Female Infertility

Trying to get pregnant without using birth control, regularly for a full year without success is considered infertility.

In about one-third of cases, infertility is due to problems with the woman's body. Another third of the time, both the woman and the man have factors contributing to the issue. In the remaining cases, the reason for infertility isn't clear, or it's a mix of problems from both partners.

Finding the cause of female infertility can be tricky. There are various treatments available, and the best one depends on what's causing the problem. Importantly, many couples experiencing infertility will eventually conceive without any medical intervention.

One of the key signs of infertility is difficulty getting pregnant. A woman's menstrual cycle can offer clues. If her period is unusually long (35 days or more) or unusually short (less than 21 days), or if it's irregular or stops altogether, it could mean she isn't releasing an egg (ovulating). Importantly, there may not be any other noticeable physical symptoms. This means a woman might feel perfectly healthy and still have an issue with ovulation, which is a crucial part of getting pregnant.

Getting help for infertility depends on your age and other factors.

• Under 35: Most doctors suggest trying to get pregnant naturally for at least a full year before considering tests or treatments. This gives your body time to conceive naturally. If you're under 35 and have been trying for a year without success, it's a good idea to talk to your doctor.

• Ages 35 to 40: If you're in this age group, it's a good idea to talk to your doctor after trying for six months. Fertility naturally declines with age, so it's important to get professional guidance sooner in this age range.

• Over 40: For those over 40, your doctor might recommend fertility tests or treatments sooner, perhaps even right away. The declining fertility rate at this age often means that time is of the essence.

Your doctor might also suggest testing or treatment right away if:

• You or your partner has known fertility problems: If either of you has a history of difficulty conceiving, it's important to discuss this with your doctor sooner rather than later.

• You have a history of irregular or painful periods: These problems can affect fertility.

• You've had pelvic inflammatory disease (PID): PID can sometimes cause damage to reproductive organs.

• You've had repeated miscarriages: This is a situation that requires medical attention and evaluation.

• You've had cancer treatment: Some cancer treatments can affect fertility.

• You have endometriosis: Endometriosis is a condition where tissue similar to the lining of your uterus grows outside of it. This can cause fertility issues.

In all these cases, discussing your concerns with your doctor is important, regardless of your age. They can help you understand your options and determine the best course of action for you.

Getting pregnant requires a series of steps to happen perfectly. Here's how it works:

1. Ovulation: One of a woman's two ovaries releases a mature egg. This egg is ready to be fertilized.

2. Egg Pickup: The fallopian tube, a tube connecting the ovary to the uterus, catches the released egg.

3. Sperm Journey: Meanwhile, sperm travel from a man's body through the woman's cervix (the opening to the uterus) and into the uterus. From there, the sperm swim up the fallopian tubes in search of the egg.

4. Fertilization: If a sperm successfully reaches and fertilizes the egg within the fallopian tube, the egg and sperm unite, creating a fertilized egg (a zygote).

5. Implantation: The fertilized egg travels down the fallopian tube to the uterus. Once there, it attaches to the lining of the uterus (implantation). This is when the fertilized egg begins to grow and develop.

This entire process needs to happen correctly for a pregnancy to start.

Factors That Can Affect Your Ability to Get Pregnant

Several things can increase the difficulty of getting pregnant. Understanding these factors can help you make choices to improve your chances.

Age: A woman's eggs are like a limited supply; as she gets older, the quality and number of her eggs decrease. Around age 35, this decline speeds up. Fewer, lower-quality eggs make it harder to conceive, and it also raises the risk of pregnancy loss (miscarriage).

Smoking: Smoking damages the cervix and fallopian tubes, which are essential for a healthy pregnancy. It also increases the chances of miscarriage and ectopic pregnancy (a pregnancy outside the uterus). Smoking is thought to speed up the aging process of the ovaries and use up eggs more quickly. Quitting smoking before trying to conceive is a very important step.

Weight: Being significantly overweight or underweight can disrupt ovulation, the monthly process where an egg is released from the ovaries. Reaching a healthy body weight, as measured by your Body Mass Index (BMI), might improve the regularity of ovulation and increase your chances of getting pregnant.

Sexual Health: Sexually transmitted infections (STIs), such as chlamydia and gonorrhea, can cause damage to the fallopian tubes, which are responsible for transporting the egg to the uterus. Having unprotected sex with multiple partners significantly increases your risk of getting an STI, which can lead to fertility problems later on.

Alcohol: Drinking too much alcohol can reduce your chances of getting pregnant. If you're trying to conceive, limiting or avoiding alcohol consumption can be beneficial.

Planning for pregnancy? Here are some helpful tips for women.

Healthy Habits for Future Mothers:

Getting pregnant is a wonderful goal! Making healthy choices before you get pregnant can boost your chances of a successful pregnancy.

• Aim for a healthy weight. Being either overweight or underweight can make it harder to get pregnant. If you need to lose weight, aim for gradual, moderate exercise. Very intense workouts, more than five hours a week, might actually make it harder to ovulate.

• Quit smoking. Smoking is harmful to your health and can greatly affect your fertility. If you smoke and are trying to get pregnant, quitting is a top priority. Smoking during pregnancy also puts your baby at risk.

• Cut down on alcohol. Drinking too much alcohol can decrease your chances of getting pregnant. Even small amounts of alcohol during pregnancy can be harmful to your developing baby. If you're thinking about getting pregnant, it's best to avoid alcohol altogether. Don't drink at all while pregnant.

• Manage stress. Stress can impact fertility treatments and overall pregnancy success. Find ways to reduce stress in your life before you try to conceive. This could include things like meditation, yoga, spending time in nature, or simply making time for relaxation.

These tips are just a starting point. It's always a good idea to talk to your doctor or a fertility specialist about your specific health needs and concerns before trying to conceive. They can provide personalized advice and support.

If you and your partner are having trouble getting pregnant after a reasonable amount of time, it's important to talk to your doctor. They can help figure out what's going on. Both of you should be evaluated.

Your doctor will first take a detailed medical history and do a physical exam. This helps them understand your overall health and any potential factors that might be affecting your ability to conceive.

To understand what's happening inside your body, your doctor might recommend some tests. These tests can help identify problems with your reproductive organs.

Here are some common fertility tests:

• X-ray dye test (Hysterosalpingography): A thin tube (catheter) is inserted into your cervix. A special liquid dye is then put into your uterus. X-rays are taken to see if your uterus and fallopian tubes are healthy and open. The dye should flow out of the fallopian tubes. If there are any blockages or problems, more tests will likely be needed.

• Ovulation tests: These tests can help determine if you're ovulating (releasing an egg). There are at-home ovulation predictor kits that you can buy. These kits measure a hormone in your urine. A blood test can also measure hormones to confirm ovulation. Sometimes, your doctor may check other hormones like prolactin to see if they are in the normal range.

• Ovarian reserve tests: These tests assess the quality and number of eggs you have available for ovulation. This is particularly important for women over 35, as egg quality and quantity can decrease with age. These tests usually involve blood tests and sometimes imaging.

• Other hormone tests: Your doctor might check the levels of other hormones involved in ovulation, as well as hormones from your thyroid and pituitary gland, which play important roles in reproduction.

• Imaging tests: A pelvic ultrasound can check for problems with your uterus or fallopian tubes. Sometimes, a special type of ultrasound called a sonohysterogram or a hysteroscopy is used to get a clearer picture of the inside of your uterus.

• Laparoscopy: This is a minor surgical procedure where a small camera is inserted through a small cut near your belly button. It allows your doctor to directly look at your fallopian tubes, ovaries, and uterus. This can help diagnose problems like endometriosis (tissue growing outside the uterus), scar tissue, blockages, or other abnormalities.

• Genetic testing: In some cases, genetic problems can affect fertility. Your doctor may recommend genetic testing to look for any potential genetic issues that might be contributing to your infertility.

It's important to remember that these tests are part of a process to find the cause of infertility. Your doctor will explain the results and discuss the next steps with you. Don't hesitate to ask questions and work closely with your doctor throughout this process.

Infertility treatment is tailored to the cause, the person's age, how long they've been struggling with infertility, and their personal preferences. Infertility is a complex issue, and treatment often requires significant time, emotional, financial, and physical commitment.

Treatment options aim to restore fertility through medication or surgery, or to help achieve pregnancy using advanced techniques.

Medications:

• Fertility drugs: These drugs, often called ovulation-stimulating medications, are the primary treatment for women with ovulation problems. They work similarly to natural hormones (follicle-stimulating hormone (FSH) and luteinizing hormone (LH)) to trigger ovulation. They can also be used to stimulate the ovaries to produce more eggs.

  • Gonadotropins: These are injected medications that encourage the ovaries to release multiple eggs. Examples include hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle). A different gonadotropin, human chorionic gonadotropin (hCG, Ovidrel, Pregnyl), is used to mature the eggs and release them. Using these medications can slightly increase the risk of having multiple babies (twins, triplets, or more) and premature birth.

Potential Risks of Fertility Drugs:

• Multiple pregnancies: Medications to stimulate ovulation, especially injectable ones, can increase the chance of having more than one baby (twins, triplets, etc.). This raises the risk of premature birth, low birth weight, and potential developmental problems later on. Doctors may adjust the medication to help reduce the risk of multiple births.

• Ovarian hyperstimulation syndrome (OHSS): This is a rare but possible side effect of injectable fertility drugs. OHSS causes the ovaries to become swollen and painful. In mild cases, symptoms like abdominal pain, bloating, nausea, vomiting, and diarrhea usually resolve on their own. More severe cases can lead to rapid weight gain, significant ovarian enlargement, fluid buildup in the abdomen, and shortness of breath. Doctors monitor women closely for signs of OHSS.

• Long-term risks: Most studies show few long-term risks associated with fertility drugs. However, some research suggests a possible link between long-term use (12+ months without success) and a slightly increased risk of certain ovarian cysts later in life. This risk might be more related to the underlying infertility problem than the treatment itself. Doctors often recommend reevaluating treatment plans and focusing on the most effective approaches every few months.

Surgical Options:

Surgical procedures are less common now, as other treatments are often more effective. They may include:

• Laparoscopic or hysteroscopic surgery: This might involve correcting problems with the uterus, removing tissue growths (polyps or fibroids), or addressing scar tissue (adhesions).
• Tubal surgery: If fallopian tubes are blocked or damaged, surgery might be an option, though IVF is usually a better choice.

Other Assisted Reproductive Techniques:

• Intrauterine insemination (IUI): Healthy sperm are placed directly into the uterus around the time of ovulation.

• In vitro fertilization (IVF): Mature eggs are collected and fertilized with sperm in a laboratory. The resulting embryos are then placed in the uterus. IVF is a more involved process, often requiring multiple hormone injections and blood tests.

Different Medications Used:

• Clomiphene citrate: Taken orally, it stimulates the pituitary gland to release more FSH and LH, encouraging egg growth. This is a first-line treatment for women under 39 without PCOS.

• Metformin: Used when insulin resistance is a factor, often in women with PCOS. It helps improve insulin sensitivity, which can improve the chances of ovulation.

• Letrozole: Similar to clomiphene, it's an aromatase inhibitor, typically used for women under 39 with PCOS.

• Bromocriptine: A dopamine agonist, it may be used if ovulation problems stem from excess prolactin production.

The choice of treatment depends on various factors and is best discussed with a healthcare professional specializing in infertility.