Infertility in women is a disorder of the reproductive system that prevents the body’s ability to ovulate and conceive. Recurrent pregnancy loss is often considered a type of infertility. A heterosexual couple is considered infertile when they have not conceived after a full year of regular sexual intercourse without using contraception. The timeframe drops to six months if the woman is over age 35. Couple infertility may be due to male factors, female factors, or a combination of both.
In addition to attempting pregnancy without success, other symptoms of infertility in women may include:
- Irregular menstrual cycles—This symptom may or may not be associated with infertility.
- Pain with sexual intercourse—This symptom may or may not be associated with infertility.
- Inability to conceive after unprotected sexual intercourse
- Recurrent miscarriage
Although a person with specific risk factors may be at an increased risk, anyone can develop infertility. Having one or more of the risk factors listed below does not necessarily mean that you will develop infertility. If you do have specific risk factors, talk with your doctor about what you can do to lower your risk.
- Woman over 35 are more likely to have fertility problems. The ovaries become less effective in producing eggs that can be successfully fertilized.
- Medical Conditions
- Menstrual cycle dysfunction—the most common cause of infertility due to failure to ovulate
- Problems with ovulation—something affects the ovary’s development and release of an egg
- Fallopian tube blockage—present from birth or a result of surgery, trauma, or pelvic infection
- Endometriosis —results when tissue from the uterine lining is found outside the uterus
In some cases, the following drugs may increase your risk of infertility:
- Chemotherapeutic agents used to treat cancer
- Pain medications
- Body Fat
- Very high or very low levels of body fat often affect hormone levels, which can alter ovarian function. A certain amount of body fat cells in women are needed to produce sufficient estrogen along with the ovaries.
- Other Risk Factors
- Excessive Exercise
- Occupational Exposures such as standing for long periods of time or being chronically exposed to dust or loud noises are linked to infertility. Other evidence suggests that the risk of infertility may be higher in women who frequently switch from working day shifts to night shifts or have job-related exposure to high temperatures, chemicals, radiation, pesticides, and other toxic substances.
The treatment and management of infertility in women may involve lifestyle changes, medications, and surgery, or a combination of approaches. The goal of treatment is to correct anatomical and/or hormonal abnormalities. If these treatments are not appropriate, or they fail, additional reproductive technology may be considered. In some cases, treatment strategies will not be successful or a couple may decide not to continue treatment. Adoption remains an alternative for couples seeking children.
Many surgical procedures are available to correct anatomic abnormalities that may interfere with normal reproduction in women. These abnormalities include fallopian tube obstructions, endometriosis, uterine fibroids, or scarring of the ovaries or other pelvic tissues due to pelvic inflammatory disease (PID). Surgical options may include:
- Laparoscopy—done to examine, diagnose, and treat many of the causes of infertility. The surgeon cuts a small opening in the abdomen. The location of this incision varies depending on the procedure, either near the navel or in the lower abdomen for pelvic conditions. A needle is inserted and used to inject carbon dioxide gas into the abdomen. This gas causes the abdominal cavity to expand and makes it easier for the doctor to see the internal structures. The doctor inserts a long, thin tubular instrument (laparoscope) that lights, magnifies, and projects an image of the internal organs onto a video screen.
If necessary, several other tiny incisions may be made in the abdomen to insert instruments that can take biopsies (samples of tissue) or perform various types of surgery, such as removal of scar tissue, endometrial implants, or repair of blocked fallopian tubes. After the laparoscope and other instruments are removed, the incisions are closed with stitches or clips and covered with a dressing.
- Laparotomy Microsurgery
Laparotomy microsurgery is similar to laparoscopy except that it requires magnification and thus allows very precise cutting and suturing.
Hysteroscopy is a surgical procedure in which a small, lighted telescopic instrument (hysteroscope) is inserted through the vagina and the cervix into the uterus. It transmits an image of the uterine canal and cavity to a television monitor, which allows the surgeon to insert surgical instruments. This procedure is used to diagnose and treat numerous disorders, including abnormal bleeding, fibroids, and uterine polyps. There are no surgical incisions with this procedure. After the cervix is dilated, the hysteroscope is guided through the cervix into the uterus. Carbon dioxide gas or fluid is pumped into the uterus to inflate it. This frequently causes discomfort or cramping. After the surgeon visualizes the uterus, other surgical procedures can be performed, such as removal of scar tissue, adhesions, small fibroids and polyps, and intrauterine devices. Hysteroscopy is also used to diagnose uterine abnormalities that may be treated with another surgical procedure and may be performed in conjunction with laparoscopy.
Assisted Reproductive Technologies (ART)
Assisted Reproductive Technologies is a general term used to describe several techniques that are used to establish a pregnancy without sexual intercourse. ART involves using human gametes (sperm and egg cells) in a lab to help with conception. The eggs and sperm can be from you and your partner or can be from a donor. The embryo formed from the egg and sperm can be implanted in your uterus or in the uterus of a surrogate woman. ART methods include:
- Artificial Insemination
Semen is collected and processed in a lab and then inserted directly into the woman’s cervix or uterus. The woman who is inseminated provides the egg, and fertilization takes place inside her body (usually in the fallopian tube). This procedure may be more successful if a woman is inseminated twice during her menstrual cycle. Artificial insemination is an option for couples that have:
- A low sperm count or problems with sperm mobility
- Problems with cervical mucus
- Sexual dysfunction
The inseminated woman may be the prospective mother or a surrogate mother. If you provide the eggs and your partner supplies the semen, the child will carry 100% of genes from you and your partner. If a surrogate woman is inseminated the child will carry either 50% genes from your male partner and 50% from the surrogate mother, or 50% genes from a sperm donor (if used) and 50% genes from the surrogate mother. Genes are carried in the eggs and sperm to the next generation through conception. Whoever provides the egg and sperm determines the genetic makeup.
- In Vitro Fertilization (IVF)
IVF proceeds in several stages. First, ovaries are stimulated through hormone treatment to cause several eggs to mature instead of the usual one egg per month. When the eggs are considered mature, a long thin needle is inserted into the vagina. With the help of ultrasound, the needle is guided to the ovary and the eggs are collected. The entire harvesting procedure usually takes 10-20 minutes, depending on the number of eggs that are collected. In many centers, the procedure is performed with local anesthesia and mild sedation. Patients can usually leave the office after an hour or so of observation.
Once eggs are harvested, they are separated from the fluid that surrounds them and placed in an incubator where their environment can be precisely controlled. Next, the eggs are fertilized with sperm. After about 24 hours, the eggs are examined to see if fertilization has occurred. In the next two to five days, eggs that have developed into multiple-cell embryos are drawn up into a plastic catheter that is passed through the cervix into the uterus, and the embryos are released into the uterus. Hormone therapy may continue for several days, and blood hormone levels will be monitored. A pregnancy test is usually performed within 12-14 days to determine whether an embryo has implanted and a pregnancy has begun.
In some cases, more embryos develop than should be introduced into the uterus for one pregnancy. These embryos can be frozen for an indefinite period of time through a process called cryopreservation. The frozen embryos can be thawed and transferred if the initial round of IVF is unsuccessful or if you want to have an additional child in the future. It should be noted, too, that IVF is often done with a donor egg and/or sperm.
If genetics or hereditary conditions are a concern, a pre-implantation genetic diagnosis can be performed on the embryo to evaluate the DNA for those conditions. This can add significant cost to the procedure.
Dr. Alex Letham of LewisGale Physicians Virginia Women’s Health is available to discuss the symptoms, causes, and options for infertility. To schedule an appointment, call our office at (540) 443-0500.