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Infertility in Females

Also known as Female Infertility, Infertility

Female infertility or male infertility encompasses ten to fifteen percent of couples who are trying to conceive. A third of the time, it is due to female infertility and a third of the time it is due to male infertility. A third of the time it is unknown or is due to a combination of fertility issues.

It can be difficult to diagnose the cause of female infertility but once diagnosed, many treatments are available. Sometimes treatment isn't necessary and half of all couples considered infertile will go on to have a baby within two years. The major symptom of infertility is the inability to conceive a child in the presence of frequent intercourse for up to a year. Long or very short cycles can indicate a problem with fertility in females. There are usually no signs of infertility on exam.

Several things are important to remember if there is an infertility problem present. First, you need to ovulate. This can be checked for using basal body temperature determination and ovulation test kits to find the LH surge indicating ovulation. You need to have sperm available. A male sperm count needs to be assessed before you can be sure it is female infertility. You also need to have regular intercourse at the right time of the cycle. The egg needs to be released in a mature state at a time where it can be fertilized by the sperm.

Other causes of infertility in females include an ovulation disorder. You need to be able to ovulate at the right time. Problems with the level of LH or FSH in the system can contribute to ovulation disorders. Polycystic ovary syndrome or PCOS can cause cysts on the ovary and can be related to insulin resistance and obesity. Luteal phase defect happens when the egg does not get supported by enough estrogen. You need estrogen to prepare the lining of the uterus. In rare cases, there can be premature ovarian failure with not enough viable eggs to create a pregnancy.

There can be damage to the fallopian tubes so they don't pass eggs or sperm through the tubes. This can be due to inflammation of the fallopian tubes or previous ectopic pregnancy. Previous pelvic surgery can do damage to the fallopian tubes. Endometriosis can cause infertility by blocking the tubes or by scarring the ovaries. It can impair fertility in a number of ways. The cervix can be narrowed or blocked so that sperm can't reach the eggs.

There can be benign polyps or myomata in the uterus or within the muscle of the uterus. These can impair fertility by blocking implantation. Many women with fibromas or myomata, however, can get pregnant anyway. Unexplained fertility happens when no real cause is found for the infertility. If you have unexplained infertility, you have the highest rate of spontaneous pregnancy of all types of infertility.

Fertility testing can include ovulation testing to see that ovulation is happening. The ovulation test kit can tell you if you are ovulating. A hysterosalpingogram can tell if the tubes are patent or not and can sometimes open the tubes in the process. It can flush out debris in the tubes. A laparoscopy is done to look at the tubes and ovaries for endometriosis or scarring of the uterus, fallopian tubes or ovaries. There is a test called ovarian reserve testing that can test the FSH levels of the cycle and involves giving clomiphene that promotes the release of eggs. An ultrasound sees how many eggs are developing. Hormone testing can check for the amount of FSH, prolactin and other reproductive hormones.

Treatment of infertility depends on the cause and how long you've been fertile. Treatment can restore fertility or can assist fertility. You can take fertility drugs that induce ovulation, such as clomiphene citrate. You can take hormonal therapies that mimic LH or FSH. There are risks to taking fertility drugs including an increased chance of twins or other types of multiples. This is less likely with the oral medications as it is with injectable medications. Another side effect of ovarian stimulating drugs is the overstimulation of ovaries and enlarged ovaries.

Gonadotropins can be given to bypass the pituitary gland and can stimulate the ovary directly. This is often used with intrauterine insemination. These include the injectable medication called hMG or human menopausal gonadotropin that helps women ovulate. FSH can be given to make the eggs mature better. Metformin is given when there is a chance of PCOS, making ovulation more likely. Human chorionic gonadotropin is used with hMG in order to stimulate the release of the egg.

Letrozole is a medication that is known as an aromatase inhibitor. It may induce ovulation in some women. It is less commonly used than clomiphene.

Surgery can restore fertility by getting rid of adhesions or endometrial tissue outside of the uterus. It can be done laparoscopically and can involve the use of laser surgery to remove unwanted tissue. Tubal reversal surgery can restore fertility in a woman who has had her tubes tied in the past.

In vitro fertilization is assisted reproduction that involves harvesting eggs and using male sperm to fertilize them outside the body. The fertilized eggs will be placed inside the uterus with some of the eggs going on to becoming fetuses.