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Female Infertility

Overview, Causes, & Risk Factors

Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Female infertility means the male is unable to impregnate the female because of female factors.

What is going on in the body?

Certain events must take place in a woman's body for pregnancy to occur:

attachment of a fertilized egg to the lining of the uterus

ovulation, which is the release of an egg from the ovary

the uniting of the egg and a man's sperm

Factors that interfere with these events are known as female factors. The inability to get pregnant may be caused by conditions in either partner. It is estimated that 30% of infertility is caused by male factors. An additional 30% is caused by female factors. The remaining 40% is caused by a combination of female and male factors.

What are the causes and risks of the condition?

There are many female factors that can make a couple unable to become pregnant. These may include conditions such as the following:

certain inherited conditions

endometriosis, a condition in which tissue that normally lines the uterus grows in other parts of the body

hormone imbalances, such as hypothyroidism

polycystic ovarian syndrome, a condition that interferes with normal release of eggs

Diseases also can be a factor in infertility, for example:

autoimmune disorders, in which the body produces antibodies to fetal tissue

diseases such as diabetes

eating disorders, such as anorexia nervosa

pelvic inflammatory disease, which is an infection of the female pelvic organs

sexually transmitted disease, such as Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. ',CAPTION,'Chlamydia');" onmouseout="return nd();">chlamydia or Neisseria gonorrhoeae\ bacteria. The infection is usually acquired through sexual contact. ',CAPTION,'Gonorrhea in Females');" onmouseout="return nd();">gonorrhea

Additional factors in infertility include the following:

chronic vaginal discharge

congenital abnormalities of the uterus

ectopic pregnancy, or implanting of the fertilized egg outside the uterus

emotional stress

excess caffeine and alcohol intake

excess weight loss or weight gain

exposure to diethylstilbestrol, also known as DES, as an infant in utero

irregular periods or menstrual cycles

previous elective surgical abortion or elective medical abortion

scarring of the fallopian tubes from abdominal or pelvic surgery

smoking

strenuous exercise

total lack of menstruation

two or more previous miscarriages

use of an intrauterine device also called an IUD, which is a form of birth control

uterine fibroids or polyps

Women over the age of 35 are more likely to be infertile.

Symptoms & Signs

What are the signs and symptoms of the condition?

Female infertility occurs when the woman does not conceive after one year of attempting to become pregnant. Other signs and symptoms depend on the underlying cause of the woman's infertility.

Diagnosis & Tests

How is the condition diagnosed?

Diagnosis of infertility begins with a medical history and physical exam. The healthcare provider may order tests, including the following:

an endometrial biopsy, which tests the lining of the uterus

hormone testing, to measure levels of female hormones

laparoscopy, which allows the provider to see the pelvic organs

ovulation testing, which detects the release of an egg from the ovary

Pap smear, to check for signs of infection

pelvic exam, to look for abnormalities or infection

a postcoital test, which is done after sex to check for problems with secretions

special X-ray tests

Prevention & Expectations

What can be done to prevent the condition?

Some cases of female infertility may be prevented by taking the following steps:

Avoid excessive exercise.

Avoid smoking.

Control diseases such as diabetes and hypothyroidism

Follow good weight management guidelines.

Get early treatment for sexually transmitted diseases.

Have regular physical examinations to detect early signs of infections or abnormalities.

Limit caffeine and alcohol intake.

Practice stress management.

Use birth control to prevent unwanted pregnancy and abortions.

What are the long-term effects of the condition?

Infertility can create tension in a couple's relationship. Sexual relations may become less pleasurable. Fertility evaluations can be expensive. Eventually, 85% of couples find a cause for their inability to conceive. However, some couples never become pregnant, even with the newest treatments. Adoption may be the best choice in some cases.

What are the risks to others?

Female infertility is not contagious. However, infertility can be caused by a sexually-transmitted disease, which may be transmitted to sexual partners.

Treatment & Monitoring

What are the treatments for the condition?

Treatment of infertility will depend on the cause. Without treatment, 15% to 20% of affected couples will eventually become pregnant. Treatment for female factors may include:

eating a healthy diet

exercising in moderation

having surgery to treat certain problems, such as endometriosis

learning about the best time to conceive

limiting caffeine and alcohol intake

making lifestyle changes, such as smoking cessation

taking antibiotics for sexually transmitted diseases

taking medications to cause ovulation, such as clomiphene and menotropins

If these treatments don't work, other means of fertilization may be considered, such as:

artificial insemination. This involves placing sperm directly in the cervix or uterus.

intracytoplasmic sperm injection. This involves placing individual sperm cells directly inside the woman's eggs.

in vitro fertilization. This involves fertilizing the egg outside the womb and then returning it to the uterus.

What are the side effects of the treatments?

Following are some of the side effects of medications used to cause ovulation:

abdominal pressure or fullness

cysts on the ovaries

headaches

hot flashes

mood changes

multiple pregnancies, such as twins or triplets

ovarian hyperstimulation syndrome, which causes fluid shifts in the body

Antibiotics may cause allergic reactions, stomach upset, and rash. Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the condition?

Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

How is the condition monitored?

Should a pregnancy occur after treatment, early pregnancy testing can be done. The woman will have regular prenatal visits to ensure a healthy pregnancy. Any new or worsening symptoms should be reported to the health care provider.

Attribution

Author:Eva Martin, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:04/30/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:08/20/01