Infertility in Women
(Female Infertility)
Definition
Causes
- An egg is released from the woman's ovaries (ovulation).
- The egg travels to the fallopian tubes. Here the man's sperm can fertilize it.
- If the egg is fertilized (conception), it moves down the fallopian tubes to the uterus.
- It implants itself into the wall of the uterus. It then begins its 40 weeks of fetal growth.
| Female Reproductive Organs |
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Problems with Ovulation
- Hormonal disorders
- Polycystic ovarian syndrome
- Ovulation disorder
- Ovarian cysts
Problems with Fallopian Tubes
- Pelvic inflammatory disease
- Endometriosis
- Previous surgeries which have changed pelvic structures or caused scar tissue in the pelvis
- Ectopic pregnancies
- Birth defects
Risk Factors
- Age: older than 35 years old
- Very high or very low levels of body fat (resulting in lack of ovulation), obesity
- Excessive exercise (causing to severe a loss of body fat)
- Chronic diseases, such as:
- Smoking
- Caffeine consumption
- Alcohol intake
-
Occupational exposure to:
- High temperatures
- Toxic substances
- Chemicals
- Pesticides
- Radiation
- Constant stress
-
History of:
- Pelvic inflammatory disease
- Endometriosis
- Polycystic ovaries
- Ectopic pregnancy
- Kidney failure
- Cirrhosis
- Pituitary tumors
- Anorexia nervosa
- Autoimmune hypothyroidism
- Uterine fibroids
- Pelvic surgery (including uterine surgery)
- Ulcerative colitis
- Crohn disease
- Epilepsy
- Cushing's disease
- Sickle cell anemia
- HIV infection
- Kidney disease
- Appendicitis with complications (ruptured appendix)
-
Medications, including
- Acetaminophen
- Ibuprofen
- Pain medications
- Antibiotics
- Antidepressants
Diagnosis
- Basal body temperature—rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy; you take your temperature every day and record it on a chart
- Blood test—to measure hormone levels
- Endometrial biopsy—to see if ovulation is causing changes in the lining of the uterus
- Hysterosalpingography (HSG)—an x-ray of the uterus and fallopian tubes
- Transvaginal ultrasound—a device inserted into the vagina to take a "picture" of the pelvic organs
- Hysteroscopy—a thin device inserted through the cervix to look inside the uterus
- Laparoscopy—a small device with a camera is inserted into incisions in the abdomen, allowing the doctor to examine the fallopian tubes, ovaries, and uterus
Treatment
Lifestyle Changes
- Changing the timing of sexual activity (to match your pattern of ovulation)
- Maintaining a healthy weight
- Avoiding tobacco and alcohol use
- Avoiding excessive exercise
- Decreasing stress and getting help for depression
Medication
Surgery
- Ovarian cysts
- Fibroids
- Scar tissue
Assisted Reproductive Technologies (ART)
- Artificial insemination—semen is collected and processed in a lab. It is then inserted directly into the woman's cervix or uterus.
- In vitro fertilization (IVF)—several mature eggs are removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the uterus.
- Gamete or zygote intrafallopian transfer (GIFT or ZIFT)—an egg is removed from the woman's body and mixed with sperm in a lab. The egg and sperm mixture or a 2-3 day old embryo is then placed in the fallopian tube.
- Blastocyst intrafallopian transfer—an egg is removed from the woman's body, injected with sperm, and allowed to develop. It is later implanted into the uterus.
- Intracytoplasmic sperm injection—a single sperm is injected into the egg. The resulting embryo can be implanted into the uterus or frozen for later use.
Prevention
- Stop smoking.
- Limit or avoid caffeine and alcohol.
- Maintain a healthy body weight.
- Protect yourself from sexually transmitted diseases (STDs) by using condoms. Minimize the number of sexual partners you have.
- Try stress management techniques.
RESOURCES
The American College of Obstetricians and Gynecologists http://www.acog.org
American Society for Reproductive Medicine http://www.asrm.org
The Hormone Foundation http://www.hormone.org
RESOLVE: The National Infertility Association http://www.resolve.org
CANADIAN RESOURCES
SexualityandU.ca http://www.sexualityandu.ca
Women's Health Matters http://www.womenshealthmatters.ca
References
American Medical Association website. Available at: http://www.ama-assn.org.
Cronin M, Schellschmidt I, Dinger J. Rate of pregnancy after using drospirenone and other progestin-containing oral contraceptives. Obstet Gynecol. 2009;114:616-622.
Female Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. A practice committee report: optimal evaluation of the infertile female. American Society for Reproductive Medicine. 2000;86:S264-S267.
Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility. Section IV. Lippincott, Williams & Wilkins; 2011.
Infertility. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130211T1206240241 . Published 2007. Accessed July 8, 2008.
Infertility. International Council on Infertility Information Dissemination website. Available at: http://www.inciid.org. Accessed July 8, 2008.
RESOLVE website. Available at: http://www.resolve.org. Accessed July 8, 2008.
6/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Luttjeboer FY, Verhoeve HR, van Dessel HJ, et al. The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review. BJOG . 2009;116:612-625.