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24 Feb

Infertility in Women: Causes and Treatment

 

Infertility is a condition that affects approximately 1 out of every 6 couples. An infertility diagnosis is given to a couple that has been unsuccessful in efforts to conceive over the course of one full year. When the cause of infertility exists within the female partner, it is referred to as female infertility. Female infertility factors contribute to approximately 50% of all infertility cases, and female infertility alone accounts for approximately one-third of all infertility cases.

The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.

Ovulation problems may be caused by one or more of the following:

    A hormone imbalance

    A tumor or cyst

    Eating disorders such as anorexia or bulimia

    Alcohol or drug use

    Thyroid gland problems

    Excess weight

    Stress

    Intense exercise that causes a significant loss of body fat

    Extremely brief menstrual cycles

 

Damage to the fallopian tubes or uterus can be caused by one or more of the following:

    Pelvic inflammatory disease

    A previous infection

    Polyps in the uterus

    Endometriosis or fibroids

    Scar tissue or adhesions

    Chronic medical illness

    A previous ectopic (tubal) pregnancy

    A birth defect

    DES syndrome (The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.)

Abnormal cervical mucus can also cause infertility. Abnormal cervical mucus can prevent the sperm from reaching the egg or make it more difficult for the sperm to penetrate the egg.

Potential female infertility is assessed as part of a thorough physical exam. The exam will include a medical history regarding potential factors that could contribute to infertility.

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Healthcare providers may use one or more of the following tests/exams to evaluate fertility:

   – A urine or blood test to check for infections or a hormone problem, including thyroid function

   – Pelvic exam and breast exam

   -A sample of cervical mucus and tissue to determine if ovulation is occurring

   -Laparoscope inserted into the abdomen to view the condition of organs and to look for blockage, adhesions or scar tissue.

   -HSG, which is an x-ray used in conjunction with a colored liquid inserted into the fallopian tubes making it easier for the technician to check for blockage.

   -Hysteroscopy uses a tiny telescope with a fiber light to look for uterine abnormalities.

   -Ultrasound to look at the uterus and ovaries. This may be done vaginally or abdominally.

   -Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.

Tracking your ovulation through fertility awareness will also help your healthcare provider assess your fertility status.

Female infertility is most often treated by one or more of the following methods:

    -Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle

    -Taking medications to stimulate ovulation

   – Using supplements to enhance fertility – shop supplements

   -Taking antibiotics to remove an infection

   -Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

There is usually nothing that can be done to prevent female infertility caused by genetic problems or illness. However, there are several things that women can do to decrease the possibility of infertility:

  • Take steps to prevent sexually transmitted diseases
  • Avoid illicit drugs
  • Avoid heavy or frequent alcohol use
  • Adopt good personal hygiene and health practices
  • Have annual checkups with your GYN once you are sexually active

It is important to contact your healthcare provider if you experience any of the following symptoms:

  • Abnormal bleeding
  • Abdominal pain
  • Fever
  • Unusual discharge
  • Pain or discomfort during intercourse
  • Soreness or itching in the vaginal area

Other Fertility Treatments for Females

Once a woman is diagnosed with infertility, the overall likelihood for successful treatment is 50%.1

Whether a treatment is successful depends on the:

    Underlying cause of the problem

    Woman’s age

    History of previous pregnancies

    How long she has had infertility issues

Fertility treatments are most likely to benefit women whose infertility is due to problems with ovulation. Treatment is least likely to benefit infertility caused by damage to the fallopian tubes or severe endometriosis.

The first step of treating infertility in many cases is to treat the underlying cause of infertility. For example, in cases where thyroid disease causes hormone imbalances, medication for thyroid disease may be able to restore fertility.

Fertility treatments for women fall into the following categories:

    Medication Treatments for Female Infertility

    Surgical Treatments for Female Infertility

    Assisted Reproductive Technology (ART)

Medication Treatments for Female Infertility

The most common medications used to treat infertility help stimulate ovulation. Examples of these types of medications include2:

    Clomiphene or Clomiphene Citrate

    Gonadotropins or human chorionic gonadotropin (hCG)

    Bromocriptine or cabergoline

Clomiphene or Clomiphene Citrate

Clomiphene is a medication patients take by mouth (orally). It causes the body to make more of the hormones that cause the eggs to mature in the ovaries.2 If a woman does not become pregnant after taking clomiphene for six menstrual cycles, a health care provider may prescribe other fertility treatments. Patients take clomiphene on days 3 to 5 of the menstrual cycle.

Clomiphene causes ovulation to occur in 80% of women treated. About half of those who ovulate are able to achieve a pregnancy or live birth.

Use of clomiphene increases the risk of having a multiple pregnancy. There is a 10% chance of twins, but having triplets or more is rare—less than 1% of cases.

Gonadotropins and Human Chorionic Gonadotropin (hCG)

Gonadotropins are hormones that are injected in a woman to directly stimulate eggs to grow in the ovaries, leading to ovulation. Health care providers normally prescribe gonadotropins when a woman does not respond to clomiphene or to stimulate follicle growth for ART.

Gonadotropins are injected starting on day 2 or day 3 of the menstrual cycle for 7 to 12 days.

While a woman is treated with gonadotropins, a health care provider uses transvaginal ultrasound to monitor the size of the developing eggs, which grow inside tiny sacs called follicles (pronounced FOL-i-kuhls). The health care providers also draw blood frequently to check the ovarian production of estrogen.

The chance of a multiple birth is higher with gonadotropins than with clomiphene, and 30% of women who conceive a pregnancy with this medication have multiple births. About two-thirds of multiple births are twins. Triplets or larger multiple births account for the remaining third.

hCG is a hormone similar to leutenizing hormone that can be used to trigger release of the egg after the follicles have developed.

Bromocriptine or Cabergoline

Bromocriptine and cabergoline are pills taken orally to treat abnormally high levels of the hormone prolactin, which can stop ovulation. Certain medications, kidney disease, and thyroid disease can cause high levels of prolactin.

Bromocriptine or cabergoline allow 90% of women to have normal prolactin levels.

Once prolactin levels become normal, 85% of women using bromocriptine or cabergoline ovulate.

Surgical Treatments for Female Infertility

If disease of the fallopian tubes is the cause of infertility, surgery can repair the tubes or remove blockages in the tubes. Success rates of these types of surgery, however, are low. These surgeries involving the fallopian tubes also increase the risk of ectopic pregnancy, which is a pregnancy that occurs outside of the uterus. Ectopic pregnancies are also called “tubal pregnancies” because they most often occur in a fallopian tube.

Surgery to remove patches of endometriosis has been found to double the chances for pregnancy. Surgery can also remove uterine fibroids, polyps, or scarring, which can affect fertility.

Source: americanpregnancy.org/National Institute of Child Health & Human Development

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