Female Infertility

A couple is believed infertile if conception does not happen:

• After one year of unprotected sex
• After 6 months in women over age 35
• If there are known problems causing infertility

To diagnose infertility, both the man and the woman are tested.

Some health care providers can do a basic infertility evaluation. But, many causes of infertility are best treated by a board-certified reproductive endocrinologist. This is an OB/GYN who has had education and training in infertility and is certified with the American Board of Obstetrics and Gynecology.

Generally, the health care provider will test both partners to find the cause of infertility. The health care provider is looking for answers to these questions:

• Is the female ovulating regularly?
• Is the male making healthy sperm?
• Are the female's egg and the male's sperm able to unite and grow normally?
• Are there any problems with implantation?
• Is the mother able to maintain the pregnancy?

These tests are often part of the basic workup for infertility.

Both Partners

Health and sexual history to look for any physical causes of infertility and find out if they have sex at the right time.

Female

• Physical exam: You will have a complete physical exam including a Pap test and testing for infection.
• Ovulation evaluation: You can check to see if you are ovulating by keeping a basal body temperature chart. This is your morning body temperature. Other ovulation prediction methods use urine samples.
• Hormone testing: Hormone testing may be recommended. Certain hormones increase and decrease at various times in the monthly cycle.
• Ultrasound: Ultrasound can show the follicles, which are the sacs that contain the developing eggs. It can also show the thickness of the uterine tissues. Your healthcare provider can also check for problems such as ovarian cysts or fibroids.
• X-rays: A hysterosalpingogram may be advised. For this test, a dye is injected into the cervical opening to see inside the uterus. This lets the radiologist see if the fallopian tubes are open.

Your health care provider will discuss the best treatment with you based on:

• How old you are
• Your overall health and medical history
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Once a diagnosis is made, you can work with a fertility expert to find the best treatment. Most people with infertility are treated with conventional therapies. This includes treatment with medicine or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many choices to offer an infertile couple.

Types of treatments for women may include:

• Intrauterine insemination: This method uses a small flexible tube called a catheter to place specially washed and prepared sperm directly into the uterus. It may be used for low sperm count or cervical mucus problems. This method is often used along with ovulation medicines.
• Ovulation medicine: These medicines help regulate the timing of ovulation. They stimulate the growth and release of mature eggs. They can also help correct hormone problems that can affect the lining of the uterus. Ovulation medicines can stimulate more than one egg to be released. This raises the chance of having twins and other multiples. Some of the common medicines include:
  • Clomiphene citrate
  • Human menopausal gonadotropins. Medicines with follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
• Surgery: Surgery may be used to treat or repair a condition such as blocked fallopian tubes or endometriosis. This may be done using laparoscopy. In a laparoscopy, a small telescope inserted into the abdominal or pelvic cavity lets the healthcare provider see internal organs. Some methods to treat infertility can be done using instruments inserted through the laparoscope.
• Assisted reproductive technology (ART): For some couples, more extensive treatment is needed. With most forms of ART, the sperm and egg are joined in the lab. The fertilized egg is then returned to the woman's uterus where it can implant and grow. While ART procedures are often costly, many are being used with success. These include:
• In vitro fertilization (IVF): This involves removing a woman's eggs and fertilizing them in the lab with sperm. The embryo is then transferred into the woman's uterus through the cervix. Most couples transfer two embryos. More may be transferred in certain cases. IVF is the most common form of ART. It is often the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. IVF is also used for infertility caused by endometriosis or male factor infertility. IVF is sometimes used to treat couples with long-term unexplained infertility who have not been able to get pregnant with other treatments.
• Intracytoplasmic sperm injection (ICSI): In this procedure, a single sperm is injected directly into an egg. This method is most commonly used to help with male factor infertility problems.
• Gamete intrafallopian transfer (GIFT): This involves using a fiber-optic instrument called a laparoscope to guide the transfer of unfertilized eggs and sperm into the woman's fallopian tubes through small incisions in her abdomen. GIFT is only used in women with healthy fallopian tubes.
• Zygote intrafallopian transfer (ZIFT): This involves fertilizing a woman's eggs in the lab. Then the laparoscope guides the transfer of the fertilized eggs (zygotes) into her fallopian tubes. ZIFT is only used in women with healthy fallopian tubes.
• Donor eggs: This involves transferring an embryo from a donor to an infertile woman. The donor gives up all parental rights to any resulting children. ART using donor eggs is more common in older women. The chance of a fertilized egg implanting is related to the age of the woman who produced the egg. Egg donors are typically in their 20s or early 30s.
• Embryo cryopreservation: In this method, the embryos are frozen for transfer at a later date. This is often used when an IVF cycle produces more embryos than can be transferred at one time. The remaining embryos can be transferred in a future cycle if needed.