Infertility in Women

What is infertility?

Infertility is not being able to get pregnant after having regular sexual intercourse without birth control for at least 1 year (or 6 months if the woman is 35 or older). Infertility may also be a problem if you can get pregnant but can’t stay pregnant until the baby is old enough to be delivered. For example, you may be infertile if you get pregnant but then keep having miscarriages.

Infertility is a problem for 1 of every 6 couples. It can be caused by problems in a man's or a woman's reproductive system. Problems in the woman's body are responsible for about half of the cases of infertility.

What is the cause?

Often a woman is infertile because her ovaries are not releasing eggs. The ovaries may have trouble releasing healthy eggs. For example, this is more likely to be a problem when a woman gets older, especially after age 35. Other things that may affect the eggs and the release of eggs (ovulation) are:

• hormone problems
• overweight or underweight
• smoking
• too much stress
• unhealthy diet
• ovarian tumors or cysts
• intense exercise, such as long-distance running
• abuse of alcohol or drugs
• tumors in the pituitary gland
• chronic illness, such as diabetes or thyroid disease
• some medicines

An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or the uterus may be damaged by:

• an infection, such as a sexually transmitted disease
• growths in the uterus, such as polyps or fibroids
• scar tissue from surgery (called adhesions)
• endometriosis (tissue from the lining of the uterus growing outside the uterus)
• a birth defect in the female organs

Problems with your cervix can make it hard for the sperm to reach and fertilize the egg. For example:

• The cervix may be very narrow or closed. This problem is called cervical stenosis.
• Your cervical mucus may not be normal.
• The cervix may be infected (cervicitis).

In rare cases, a woman's body is allergic to sperm and destroys it.

Some rare genetic problems also cause infertility.

Often the cause of infertility cannot be found and is called unexplained infertility.

How is it diagnosed?

You and your partner should have thorough physical exams if you cannot get pregnant after 1 year of trying. If you are over age 35, you should see your healthcare provider after 6 months of trying to get pregnant. At your exam you will be asked about:

• your sexual history, including any previous pregnancies
• your medical and family history
• your diet and exercise habits
• stress
• your use of drugs, alcohol, and tobacco
• your sexual practices, such as how often you have sex and whether you use lubricants

You may need to find out if you are ovulating each month. Blood tests or an ultrasound scan of the ovaries may be done to see if you are ovulating. You are probably ovulating regularly if you get your period regularly every month.

Other tests that may be done are:

• urine and blood tests to check for infections or hormone problems
• tests of samples of cervical mucus
• tests of your partner's semen to check his sperm

You may have the following procedures to check for problems with the fallopian tubes or uterus:

• hysterosalpingogram, which is an X-ray of the uterus and fallopian tubes with dye
• hysteroscopy, which uses a scope put into the vagina, through the cervix, and into the uterus to examine the inside of the uterus
• laparoscopy, which uses a scope put through a tiny cut in your belly to look at the female organs

How is it treated?

If your healthcare provider can find a cause of the infertility, he or she will try to treat the cause. Treatment for infertility may include medicine (usually hormones or antibiotics) or surgery. Sometimes both partners need treatment. Examples of treatments for women are:

• taking hormones
• quitting smoking
• stopping use of alcohol or drugs
• taking drugs to make you release more eggs
• having surgery
• planning to have sex on certain days

If your partner's sperm count is low, artificial insemination may be an option. When this is done, semen is collected at several different times and stored until there are enough sperm. The semen is then put into your uterus or fallopian tubes during the most fertile time of your menstrual cycle. Another choice is to use sperm donated by another man.

Assisted reproductive technology (ART) is another option. It uses several different methods to remove eggs from your body, fertilize the eggs with sperm in the lab, and put the fertilized eggs (embryos) back into your body. The most effective method is in vitro fertilization. It is often done when a man's sperm count is low or your fallopian tubes are blocked. ART can be expensive and time-consuming, but it has made it possible for many couples to have children. ART may not be covered by your health insurance company.

Many couples who are treated for infertility are able to have a baby, but looking for and treating causes of infertility can be stressful for a couple. It can strain your relationship. Counseling may help you get through hard times.

How can I help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or an illness. However, you can do the following to lower the risk of infertility:

• Prevent sexually transmitted diseases by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Limit the amount of alcohol you drink to no more than 1 or 2 drinks a week.
• Avoid the use of street drugs (such as heroin).
• Don’t overuse prescription and nonprescription drugs.
• Don’t smoke.
• Practice good personal hygiene to prevent infections.
• Don’t use lubricants during sex. It can make it harder for sperm to reach the egg.

Contact your healthcare provider about any signs of infection or hormonal changes, such as:

• a discharge from the vagina that is not normal
• pain or swelling in your belly
• fever
• bleeding from your vagina that is not normal
• a change in your menstrual periods
• discomfort during sex
• sores and itching in the vagina or rectal area