Female Infertility

Female infertility refers to a woman's inability to get pregnant (conceive) after a year of having sex regularly (or after 6 months in women over age 35) without using birth control. Infertility can also mean that a woman is not able to carry a pregnancy to full term.

Both women and men can experience fertility problems.

What are the causes?

• Problems with reproductive organs. Infertility can result if a woman:
  • Is not ovulating or is ovulating irregularly.
  • Has a blockage or scarring in the fallopian tubes.
  • Has uterine fibroids. This is a benign mass of tissue or muscle (tumor) that can develop in the uterus.
  • Has an abnormally shaped uterus.
  • Has an abnormally short cervix or a cervix that does not remain closed during a pregnancy.
• Certain medical conditions. These may include:
  • Polycystic ovary syndrome (PCOS). This is a hormonal disorder that can cause small cysts to grow on the ovaries. This is the most common cause of infertility in women.
  • Endometriosis. This is a condition in which the tissue that lines the uterus (endometrium) grows outside of its normal location.
  • Cancer and cancer treatments, such as chemotherapy or radiation.
  • Premature ovarian failure. This is when ovaries stop producing eggs and hormones before age 40.
  • Sexually transmitted infections, such as chlamydia or gonorrhea.
  • Autoimmune disorders. These are disorders in which the body's defense system (immune system) attacks normal, healthy cells.

Infertility can be linked to more than one cause. For some women, the cause of infertility is not known (unexplained infertility).

What increases the risk?

• Age. A woman's fertility declines with age, especially after her mid-30s.
• Stress.
• Smoking.
• Being underweight or overweight.
• Drinking too much alcohol.
• Using drugs such as anabolic steroids, cocaine, and marijuana.
• Exercising excessively.

What are the signs or symptoms?

The main sign of infertility in women is the inability to get pregnant or carry a pregnancy to full term.

How is this diagnosed?

• Checking whether you are ovulating each month. The tests may include:
  • Blood tests to check hormone levels.
  • An ultrasound of the ovaries.
  • Taking a sample of the tissue that lines the uterus and checking it under a microscope (endometrial biopsy).
• Doing additional tests. This is done if ovulation is normal. Tests may include:
  • Hysterosalpingogram. This X-ray test can show the shape of the uterus and whether the fallopian tubes are open.
  • Laparoscopy. This test uses a lighted tube (laparoscope) to look for problems in the fallopian tubes and other organs.
  • Transvaginal ultrasound. This imaging test is used to check for abnormalities in the uterus and ovaries.
  • Hysteroscopy. This test uses a lighted tube to check for problems in the cervix and the uterus.

To be diagnosed with infertility, both partners will have a physical exam. Both partners will also have an extensive medical and sexual history taken. Additional tests may be done.

How is this treated?

• Women may take medicine to:
  • Correct ovulation problems.
  • Treat other health conditions.
• Surgery may be done to:
  • Repair damage to the ovaries, fallopian tubes, cervix, or uterus.
  • Remove growths from the uterus.
  • Remove scar tissue from the uterus, pelvis, or other organs.

Assisted reproductive technology (ART)

Assisted reproductive technology (ART) refers to all treatments and procedures that combine eggs and sperm outside the body to try to help a couple conceive. ART is often combined with fertility drugs to stimulate ovulation. Sometimes ART is done using eggs retrieved from another woman's body (donor eggs) or from previously frozen fertilized eggs (embryos).

• Intrauterine insemination (IUI). A long, thin tube is used to place sperm directly into a woman's uterus. This procedure:
  • Is effective for infertility caused by sperm problems, including low sperm count and low motility.
  • Can be used in combination with fertility drugs.
• In vitro fertilization (IVF). This is done when a woman's fallopian tubes are blocked or when a man has low sperm count. In this procedure:
  • Fertility drugs are used to stimulate the ovaries to produce multiple eggs.
  • Once mature, these eggs are removed from the body and combined with the sperm to be fertilized.
  • The fertilized eggs are then placed into the woman's uterus.

Follow these instructions at home:

Lifestyle

• If you drink alcohol, limit how much you have to 0–1 drink a day.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Practice stress reduction techniques that work well for you, such as regular physical activity, meditation, or deep breathing.
• Make dietary changes to lose weight or maintain a healthy weight. Work with your health care provider and a dietitian to set a weight-loss goal that is healthy and reasonable for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Seek support from a counselor or support group to talk about your concerns related to infertility. Couples counseling may be helpful for you and your partner.
• Keep all follow-up visits. This is important.

Where to find support

• Resolve - The National Infertility Association: resolve.org

Contact a health care provider if:

• You feel that stress is interfering with your life and relationships.
• You have side effects from treatments for infertility.

Summary

• Female infertility refers to a woman's inability to get pregnant (conceive) after a year of having sex regularly (or after 6 months in women over age 35) without using birth control.
• To be diagnosed with infertility, both partners will have a physical exam. Both partners will also have an extensive medical and sexual history taken.
• Seek support from a counselor or support group to talk about your concerns related to infertility. Couples counseling may be helpful for you and your partner.