Female Infertility
What is Female Infertility?
Infertility is generally considered to be the failure to conceive after one year of unprotected sexual activity. One in every five couples in the US will experience infertility at some point.
Major causes of infertility in women include ovarian dysfunction (twenty percent), abnormal tube function (30%) and cervical factors (five percent).
Other factors include uterine abnormalities such as congenital abnormalities and exposure to a hormone once given to prevent miscarriages, absent or infrequent ovulation, vigorous athletic training, tobacco, and alcohol or drug use.
How is it diagnosed?
History: The individual will report failure to conceive. Pertinent history includes past pelvic inflammatory disease or sexually transmitted diseases, pregnancies or abortions, menstrual pattern, and sexual activity.
Physical exam: A general physical and a thorough pelvic exam will be done. A pelvic exam may be scheduled after sexual intercourse to determine whether cervical mucus is normal.
Tests that may be done include complete blood count (CBC), urinalysis, cervical cultures, blood tests for syphilis, rubella antibody, thyroid function, sickle cell anemia (if black), serial urinary luteinizing hormone tests, serum progesterone level, follicle stimulating hormone level, prolactin level, histocompatibility antigen testing, ultrasound of the fallopian tubes and ovaries, hysterosalpingography, endometrial biopsy, and laparoscopy.
How is Female Infertility treated?
Treatment depends on the underlying cause and may include hormone supplementation, antibiotics, fertility drugs, condom use to decrease antibody production, exercise and weight gain, removal or repair of obstructions or tumors via surgery, artificial insemination and in vitro fertilization with embryo transfer.
Medications
Femara (Letrozole), Arimidex (Anastrozole), Premarin (Conjugated Estrogens)
What might complicate it?
The presence of infertility in both partners may complicate treatment. Various ethical and moral decisions may need to be made. Infertility that is severe or prolonged over three years is more difficult to treat. Advancing age may introduce a sense of urgency about treatment.
Predicted outcome
The chances of conceiving are good if the reason for the infertility can be found and treated. When the cause is unexplained, pregnancy occurs 34% of the time within six months and 76% of the time within two years of treatment. In vitro fertilization is successful 20% to 50% of the time. Failure to impregnate can cause frustration, resentment, feelings of inadequacy, anger, guilt and marital strife. The time and financial costs of fertility treatment may be a burden. Adoption may be the only option.
Alternatives
Other possible diagnoses include ovarian or uterine tumors, polycystic ovaries, pituitary microadenoma, hypothalamic amenorrhea, and endometriosis.
Appropriate specialists
Gynecologist and fertility specialist.
Last updated 4 April 2018