Female Infertility

Female infertility, a common condition, is the inability to get pregnant or have a successful pregnancy. This condition is usually diagnosed when a woman has failed to get pregnant after trying for 12 consecutive months (through unprotected sexual activity). IWHC’s Fertility Specialists are able to provide many options for treating infertility. These include medications to correct hormonal problems and surgery for physical issues like dyspareunia (painful intercourse).

What is female infertility and how can it be prevented?

Infertility refers to a condition that affects the ability to become pregnant or give birth to a baby. This is most common in heterosexual couples (man or woman) after one year of trying. However, it may be diagnosed earlier depending on other factors. One third of the causes of infertility in heterosexual couples are due a male problem. The other third is due to a woman’s problem. A third are due a combination of unknown and known reasons. If the cause of infertility is determined to be from the female partner, this is called female infertility (or “female factor”) infertility.

Is female infertility common?

Infertility can be a serious condition. Infertility affects at least 10% of women. As a woman gets older, her chances of becoming infertile increase.

SYMPTOMS & CAUSES

What causes female infertility?

Infertility can be caused by many different factors. It can be hard to determine the cause. Some couples experience infertility that is “unexplained”, or multifactorial infertility. This refers to multiple causes, which often include both male and female factors. Female factor infertility could be caused by:

• Problems in the uterus: These include polyps and fibroids, adhesions, or septum within the cavity of your uterus. While fibroids and polyps can develop on their own, other abnormalities such as a septum (or other anomalies) may be present from birth. After surgery such as a dilation or curettage (D&C), adhesions may form.
• Problems in the Fallopian Tubes: The most frequent cause of “tubal factor” infertility is pelvic inflammatory disease. This condition is usually caused by Chlamydia or Gonorrhea. It can be caused by other infections such as appendicitis.
• Ovulation problems: A woman might not ovulate (release an eggs) as often as she would like. Hormonal problems, past eating disorders, substance abuse and pituitary tumors all can influence ovulation.
• Egg quality and quantity problems: Women have all of their eggs when they are born, and the supply can “run out” before menopause. Some eggs may have an insufficient number of chromosomes, which makes them unable to fertilize and grow into healthy fetuses. These chromosomal problems (such as balanced translocation) may affect all eggs. Some are random, but more common as women age.

Who is at greatest risk of female infertility?

There are many factors that can increase the risk of female infertility. Female infertility can be caused by a variety of factors, including genetic (inherited) traits, lifestyle choices, age, and general health. You may also need to consider:

• Age
• Hormone issues that stop ovulation
• Atypical menstrual cycle
• Obesity
• Being underweight
• Extreme exercise can result in a lower body-fat percentage
• Endometriosis
• Structural problems: Problems with the fallopian tubes or uterus, as well as the ovaries
• Uterine Fibroids
• Cysts
• Tumors
• Autoimmune Disorders
• Sexually Transmitted Infections
• Polycystic Ovary Syndrome
• Primary Ovarian Insufficiency
• Substance Abuse
• Smoking
• Past Ectopic Pregnancy

What does age have to do with female infertility?

As a woman gets older, her chances of getting pregnant drop. Because many couples wait until their 30’s and 40’s to have children, age is becoming a common factor in female fertility. Fertility issues are more common in women over 35. This is due to:

• The overall number of eggs is lower
• An abnormally high number of chromosomes is found in eggs
• Increased risk for other health conditions

DIAGNOSIS AND TESTING

What questions will my doctor ask me during an appointment to diagnose female fertility?

Your healthcare provider will want to know your past pregnancies, miscarriages, and menstrual cycles. They may also ask about unusual vaginal bleeding, or discharge. Your past pelvic infections and sexually transmitted infections (STIs) may be brought up. Some questions may include:

• Are your menstrual cycles regular and normal or irregular and painful?
• Are you experiencing heavy bleeding?
• Are you experiencing any pelvic pain?
• Have you had any past abdominal surgery?

To diagnose female infertility, what tests will my healthcare provider run?

As part of a physical examination, some tests can be performed in your healthcare provider’s office. These tests could include:

• A complete physical exam
• A Pap test
• A pelvic exam
• A pelvic ultrasound
• Examine the breasts to determine if there is unusual milk production

You may also need to have other tests done in a laboratory. These tests include:

• Blood tests: The type of laboratory tests you need will depend on your medical history and the diagnosis your doctor is considering. Tests for thyroid, prolactin, ovarian reserve, and progesterone are some examples of lab tests.
• X-ray hysterosalpingogram: The caregiver injects a dye into the cervix, and then watches with an x-ray how it moves through the fallopian tubes. This test is used to check for blockages.
• Laparoscopy: To examine the organs, a small monitor called a laparoscope (or laparoscope) is inserted into the abdomen.
• Transvaginal ultrasound: This test is performed by inserting an ultrasound probe into the vagina. This allows healthcare providers to see more of the organs, such as the uterus or ovaries.
• Saline sonohysterogram: This test examines the lining of your uterus to determine if there are any fibroids, polyps or other structural abnormalities. The transvaginal ultrasound uses saline (water) to fill the uterus.
• Hysteroscopy: This test involves inserting a thin, flexible device called a “hysteroscope” into the vagina through the cervix to view the inside the uterus.

MANAGEMENT & TREATMENT

What is the treatment for female infertility?

There are many treatment options available once your healthcare provider has determined the cause of female infertility. The type of treatment will depend on the cause. Surgery may be an option for structural problems, but hormonal medication can be used to treat other issues (ovulation problems, thyroid conditions).

Women with infertility may consider adoption or gestational surrogacy if they wish to start a family.

PREVENTION

Can infertility be prevented in females?

It is impossible to predict or prevent most forms of female infertility. Infertility can be prevented by reducing the risk factors. Lifestyle modifications such as quitting smoking and reducing alcohol intake can help to improve fertility. It is also important to maintain a healthy weight, and good exercise habits. Regular visits to your healthcare provider are important in order to discuss any risks that may exist for female infertility.

PROGNOSIS

The individual and the cause of female infertility will determine the outlook. The outlook for female infertility is generally good if medication can be used to treat an abnormal ovulatory condition or a simple surgery can be performed to correct a structural problem (polyps, solitary fibroids). To find out more about your prognosis, talk to your doctor about your family history and any underlying medical conditions.

When should I consult my doctor regarding female infertility?

If you’re a woman living in a heterosexual relationship and having regular intercourses and menstrual periods, your doctor should be consulted after 12 months (or six months if you’re over 35) of trying to conceive. 

Note from Iowa Women’s Health Center:

It can be extremely stressful to experience infertility. Reach out to your healthcare provider if you’ve been trying unsuccessfully to get pregnant for more than 12 months, or six months if over 35. Your provider will help you create a plan to move forward once you have been diagnosed.