Infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year with no success.
Infertility results from female
factors about one-third of the time and both female and male factors about
one-third of the time. The cause is either unknown or a combination of male and
female factors in the remaining cases.
Symptoms
The main symptom of infertility
is the inability to get pregnant. A menstrual cycle that's too long (35 days or
more), too short (less than 21 days), irregular or absent can mean that you're
not ovulating. There might be no other signs or symptoms.
Up to age
35, most
doctors recommend trying to get pregnant for at least a year before testing or
treatment.
If you're
between 35 and 40, discuss
your concerns with your doctor after six months of trying.
If you're
older than 40, your
doctor might suggest testing or treatment right away.
Causes
For pregnancy to occur, every
step of the human reproduction process has to happen correctly. The steps in
this process are:
One of the two ovaries releases a mature egg.
The egg is picked up by the fallopian tube.
Sperm swim up the cervix, through the uterus and
into the fallopian tube to reach the egg for fertilization.
The fertilized egg travels down the fallopian tube
to the uterus.
The fertilized egg attaches (implants) to the
inside of the uterus and grows.
Fertilization and implantation
During fertilization, the sperm
and egg unite in one of the fallopian tubes to form a zygote. Then the zygote
travels down the fallopian tube, where it becomes a morula. Once it reaches the
uterus, the morula becomes a blastocyst. The blastocyst then burrows into the
uterine lining a process called implantation.
In women, a number of factors can
disrupt this process at any step. Female infertility is caused by one or more
of the factors below.
Ovulation disorders
Ovulating infrequently or not at
all accounts for most cases of infertility. Problems with the regulation of
reproductive hormones by the hypothalamus or the pituitary gland or problems in
the ovary can cause ovulation disorders.
Polycystic ovary syndrome (PCOS). polycystic ovary syndrome
(PCOS) causes a hormone imbalance, which affects ovulation. PCOS is
associated with insulin resistance and obesity, abnormal hair growth on the
face or body, and acne. It's the most common cause of female infertility.
Hypothalamic dysfunction. Two hormones produced by
the pituitary gland are responsible for stimulating ovulation each month follicle-stimulating
hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional
stress, a very high or very low body weight, or a recent substantial weight
gain or loss can disrupt production of these hormones and affect ovulation.
Irregular or absent periods are the most common signs.
Primary ovarian insufficiency. Also called premature
ovarian failure, this is usually caused by an autoimmune response or by
premature loss of eggs from your ovary, possibly as a result of genetics or
chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production
in women under age 40.
Too much prolactin. The pituitary gland can
cause excess production of prolactin (hyperprolactinemia), which reduces
estrogen production and can cause infertility. This can also be caused by
medications you're taking for another condition.
Damage to fallopian tubes (tubal
infertility)
Damaged or blocked fallopian
tubes keep sperm from getting to the egg or block the passage of the fertilized
egg into the uterus. Causes of fallopian tube damage or blockage can include:
Pelvic inflammatory disease, an infection of the
uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually
transmitted infections
Previous surgery in the abdomen or pelvis,
including surgery for ectopic pregnancy, in which a fertilized egg implants and
develops somewhere other than the uterus, usually in a fallopian tube
Endometriosis
Endometriosis occurs when tissue
that typically grows in the uterus implants and grows in other places. This
extra tissue growth ,and the surgical removal of it , can cause scarring, which
can block fallopian tubes and keep an egg and sperm from uniting.
Endometriosis can also disrupt
implantation of the fertilized egg. The condition also seems to affect
fertility in less-direct ways, such as damage to the sperm or egg.
Uterine or cervical causes
Several uterine or cervical
causes can interfere with the egg implanting or increase the risk of
miscarriage:
Benign polyps or tumors (fibroids or myomas) are
common in the uterus. Some can block fallopian tubes or interfere with
implantation, affecting fertility. However, many women who have fibroids or
polyps do become pregnant.
Problems with the uterus present from birth, such
as an unusually shaped uterus, can cause problems becoming or remaining
pregnant.
Cervical stenosis, a narrowing of the cervix, can
be caused by an inherited malformation or damage to the cervix.
Sometimes the cervix can't produce the best type of
mucus to allow the sperm to travel through the cervix into the uterus.
Unexplained infertility
In some cases, the cause of
infertility is never found. A combination of several minor factors in both
partners could cause unexplained fertility problems. Although it's frustrating
to get no specific answer, this problem can correct itself with time. But you
shouldn't delay treatment for infertility.
Risk factors
Age. The quality and quantity of a woman's eggs
begin to decline with age. In the mid-30s, the rate of follicle loss speeds,
resulting in fewer and poorer quality eggs. This makes conception more
difficult, and increases the risk of miscarriage.
Smoking. Besides damaging your cervix and fallopian
tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It's
also thought to age your ovaries and deplete your eggs prematurely. Stop
smoking before beginning fertility treatment.
Weight. Being overweight or significantly underweight
may affect ovulation. Getting to a healthy body mass index (BMI) might increase
the frequency of ovulation and likelihood of pregnancy.
Sexual history. Sexually transmitted infections such as
chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex
with multiple partners increases your risk of a sexually transmitted infection
that may cause fertility problems later.
Alcohol. Excess alcohol consumption can reduce
fertility.
Prevention
Maintain a healthy weight. Overweight and underweight
women are at increased risk of ovulation disorders. If you need to lose weight,
exercise moderately. Strenuous, intense exercise of more than five hours a week
has been associated with decreased ovulation.
Quit smoking. Tobacco has multiple negative effects on
fertility, as well as your general health and the health of a fetus. If you
smoke and are considering pregnancy, quit now.
Avoid alcohol. Heavy alcohol use may lead to decreased
fertility. And any alcohol use can affect the health of a developing fetus. If
you're planning to become pregnant, avoid alcohol, and don't drink alcohol
while pregnant.
Reduce stress. Some studies have shown that stress can cause
couples to have poorer results with infertility treatment. Try to reduce stress
in your life before trying to become pregnant.
Diagnosis
Ovulation testing. An at-home,
over-the-counter ovulation prediction kit detects the surge in luteinizing
hormone (LH) that occurs before ovulation. A blood test for progesterone — a
hormone produced after ovulation — can also document that you're ovulating.
Other hormone levels, such as prolactin, also might be checked.
Hysterosalpingography. During
hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is
injected into your uterus and an X-ray is taken to check for problems inside
the uterus. The test also shows whether the fluid passes out of the uterus and
spills out of your fallopian tubes. If any problems are found, you'll likely
need further evaluation.
Ovarian reserve testing. This
testing helps determine the quality and quantity of eggs available for
ovulation. Women at risk of a depleted egg supply — including women older than
35 — might have this series of blood and imaging tests.
Other hormone testing. Other
hormone tests check levels of ovulatory hormones as well as thyroid and
pituitary hormones that control reproductive processes.
Imaging tests. A pelvic ultrasound looks for uterine or
fallopian tube disease. Sometimes a sonohysterogram, also called a saline
infusion sonogram, or a hysteroscopy is used to see details inside the uterus
that can't be seen on a regular ultrasound.
Hysterosalpingography
A doctor or technician places a slender catheter inside your cervix. It
releases a liquid contrast material that flows into your uterus. The dye traces
the shape of your uterine cavity and fallopian tubes and makes them visible on
X-ray images.
Depending on your situation, rarely your testing might include:
Laparoscopy. This minimally invasive surgery involves
making a small incision beneath your navel and inserting a thin viewing device
to examine your fallopian tubes, ovaries and uterus. A laparoscopy can identify
endometriosis, scarring, blockages or irregularities of the fallopian tubes,
and problems with the ovaries and uterus.
Genetic testing. Genetic testing
helps determine whether there any changes to your genes that may be causing
infertility.
Treatment
Infertility treatment depends on the cause, your age, how long you've
been infertile and personal preferences. Because infertility is a complex
disorder, treatment involves significant financial, physical, psychological and
time commitments.
Treatments can either attempt to restore fertility through medication or
surgery, or help you get pregnant with sophisticated techniques.
Risks of fertility drugs
Pregnancy with multiples. Oral
medications carry a fairly low risk of multiples (less than 10%) and mostly a
risk of twins. Your chances increase up to 30% with injectable medications.
Injectable fertility medications also carry the major risk of triplets or more.
Generally, the
more fetuses you're carrying, the greater the risk of premature labor, low
birth weight and later developmental problems. Sometimes, if too many follicles
develop, adjusting medications can lower the risk of multiples.
Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce ovulation can cause ovarian
hyperstimulation syndrome (OHSS), which is rare. Signs and symptoms, which
include swollen and painful ovaries, usually go away without treatment, and
include mild abdominal pain, bloating, nausea, vomiting and diarrhea.
It's possible
to develop a more severe form of OHSS that can also cause rapid
weight gain, enlarged painful ovaries, fluid in the abdomen and shortness of
breath.
Long-term risks of ovarian tumors. Most
studies of women using fertility drugs suggest that there are few if any
long-term risks. However, a few studies suggest that women taking fertility
drugs for 12 or more months without a successful pregnancy might be at
increased risk of borderline ovarian tumors later in life.
Women who
never have pregnancies have an increased risk of ovarian tumors, so it might be
related to the underlying problem rather than the treatment. Since success
rates are typically higher in the first few treatment cycles, reevaluating
medication use every few months and concentrating on the treatments that have
the most success appear to be appropriate.
Surgery to restore fertility
Several surgical procedures can correct problems or otherwise improve
female fertility. However, surgical treatments for fertility are rare these
days due to the success of other treatments. They include:
Laparoscopic or hysteroscopic surgery. Surgery
might involve correcting problems with the uterine anatomy, removing
endometrial polyps and some types of fibroids that misshape the uterine cavity,
or removing pelvic or uterine adhesions.
Tubal surgeries. If your fallopian
tubes are blocked or filled with fluid, your doctor might recommend
laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal
opening. This surgery is rare, as pregnancy rates are usually better with in
vitro fertilization (IVF). For this surgery, removal of your tubes or blocking
the tubes close to the uterus can improve your chances of pregnancy with in
vitro fertilization (IVF).
Reproductive assistance
The most commonly used methods of reproductive assistance include:
Intrauterine insemination (IUI). During
intrauterine insemination (IUI), millions of healthy sperm are placed inside
the uterus around the time of ovulation.
Assisted reproductive technology. This
involves retrieving mature eggs, fertilizing them with sperm in a dish in a
lab, then transferring the embryos into the uterus after
fertilization. IVF is the most effective assisted reproductive
technology. An IVF cycle takes several weeks and requires frequent
blood tests and daily hormone injections.
HOMEOPATHY
MEDICINES
In homeopathy, female
infertility is treated through an individualized
approach, considering the woman’s physical symptoms, menstrual
pattern, hormonal balance, emotional state, and overall constitution. Remedies
such as Sepia, Pulsatilla, Calcarea carbonica, Natrum muriaticum,
and Lachesis are selected based on the totality of symptoms
rather than the diagnosis alone.
