Female Infertility

What is female infertility?

Female infertility means you have not been able to get pregnant after 1 year of regular sex without birth control. Problems with your hormones or reproductive system may cause infertility. The female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina. The process of getting pregnant begins with ovulation. Ovulation is when the ovaries release an egg each month. The egg travels down the fallopian tube and is fertilized by sperm.

What causes female infertility?

The cause of infertility may be unknown. The following are some common causes of infertility:

  • Ovulation disorder: This is the most common cause of infertility among women. Changes in the hormones that affect ovulation may be caused by disorders of the hypothalamus and pituitary gland. These are located in the brain and they control the release of hormones that cause ovulation. Polycystic ovarian syndrome (PCOS) is another disorder that can affect ovulation. This condition causes the ovaries to produce higher levels of male hormones than female hormones. This condition may prevent ovulation.

  • Blocked or damaged fallopian tubes: Previous infections, such as pelvic inflammatory disease (PID), may cause swelling or scars in your fallopian tubes. This damages and blocks the tubes, which may make it difficult for your egg to get fertilized. It may also cause problems with the fertilized embryo attaching to the womb.

  • Endometriosis: This is a condition that causes the tissues that line the uterus to grow outside the uterus. These tissues may attach to the ovaries and other abdominal organs and cause you to become infertile.

  • Abnormal cervix or uterus: You may have been born with a defect in your uterus or cervix that prevents pregnancy.

  • Autoimmune diseases: An autoimmune disease, such as thyroid disease or diabetes, may cause infertility.

  • Other causes: Fertility decreases naturally as women age. Certain medicines that are used to treat mental problems, depression, or cancers may also affect fertility. Infertility may also be caused by previous surgeries done on the abdomen or pelvis. Obesity, a large weight loss, stress, and use of tobacco, alcohol, or illegal drugs also affect fertility.

What are the signs and symptoms of female infertility?

The main sign of female infertility is that you have not been able to get pregnant after 1 year of regular unprotected sex. Other signs and symptoms will depend on what is causing your infertility. This may include irregular menstruation, pain in the lower abdomen, or unusual discharge from your vagina.

How is female infertility diagnosed?

Your caregiver will ask questions about your past and current health and your lifestyle. This may include questions about your period, past pregnancies, length of infertility, and sexual history. He will also do a physical exam. You may also need any of the following tests:

  • Pelvic exam: This is also called an internal or vaginal exam. During a pelvic exam, feel free to ask for a woman to be present if one is not. Your caregiver gently puts a warmed speculum into your vagina. A speculum is a tool that opens your vagina. This lets your caregiver see your cervix (bottom part of your uterus). With gloved hands, your caregiver will check the size and shape of your uterus and ovaries.

  • Blood and urine tests: Hormone levels will be checked in your blood and urine. These tests help tell caregivers when you ovulate and if you have the right amount of hormones to get pregnant. Blood may be drawn at different times during your menstrual cycle.

  • Hysteroscopy: Your caregiver puts a scope through your vagina and cervix to look into your uterus. It may also be done with a laparoscopy.

  • Laparoscopy: This is a surgery to look inside your abdomen. Caregivers may remove a piece of tissue from your uterus, ovaries, fallopian tubes, bowels, or other organs. The tissues are sent to a lab for tests to see if endometriosis is present. A scope (thin tube with a camera) is put into your abdomen through a small cut in your bellybutton. Dye may be used to see if the fallopian tubes are open.

  • Hysterosalpingography: This test uses x-rays to take pictures of the inside of the uterus. Dye can be used to see if the fallopian tubes are open. Caregivers may also check for other problems, such as tumors.

  • Ultrasound: Sound waves are used to show pictures of the inside of your abdomen. A small handle with lotion on it is gently moved around your abdomen. Your caregiver may also do a vaginal ultrasound. Pictures of your uterus, ovaries, or cervix are seen on a monitor.

  • MRI: This scan uses powerful magnets and a computer to take pictures of your body. An MRI may show problems in your pituitary or adrenal glands, abdomen, or pelvis. You may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with any metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.

How is female infertility treated?

Treatment depends on the cause of infertility. Treatment may increase your ability to get pregnant. You may need any of the following:

  • Medicines:

    • Dopamine agonists: These medicines stop the production of prolactin and cause ovulation.

    • Clomiphene citrate: This medicine causes the pituitary gland to release more hormones, such as follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate the ovaries to produce an egg cell each month.

    • Gonadotrophins: These medicines act like hormones and make the ovaries release an egg.

    • Metformin: This medicine may be given along with clomiphene if you have PCOS to help cause ovulation.

  • Surgery: You may have surgery to find the cause of your infertility. During surgery, endometrial tissues that are growing in the wrong places may be removed. Caregivers may also repair blockages or other problems in your fallopian tubes.

  • Assisted reproductive technology (ART): This is usually done when all other treatments have failed. This may include placing the sperm directly in the cervix or uterus, or directly inside the woman's eggs. In some cases, the egg is fertilized outside the womb and then returned to the uterus. Ask your caregiver for more information about ART.

Where can I find support and more information?

  • International Council on Infertility Information Dissemination
    P.O. Box 6836
    Arlington , VA 22206
    Phone: 1- 703 - 379-9178
    Web Address: http://www.inciid.org
  • RESOLVE The National Infertility Association
    1760 Old Meadow Rd, Ste 500
    McLean , VA 22102
    Phone: 1- 703 - 556-7172
    Web Address: www.resolve.org

When should I contact my caregiver?

Contact your caregiver if:

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You have foul-smelling discharge coming out of your vagina.

  • You have heavy or unusual vaginal bleeding.

  • You have pain in your abdomen or lower back that does not go away.

  • Your symptoms get worse or come back, even after treatment.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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