• Infertility in Women

    (Female Infertility)

    Definition

    Infertility is not being able to conceive after a year of trying. This means having regular, unprotected sex. About one-third of cases are caused by male factors. An equal number are caused by female factors. In the remaining cases, the cause is unknown or is due to problems with both partners.

    Causes

    Successful conception involves many steps:
    • An egg is released from the woman's ovaries (ovulation).
    • The egg travels to the fallopian tubes. Here the man's sperm can fertilize it.
    • If the egg is fertilized (conception), it moves down the fallopian tubes to the uterus.
    • It implants itself into the wall of the uterus. It then begins its 40 weeks of fetal growth.
    Most cases of infertility are due to problems with ovulation or problems with fallopian tubes.
    Female Reproductive Organs
    Fallopian Tube, Ovary, and Uterus
    Copyright © Nucleus Medical Media, Inc.

    Problems with Ovulation

    If the egg is not released from the follicle in the ovary, you will not be able to conceive. Up to 40% of cases are due to this. Some factors that can cause problems are:

    Problems with Fallopian Tubes

    If the fallopian tubes are damaged or blocked, it is difficult for the egg to be fertilized or to travel to the uterus. Problems can be caused by:

    Risk Factors

    These factors increase your chance of developing infertility:

    Symptoms

    After one year of trying to conceive, you and your partner should seek help.

    Diagnosis

    During the first visit, you will both be evaluated. The doctor will ask about symptoms and medical history. Your doctor will look for physical problems that might cause infertility.
    The following tests may be done to see if you are ovulating:
    • Basal body temperature—rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy; you take your temperature every day and record it on a chart
    • Blood test—to measure hormone levels
    • Endometrial biopsy—to see if ovulation is causing changes in the lining of the uterus
    The following may be done 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 device with a camera is inserted into incisions in the abdomen, allowing the doctor to examine the fallopian tubes, ovaries, and uterus

    Treatment

    Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

    Lifestyle Changes

    Your doctor may suggest that you first try:

    Medication

    If you do not ovulate, you may be given medications that cause ovulation. The likelihood of multiple births is increased with these medications.

    Surgery

    If the fallopian tubes are blocked, you may need surgery to open them. Surgery is also used to repair problems with organs or to remove:

    Assisted Reproductive Technologies (ART)

    ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from you and your partner or donated. ART methods include:
    • Artificial insemination—semen is collected and processed in a lab. It is then inserted directly into the woman's cervix or uterus.
    • In vitro fertilization (IVF)—several mature eggs are removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
    • Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.
    • Blastocyst intrafallopian transfer—an egg is removed from the woman's body, injected with sperm, and allowed to develop. It is later implanted into the uterus.
    • Intracytoplasmic sperm injection—a single sperm is injected into the egg. The resulting embryo can be implanted into the uterus or frozen for later use.

    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.
    • Protect yourself from sexually transmitted diseases (STDs) by using condoms. Minimize the number of sexual partners you have.
    • Try stress management techniques.

    RESOURCES

    The American College of Obstetricians and Gynecologists http://www.acog.org

    American Society for Reproductive Medicine http://www.asrm.org

    The Hormone Foundation http://www.hormone.org

    RESOLVE: The National Infertility Association http://www.resolve.org

    CANADIAN RESOURCES

    SexualityandU.ca http://www.sexualityandu.ca

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    American Medical Association website. Available at: http://www.ama-assn.org.

    Cronin M, Schellschmidt I, Dinger J. Rate of pregnancy after using drospirenone and other progestin-containing oral contraceptives. Obstet Gynecol. 2009;114:616-622.

    Female Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. A practice committee report: optimal evaluation of the infertile female. American Society for Reproductive Medicine. 2000;86:S264-S267.

    Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility. Section IV. Lippincott, Williams & Wilkins; 2011.

    Infertility. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130211T1206240241 . Published 2007. Accessed July 8, 2008.

    Infertility. International Council on Infertility Information Dissemination website. Available at: http://www.inciid.org. Accessed July 8, 2008.

    RESOLVE website. Available at: http://www.resolve.org. Accessed July 8, 2008.

    6/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Luttjeboer FY, Verhoeve HR, van Dessel HJ, et al. The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review. BJOG . 2009;116:612-625.

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