Infertility


Infertility

Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 15 percent of couples are infertile, which means that they’ve been trying to get pregnant for at least a year — or for at least six months if you’re a woman age 35 or older.
Generally, infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.
The cause of female infertility can be difficult to diagnose, but many treatments are available. Treatment isn’t always necessary: Half of all infertile couples will go on to conceive a child spontaneously within the next 24 months.

Symptoms

The main symptom of infertility is the inability of a couple to get pregnant. An abnormal menstrual cycle that’s too long (35 days or more) or too short (less than 21 days) can be a sign of female infertility. There may be no other outward signs or symptoms.

When to see a doctor

If you’re in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.
If you’re age 35 to 40, discuss your concerns with your doctor after six months of trying.
If you’re over 40 or have a history of irregular or painful periods, pelvic inflammatory disease (PID), repeated miscarriages, prior cancer treatment or endometriosis, your doctor may want to begin testing or treatment right away.

Causes

For pregnancy to occur, every part of the complex human reproduction process — from the ovary’s release of a mature egg to the fertilization of the egg to the fertilized egg’s implantation and growth in the uterus — has to take place just right. In women, a number of factors can disrupt this process at any stage. Female infertility is caused by one or more of these factors.

  • Ovulation disorders: Ovulation disorders account for infertility in 25 percent of infertile couples. These can be caused by flaws in the regulation of reproductive hormones.
  • Abnormal FSH and LH secretion: The two hormones responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are produced by the pituitary gland in a specific pattern during the menstrual cycle.
  • Polycystic ovary syndrome (PCOS): In PCOS, complex changes occur in the hypothalamus, pituitary and ovary, resulting in overproduction of male hormones (androgens), which affects ovulation.
  • Luteal phase defect: Luteal phase defect happens when your ovary doesn’t produce enough of the hormone progesterone after ovulation. Progesterone is vital in preparing the uterine lining for a fertilized egg.
  • Premature ovarian failure: This disorder is usually caused by an autoimmune response, where your body mistakenly attacks ovarian tissues. It results in the loss of the eggs in the ovary, as well as in decreased estrogen production.

Damage to fallopian tubes (tubal infertility)

When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or close off the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

  • Inflammation of the fallopian tubes (salpingitis) due to chlamydia or gonorrhea
  • Previous ectopic pregnancy, in which a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of in the uterus
  • Previous surgery in the abdomen or pelvis

Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which impairs fertility. Researchers think that the excess tissue may also produce substances that interfere with conception.

  • Cervical narrowing or blockage
  • Uterine causes
  • Unexplained infertility

Treatment

How your infertility is treated depends on the cause, your age, how long you’ve been infertile and personal preferences. Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before you’re able to conceive.
Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.
Fertility restoration: Stimulating ovulation with fertility drugs
Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. In general, they work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation.
Using fertility drugs carries some risks:

  • Becoming pregnant with twins or other multiples
  • Developing enlarged ovaries

There are several fertility drugs for abnormal LH and FSH production. These drugs include:

  • Clomiphene citrate (Clomid, Serophene)
  • Gonadotropins
  • Fertility restoration: Surgery
  • Reproductive assistance: In vitro fertilization