Female Infertility

GENERAL INFORMATION:

What is female infertility?

• Female infertility is when a woman is unable to get pregnant after one year of trying. This means that you have had regular sex without birth control and have not been able to get pregnant. Birth control includes birth control pills, a diaphragm, condoms, or the rhythm method. This condition may happen in a woman who has never been pregnant or after one or more pregnancies. It is usually caused by a problem in the reproductive system or the hormones that affect pregnancy. Hormones are special chemicals produced by the body that control your reproductive system before, during, and after a pregnancy.
  
  
• The female reproductive system includes the ovaries, fallopian tubes, uterus (womb), cervix (bottom part of the uterus), and vagina. This system is located in the lower abdomen (stomach). Normally, the whole process of getting pregnant begins with ovulation. Ovulation is when the ovaries release an egg each month. The egg travels down the fallopian tube, joins with sperm from a recent sexual act, and is fertilized. The fertilized egg attaches to the endometrium (lining of the uterus) and starts to grow inside the womb. If the egg is not fertilized, you may menstruate (have a period) 10 to 14 days after your egg is released.

What causes female infertility? A woman may become infertile because of problems with her hormones or reproductive system. The cause may also be unknown. The following are some of the common causes of an inability to get pregnant:

• Abnormal cervix or uterus: Some women are born with defects in their uterus or cervix, which may prevent pregnancy.
  
  
• Autoimmune diseases: The immune system is the part of your body that fights infection. An autoimmune disease, like thyroid disease or diabetes, may cause problems in women who desire pregnancy.
  
  
• 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 and may cause egg-fertilizing problems. It may also cause problems with the fertilized embryo attaching to the womb.
  
  
• Endometriosis: This is a disease where tissues lining the uterus are found outside the uterus. These tissues may attach to the ovaries and other abdominal organs and cause a woman to become infertile.
  
  
• Ovulation disorder: This is the most common cause of infertility among women. Changes in the hormones that affect ovulation may be caused by the following:
  
  
  • Hypothalamic-pituitary disorders: These structures are found in the brain and control the release of hormones into the bloodstream. Prolactin hormone increases when you have a pituitary tumor and causes problems with your monthly periods and ovulation.
    
    
  • Polycystic ovarian syndrome: This is also called PCOS. This is a condition where the ovaries produce higher levels of male hormones than female hormones.
  
  
• Other causes:
  
  
  • Age 30 years and above. Fertility decreases naturally as women age.
    
    
  • Certain medicines that are used to treat mental problems, depression, or cancers.
    
    
  • Not having sex frequently or not having it in time for ovulation.
    
    
  • Previous surgeries done on the abdomen or pelvis, such as taking out your appendix.
    
    
  • Stress.
    
    
  • Use of tobacco, alcohol, or illegal (street) drugs.
    
    
  • Being overweight or losing too much weight.

What are the signs and symptoms of female infertility? The inability to get pregnant, after a year of regular unprotected sex, is the primary sign of female infertility. 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 take a health history from you. This includes past pregnancies, length of infertility, and sexual history. Caregivers will also ask questions about your past and current medical history and your lifestyle. You may have one or more of the following tests:

• 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: This test is where a scope is put into your uterus through your vagina and cervix. This helps your caregiver look into your uterus. It may also be done with a laparoscopy.
  
  
• Imaging tests:
  
  
  • Hysterosalpingography: This test, also called HSG, 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.
    
    
  • Magnetic resonance imaging test: This test is also called an MRI. During an MRI, computerized pictures are taken of your body using radiowaves. Caregivers use these pictures to look for problems in your pituitary or adrenal glands, abdomen, or pelvis (hips). You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • 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 (stomach). The handle may also be placed in your vagina. Pictures of your uterus, ovaries, or cervix are seen on a TV-like screen.
  
  
• 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 at your umbilicus (belly button). Dye may be used to see if the fallopian tubes are open.
  
  
• 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.

How is female infertility treated? Treatment depends on the cause of infertility. With treatment, you may have a greater chance of getting pregnant. You may need one or more of the following:

• Fertility medicines: These medicines treat ovulation problems by making you ovulate or controlling ovulation.
  
  
  • Dopamine agonists: These medicines stop the production of prolactin and cause ovulation in women.
    
    
  • Hormone therapy: These are special hormones that are needed to help you get pregnant or help you stay pregnant.
    
    
    • Clomiphene citrate: This medicine causes the pituitary gland to release more hormones, such as follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones motivate 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 helps the ovaries speed up the release of eggs.
  
  
• Surgery: You may have surgery to check what might be causing you to be infertile. 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? Infertility can be a life-changing condition for you and your family. Accepting that you have infertility may be hard. You and those close to you may feel scared, angry, or sad. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group. This is a group of people who also have fertility problems. Contact the following for more information:

• American Society for Reproductive Medicine
  1209 Montgomery Highway
  Birmingham, AL 35216-2809
  Phone: 1-205-978-5000
  Web Address: http://www.asrm.org
  

• 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
  7910 Woodmont Ave, Ste 1350
  Bethesda, MD 20814
  Phone: 1-301-652-8585
  Web Address: www.resolve.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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