Female infertility

Description

Infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year without success.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is unknown or a combination of male and female factors in the remaining cases.

The causes of female infertility can be difficult to diagnose. There are many treatments, depending on the cause of infertility. Many infertile couples will conceive a child without treatment.

Symptoms

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There could be no other signs or symptoms.

When to see a doctor

When to seek help may depend on your age:

  • Until the age of 35 years, most of the doctors recommend trying to get pregnant for at least one year prior to the test or treatment.
  • If you are between 35 and 40, discuss your concerns with your doctor after six months of trying.
  • If you are over 40, your doctor may suggest testing or treatment right away.

Your doctor may also want to begin testing or treatment right away if you or your partner has fertility issues, or if you have a history of irregular or painful periods, pelvic inflammatory disease, recurrent miscarriages, the treatment of cancer, or endometriosis.

Causes

During pregnancy occur in each step of the process of human reproduction that has to happen correctly. The steps in this process are:

  • One of the two ovaries releases a mature egg.
  • The egg is picked up by the fallopian tube.
  • The sperm swim up the cervix, through the uterus and into the fallopian tubes to reach the egg for fertilization.
  • The fertilized egg travels down the fallopian tube toward the uterus.
  • The fertilized egg attaches (implants) for the inside of the uterus and grows.

In women, a number of factors that can alter this process at any step. Female infertility is caused by one or more of the following factors.

Ovulation disorders

Ovulate infrequently or not at all account for the majority of the cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovaries can cause ovulation disorders.

  • Polycystic ovary syndrome (PCOS). polycystic ovary syndrome (PCOS) causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It is the most common cause of female infertility.
  • Dysfunction of hypothalamic. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt the production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
  • Primary ovarian failure. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from the ovary, possibly as a result of genetics or chemotherapy. The ovary does not produce the eggs, and it reduces the production of estrogen in women under the age of 40 years.
  • Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. This can also be caused by medications you are taking for another condition.

Damage to the fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes, preventing sperm from reaching the egg or block the passage of the fertilized egg in the uterus. Causes of fallopian tube damage or blockage can include:

  • Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
  • Previous surgery in the abdomen or pelvis, including the surgery, ectopic pregnancy, in which a fertilized egg implants and develops in a place other than the uterus, usually in the fallopian tubes

Endometriosis

Endometriosis occurs when the tissue that normally grows in the uterus implants and grows in other places. This extra growth of the tissue and the surgical removal of the same — can cause scarring, which may block the fallopian tubes and keeping the egg and sperm from uniting.

Endometriosis can also affect the implantation of the fertilized egg. The condition also seems to affect fertility in a direct way, such as damage to the sperm or egg.

Uterine or cervical causes

Several uterine or cervical causes can interfere with the egg to implant or increase the risk of miscarriage:

  • Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some of them can block the fallopian tubes or interfere with implantation, which affect fertility. However, many of the women who have fibroids or polyps become pregnant.
  • Problems with the uterus, present from birth, as an unusual form of the uterus, it can cause problems to become or stay pregnant.
  • Cervical stenosis, a narrowing of the cervix, can be caused by a malformation hereditary or damage to the cervix.
  • Sometimes the cervix can not produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Unexplained infertility

In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. While it's frustrating to get no specific answer, this problem can be corrected with the time. But you should not delay the treatment for infertility.

Risk factors

There are certain factors that can put you at greater risk of infertility, including:

  • Age. The quality and quantity of a woman's eggs begin to decline with age. In the mid-30s, the rate of follicle loss rates, resulting in fewer and poorer quality of the eggs. This makes the design more difficult and increases the risk of spontaneous abortion.
  • The habit of smoking. In addition to damaging the neck of the uterus and fallopian tubes, smoking increases the risk of miscarriage and ectopic pregnancy. It is also the thought of the age of their ovaries and deplete their eggs ahead of time. Quit smoking before starting fertility treatment.
  • Weight. Being overweight or significantly underweight can affect ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and the chance of pregnancy.
  • Sexual History. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex with multiple partners increases the risk of a sexually transmitted infection that can cause fertility problems later.
  • The consumption of Alcohol. The excessive consumption of alcohol can reduce fertility.

Prevention

For women thinking about getting pregnant soon or in the future, these tips might help:

  • Maintain a healthy weight. Overweight and underweight women have an increased risk of ovulation disorders. If you need to lose weight, moderate exercise. Strenuous, intense exercise for more than five hours per week has been associated with a decrease in ovulation.
  • Stop smoking. The tobacco has multiple negative effects on fertility, as well as your general state of health and the health of the fetus. If you smoke and are considering the possibility of pregnancy, quit smoking now.
  • Avoid the consumption of alcohol. The excessive use of alcohol can lead to decreased fertility. And any use of alcohol can affect the health of a developing fetus. If you are planning to become pregnant, avoid alcohol, and not to drink alcohol during pregnancy.
  • Reduce stress. Some studies have shown that stress can cause couples to have worse results with the treatment of infertility. Try to reduce the stress in your life before trying to get pregnant.

Female infertility

Diagnosis

If you have been unable to conceive within a reasonable period of time, seek help from your doctor for evaluation and treatment of infertility. You and your partner should be evaluated. The doctor will take a detailed medical history and perform a physical exam.

Fertility tests may include:

  • The ovulation tests. In the house, over-the-counter ovulation prediction kit detects the surge of luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone, a hormone that is produced after ovulation — can also the document that you are ovulating. The levels of other hormones, such as prolactin, also it can be reviewed.
  • Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into the uterus and an x-ray to check if there are problems on the inside of the uterus. The test also shows if the liquid comes out of the uterus and is shed of your fallopian tubes. If problems are detected, it is likely that you will need for an additional evaluation.
  • Ovarian reserve testing. This test helps to determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted supply of eggs — including women older than 35 years — I could have this series of blood and imaging tests.
  • Other evidence of the hormone. Other hormone tests check the levels of hormones of ovulation, as well as thyroid and pituitary hormones that control reproductive processes.
  • Imaging tests. A pelvic ultrasound is viewed from the neck of the uterus or the fallopian tubes of the disease. Sometimes a sonohysterogram, also called a saline infusion sonography or hysteroscopy is used to view the details on the inside of the uterus, which can't be seen in an ultrasound.

Depending on your situation, rarely tests may include:

  • The laparoscopy. This minimally-invasive surgery involves making a small incision below the navel and the insertion of a thin display device to examine the fallopian tubes, the ovaries and the uterus. A laparoscopy can identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and the problems with the ovaries and the uterus.
  • The genetic testing. Genetic testing helps to determine if there is any change in the genes that can cause infertility.

Treatment

Treatment of infertility depends on the cause, your age, how long you've been infertile, and personal preferences. Because infertility is a complex disorder, the treatment involves significant financial, physical, psychological, and time commitments.

The treatments can attempt to restore fertility through medication or surgery, or to help get pregnant with sophisticated techniques.

Medications to restore fertility

Drugs that regulate or stimulate ovulation, are known as the fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.

Fertility drugs generally function as natural hormones-the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. It is also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs.

Fertility drugs are:

  • The clomiphene citrate. It is taken by mouth, this drug stimulates ovulation by causing the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulates the growth of an ovarian follicle containing an egg. This is usually the first line of treatment for women under the age of 39 who do not have polycystic ovary syndrome (PCOS).
  • The gonadotropins.These injected treatments stimulate the ovary to produce multiple eggs. Gonadotropin drugs includehuman menopausal gonadotropin or hMG (Menopur) andFSH(Gonal-F, Follistim AQ, Bravelle). Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and the trigger of his release at the time of ovulation. There is concern that there is a greater risk of conceiving multiples and to have a preterm delivery with gonadotropin use.
  • Metformin. This medicine is used when insulin resistance is known or suspected that the cause of the infertility, usually in women with a diagnosis of polycystic ovary syndrome . Metformin (Fortamet) helps to improve insulin resistance, which can improve the probability of ovulation.
  • Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors and works in a similar way to clomiphene. Letrozole is usually used for the younger woman of 39 who have PCOS .
  • Bromocriptine. Bromocriptine (Cycloset, Parlodel), a dopamine agonist, may be used when ovulation problems are caused by the excess production of prolactin (hyperprolactinemia) by the pituitary gland.

The gonadotropins. These injected treatments stimulate the ovary to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle).

Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and the trigger of his release at the time of ovulation. There is concern that there is a greater risk of conceiving multiples and to have a preterm delivery with gonadotropin use.

Risks of fertility drugs

The use of fertility medication carries some risks, such as:

  • Pregnancy with multiples.Oral medications carry very low risk of multiples (less than 10%) and a risk of twins. Your chances of an increase of up to 30% with injectable medications. Injectable fertility medications also carry the highest risk of triplets or more. In general, the more fetuses that you are carrying, the greater the risk of premature birth, low birth weight and subsequent development of problems. Sometimes, if there are too many follicles develop, the adjustment of medication can reduce the risk of multiple pregnancies.
  • The ovarian hyperstimulation syndrome (OHSS).The injection of fertility drugs to induce ovulation can cause ovarian hyperstimulation syndrome (OHSS), which is rare. Signs and symptoms include swelling and pain of the ovaries, usually goes away without treatment, and include mild abdominal pain, bloating, nausea, vomiting, and diarrhea. It is possible to develop a more severe form ofOHSSthat can also cause rapid weight gain, painful enlargement of the ovaries, fluid in the abdomen, and shortness of breath.
  • The long-term risks of ovarian tumors.The majority of studies of women, the use of fertility drugs suggest that there are few, if any, the long-term risks. However, some studies suggest that women who take fertility drugs for 12 months or more without a successful pregnancy may be at increased risk of ovarian tumors borderline later in life. Women who have never been pregnant have an increased risk of tumors of the ovary, so that could be related to the underlying problem instead of receiving the treatment. Given that the success rates are generally higher in the first few cycles of treatment, recognizing the use of drugs every few months and that focuses on the treatments that are most successful seem to be appropriate.

Pregnancy with multiples. Oral medications carry very low risk of multiples (less than 10%) and a risk of twins. Your chances of an increase of up to 30% with injectable medications. Injectable fertility medications also carry the highest risk of triplets or more.

In general, the more fetuses that you are carrying, the greater the risk of premature birth, low birth weight and subsequent development of problems. Sometimes, if there are too many follicles develop, the adjustment of medication can reduce the risk of multiple pregnancies.

The ovarian hyperstimulation syndrome (OHSS). The injection of fertility drugs to induce ovulation can cause ovarian hyperstimulation syndrome (OHSS), which is rare. Signs and symptoms include swelling and pain of the ovaries, usually goes away without treatment, and include mild abdominal pain, bloating, nausea, vomiting, and diarrhea.

It is possible to develop a more severe form of ovarian hyperstimulation syndrome, which can also cause rapid weight gain, painful enlargement of the ovaries, fluid in the abdomen, and shortness of breath.

The long-term risks of ovarian tumors. The majority of studies of women, the use of fertility drugs suggest that there are few, if any, the long-term risks. However, some studies suggest that women who take fertility drugs for 12 months or more without a successful pregnancy may be at increased risk of ovarian tumors borderline later in life.

Women who have never been pregnant have an increased risk of tumors of the ovary, so that could be related to the underlying problem instead of receiving the treatment. Given that the success rates are generally higher in the first few cycles of treatment, recognizing the use of drugs every few months and that focuses on the treatments that are most successful seem to be appropriate.

The surgery to restore fertility

Several surgical procedures that can correct the problems or otherwise improve the fertility of the woman. However, the surgical treatments for fertility is rare these days due to the success of other treatments. They include:

  • Laparoscopic surgery or hysteroscopy. The surgery may involve the correction of issues with the uterine anatomy, the removal of endometrial polyps and some types of fibroids that distort the uterine cavity, or the elimination of the pelvis, or adhesions, uterine.
  • The ligation surgeries. If your fallopian tubes are blocked or filled with fluid, the doctor may recommend laparoscopic surgery to remove the adhesions, dilating a tube or to create a new tubal opening. This surgery is rare, as the rates of pregnancy are generally better with in vitro fertilization (IVF). For this surgery, the removal of the tubes or the blocking of the tube near the uterus, can improve the chances of pregnancy with in vitro fertilization (IVF).

Reproductive assistance

The most commonly used methods for reproductive assistance include:

  • Intrauterine insemination (IUI). During the intrauterine insemination (IUI), millions of sperm are placed inside the uterus around the time of ovulation.
  • The technology of assisted reproduction. This implies the recovery of mature eggs, fertilizing them with sperm in a dish in a laboratory, the transfer of embryos in the uterus after fertilization. IVF is the most effective assisted reproductive technology. One cycle of IVF takes several weeks and requires frequent blood tests and daily injections of the hormone.

Coping and support

Dealing with infertility can be emotionally and physically exhausting. To deal with the ups and downs of infertility testing and treatment, consider the following strategies:

  • Learn all that you can. Ask your doctor to explain the steps for your therapy to help you and your partner to prepare. Understanding the process can help to reduce anxiety.
  • Seek support. Although infertility can be a deeply personal, getting to your partner, family or close friends, or a professional support. Many online support groups allow you to discuss issues related to infertility without identifying yourself.
  • Exercise and eating a healthy diet. Maintain a moderate exercise routine and eating healthy food can improve your outlook and stay focused on living your life despite the problems of fertility.
  • Consider other options. Determine the alternatives to adoption, donor sperm or egg, or even not to have children — as soon as possible in the process of infertility treatment. This can reduce anxiety during treatments, and the disappointment if conception does not occur.

Preparing for your appointment

For an infertility evaluation, it is likely that you see a physician who specializes in the treatment of disorders that prevent couples from the conception (assisted reproduction). It is likely that your doctor will want to evaluate both you and your partner.

What you can do

To prepare for your appointment:

  • Chart of the menstrual cycle and associated symptoms for a couple of months. In a calendar or an electronic device, the registry when the period starts and stops and how your cervical mucus looks. Take note of the days that you and your partner have sex.
  • Make a list of all the medicines, vitamins, herbs, or other supplements that you take. Include the dose and how often you take.
  • Bring previous medical records. Your doctor will want to know what tests you have had and the treatments I have tried.
  • Bring a notebook or electronic device with you. You can get a large amount of information on your visit, and it can be difficult to remember everything.
  • Think of the questions that I will ask. List of the most important questions first to make sure they get answered.

Some basic questions to ask include:

  • When and how often should we have sex if we hope to conceive?
  • There are life style changes that we can do to improve the chances of getting pregnant?
  • Do you recommend the test?? If so, what type?
  • The availability of medicines that can improve the ability to conceive?
  • What side effects can the drug cause?
  • Explain the treatment options in detail?
  • What treatment is recommended in our situation?
  • What is your success rate to help couples to achieve pregnancy?
  • Do you have brochures or other printed material that we can have?
  • What sites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Some possible questions that your doctor or other health care provider can do include:

  • How long have you been trying to get pregnant?
  • How often do you have sex?
  • Have you ever been pregnant? If so, what was the result of the pregnancy?
  • You have had pelvic or abdominal surgeries?
  • Have you been treated for gynaecological conditions?
  • At what age did you start having periods?
  • On average, how many days passed between the start of a menstrual cycle and the beginning of your next menstrual cycle?
  • Do you have premenstrual symptoms such as breast tenderness, abdominal bloating or cramps?
Symptoms and treatment of Female infertility