|What Is Female Infertility?
Infertility means, despite trying you cannot conceive a baby. There are two types of infertility; primary infertility is medically defined as the inability to conceive a baby after one year of regular unprotected sex. Secondary infertility means you have been pregnant at least once, but have been unable to conceive any more children since. About 40 percent of infertility cases are due to problems on the female side, 40 percent are male related and in the remaining 20 percent of cases the cause is never identified. This is known as unexplained infertility. Making a baby is a complicated process. For conception to occur it relies on a lot of good team work. It relies on healthy sperm from the man, healthy eggs from the woman, unblocked fallopian tubes so that the sperm can travel to meet the egg, the sperm needs to be strong enough to fertilize the egg when they meet; and then the fertilized egg (now called an embryo) needs to travel to the womb and implant. Finally for the embryo to grow it must be healthy and the mother's hormones need to be balanced enough to provide a hospital environment for it to develop. If there is a problem in just one of these areas, infertility can result.
What Are The Symptoms?
The main symptom is the inability to fall pregnant. It is recommended that women under the age of 30 wait a year before seeking fertility testing by a doctor. Women over 30 should seek a diagnosis after 6 months (because the clock is ticking). However you may want to consider fertility tests or treatment straight away if you:
• Have a history of irregular periods or painful periods.
• Have problems pinpointing when you ovulate.
• Have a history of sexually transmitted diseases (STDs).
• Experienced one or more miscarriages.
• Have an unhealthy body mass index (BMI) - either you are very overweight or underweight.
• Have had a prior cancer treatment or want to preserve your fertility because you require cancer treatment.
• Have endometriosis or PCOS.
• Are aged over 40.
What Causes Female Infertility?
The cause of infertility in women is not always easy to diagnose. (Male infertility tends to be more straight forward, usually it's linked to poor quality or quantity of sperm or occasionally due to past medical treatments, trauma to the groin or genetic factors). In women the causes of infertility are much more wide ranging, which means it can take longer to diagnose. Possible causes include:
Failure To Ovulate
Failure to ovulate every month is the most common cause of infertility. Women who have irregular periods do not ovulate regularly, and this makes pregnancy more difficult. Conditions which can affect ovulation include PCOS, premature ovarian failure and hormone imbalances.
Polycystic ovarian syndrome (PCOS), the majority of women with PCOS fail to ovulate.
Premature Ovarian Failure
This is a condition where a woman's ovaries stop producing estrogen and stop ovulating before the age of 40. The disorder is usually a response to an autoimmune condition whereby the body mistakenly attacks the ovaries, thinking they are a foreign invader. Read about the importance and effects of estrogen on the body.
Two hormones are responsible for ovulation every month; these are follicle stimulating hormone (FSH) and luteinizing hormone (LH). Stress, obesity or very low body weight can affect the production of these hormones causing a hormonal imbalance; the most common sign of a hormone imbalance are irregular or missed periods. Additionally, if your body doesn't produce enough of the hormone progesterone after ovulation, the lining of the womb will not be adequately prepared for the fertilized egg. This is known as a luteal phase defect.
Endometriosis, a sometimes painful condition that cause cysts and distorts (scars) the structure of the reproductive organs, including the fallopian tubes. See also, can endometriosis cause miscarriages?
Damage To Fallopian Tubes
Damage to the fallopian tubes can cause infertility. Damage may be due to inflammation from a sexually transmitted disease (STDs) like chlamydia or gonorrhea. Or it can be caused by a previous ectopic pregnancy where a fertilized eggs starts to grow in the fallopian tubes instead of the womb. In rare cases, fallopian tube cancer is found.
If the cervix is too narrow or blocked, the sperm cannot travel to the egg. This may be caused by damage to the cervix or you could just be born with a blockage.
Uterine fibroids are associated with repeat miscarriages. They can prevent conception by blocking the fallopian tubes or disrupting the embryo from settling in the womb.
Average time it takes for couples to fall pregnant: How long does it take to get pregnant?
Fertility after the contraceptive pill: How long does it take to get pregnant after stopping the Pill?
Can Anything Increase My Risk Factors For Infertility?
Yes, there are a few things that can increase your risk. These are:
Age: After the age of 32 the quality of your eggs starts to decline. By the age of 35 onwards the statistics start to seriously stack against you. See, what age does fertility go down in women?
Heavy Drinking: Women who drink more than 3 alcoholic drinks a day have problems conceiving.
Smoking: Smokers are 50 percent more likely to miscarry. They are four times more likely to experience an ectopic pregnancy, and even if the embryo survives all this, it has a higher chance of being born with a birth defect.
Coffee: Drinking more than 6 cups of coffee (containing caffeine) a day can decrease your fertility.
Sexual History: If you have had STDs or pelvic inflammatory disease, your risk of infertility is higher.
Weight: Being obese or very underweight for your height raises your risk by upsetting your hormone balance.
How Is It Diagnosed?
Initially you may choose to buy an ovulation prediction kit from your pharmacy to determine your most fertile days. This kit does not require a prescription and can be used at home to detect luteinizing hormones (LH), an indication that you are ovulating. It is also useful for pinpointing the day you ovulate so that you can plan to have sex with your partner on that day. You normally have a 12 to 24 hour window to fertilize the egg before it dies.
If you continue to have problems you will need to seek medical advice and more professional fertility testing. You may initially choose to visit a family doctor or gynecologist, or you might attend a fertility clinic. At any point if your doctor feels your case requires specialized treatment you will be sent to a clinic.
Baseline Blood Tests: This is a blood test which checks for a range of hormone imbalances.
Hysterosalpingography (HSG): This is an X-ray used to check the size and shape of your fallopian tubes and womb. It will highlight if there are any blockages in the fallopian tube or if there are any other abnormalities preventing pregnancy such as uterine fibroids, endometriosis or benign growths called polyps.
Sonohysterogram: A sonohysterogram is similar to a HSG, except a saline solution rather than a dye is injected; and an ultrasound is used rather than an X-ray. It is very effective for evaluating the uterus but is less useful for checking the fallopian tubes. It is used more for following up on surgeries or to verify findings from a HSG.
This is a surgery performed under general anesthesia. A small camera device with a light (laparoscope) is inserted through the navel (picture). Laparoscopy can be used for exploratory purposes, or it can be used for treating a condition.
Hysteroscopy: Sometimes it can be hard to see fibroids or small polyps using a HSG, so for a closer look at the womb, your doctor might recommend a hysteroscopy. A small tube is inserted through the vagina as far as the womb and images are transmitted onto a screen for analysis.
Immune Screening or Immunological Screening: This involves a highly expensive range of tests and treatment to do with the patient's immune system in pregnancy. It may be recommended to women who have repeated miscarriages.
How Is It Treated?
In many cases infertility treatment is not necessary. As many as 1 in 5 couples spontaneously become pregnant within 2 years without treatment. Of those who do choose treatment, nearly 90 percent are treated with conventional therapies like fertility drugs or corrective surgery to repair reproductive disorders. A small minority will opt for assisted reproductive technology (ART), including options like In Vitro fertilization (IVF), egg donation and even surrogacy. All these options are also discussed in our article infertility treatment. For support and resources check out infertility resources.
It's Official, Reduce Your Stress!
According to a recent study, stress CAN make women infertile. One important recently discovered that women with high levels of a stress produce extra cortisol hormones. These hormones in excessive levels cause them to stop ovulating so they cannot conceive. The study also showed that 80 percent of the women who underwent cognitive behavioral therapy to reduce their stress levels started ovulating again within 20 weeks. Read, is there an online test for stress?