging begins to reduce fertility as early as age 30, and pregnancy rates are very low after age 44, even when fertility medications are used. Even though fertility is less reliable for women of older ages, approximately 20% of women in the United States have their first child at or after age 35.

More and more women are waiting until their 30s and 40s to have children. Actually, about 20% of women in the United States now have their first child after age 35. So age is an increasingly common cause of fertility problems. About one third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

The ability of a woman's ovaries to release eggs ready for fertilization declines with age.
The health of a woman's eggs declines with age.
As a woman ages she is more likely to have health problems that can interfere with fertility.
As a women ages, her risk of having a miscarriage increases.

Wikipedia presents the following, rather overwhelming, list of factors relating to female infertility:

General factors
Diabetes mellitus, thyroid disorders, adrenal disease
Significant liver, kidney disease
Psychological factors
Hypothalamic-pituitary factors:
Kallmann syndrome
Hypothalamic dysfunction
Hyperprolactinemia
Hypopituitarism
Ovarian factors
Polycystic ovary syndrome
Anovulation
Diminished ovarian reserve
Luteal dysfunction
Premature menopause
Gonadal dysgenesis (Turner syndrome)
Ovarian neoplasm
Tubal/peritoneal factors
Endometriosis
Pelvic adhesions
Pelvic inflammatory disease (PID, usually due to chlamydia)
Tubal occlusion
Uterine factors
Uterine malformations
Uterine fibroids (leiomyoma)
Asherman's Syndrome
Cervical factors
Cervical stenosis
Antisperm antibodies
Insufficient cervical mucus (for the travel and survival of sperm)
Vaginal factors
Vaginismus
Vaginal obstruction
Genetic factors
Various intersexed conditions, such as androgen insensitivity syndrome

Female infertility is usually determined as part of a thorough physical exam. The exam will include a comprehensive medical history including potential factors that could contribute to infertility.  As a follow-up to the exam, your healthcare provider may use one or more of the following tests to help assess female infertility:

1) urine and blood test;
2) a sample of cervical mucus and tissue to determine if ovulation is occurring;
3) a post coital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus
4) laparoscopy: During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy
5) Hysterosalpingography: In this test, doctors use x-rays to check for physical problems of the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. This dye shows up on the x-ray. This allows the doctor to see if the dye moves normally through the uterus into the fallopian tubes. With these x-rays doctors can find blockages that may be causing infertility.
6) Ultrasound tests to assess the thickness of the lining of the uterus (endometrium), monitor follicle development, and check the condition of the uterus and ovaries;
7) monitoring of your fertility cycle; and
8) an endometrial biopsy which involves scraping a small amount of tissue from the endometrium

Female infertility is most often treated by conventional methods that include one or more of the following:

· Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
· Taking medications to stimulate ovulation
· Taking antibiotics to remove an infection
· Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvis area.

Treatments including Intrauterine insemination (IUI), known by most people as artificial insemination, and Assisted Reproductive Technology (ART).  Detailed information on IUI, ART, and other infertility treatments, are available at Infertility treatments and Infertility drugs.

Although it may be possible to become pregnant on your own after one year of trying to conceive, it is wise to speak with a physician after one year and possibly begin an infertility evaluation. If you are over 35 and want to become pregnant, you may want to consult your health care provider after four to six months of trying to conceive, because pregnancy is less likely to occur without fertility treatment at your age.

If you are undergoing fertility treatment, including taking medications to stimulate your ovaries, it is important for you to notify your infertility specialist about any and all symptoms you notice including pelvic pain and abdominal swelling.

A psychologist or other mental health professional, experienced in infertility and infertility options, can often be an invaluable resource to help the infertile person or couple.

For more about infertility and adoption and/or for more specific information on receiving psychological help and treatment, visit the websites and resources listed below and please feel free to contact me, Dr. Vince Berger, at 717 737 9068 or 717 761 5989.