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Infertility in Women

(Female Infertility)

Definition

Infertility is not being able to conceive after a year of trying. This means having regular, unprotected sex. About one-third of cases are caused by male factors. An equal number are caused by female factors. In the remaining cases, the cause is unknown or is due to problems with both partners.

Causes

Successful conception involves many steps:
Most cases of infertility are due to problems with ovulation or problems with fallopian tubes.
Female Reproductive Organs
Fallopian Tube, Ovary, and Uterus
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Problems with Ovulation

If the egg is not released from the follicle in the ovary, you will not be able to conceive. Up to 40% of cases are due to this. Some factors that can cause problems are:

Problems with Fallopian Tubes

If the fallopian tubes are damaged or blocked, it is difficult for the egg to be fertilized or to travel to the uterus. Problems can be caused by:

Risk Factors

These factors increase your chance of developing infertility:

Symptoms

After one year of trying to conceive, you and your partner should seek help.

Diagnosis

During the first visit, you will both be evaluated. The doctor will ask about symptoms and medical history. Your doctor will look for physical problems that might cause infertility.
The following tests may be done to see if you are ovulating:
The following may be done to check if your uterus and fallopian tubes are normal:

Treatment

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Lifestyle Changes

Your doctor may suggest that you first try:

Medication

If you do not ovulate, you may be given medications that cause ovulation. The likelihood of multiple births is increased with these medications.

Surgery

If the fallopian tubes are blocked, you may need surgery to open them. Surgery is also used to repair problems with organs or to remove:

Assisted Reproductive Technologies (ART)

ART involves using human sperm and eggs or embryos in a lab to help with conception. The eggs and sperm can be from you and your partner or donated. ART methods include:
  • 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

Not all causes of infertility can be prevented. The following steps may help:

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.

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