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Female Infertility

What causes female infertility?

  • Ovulation dysfunction. With this condition, the woman's reproductive system does not produce the proper amounts of hormones necessary to develop, mature and release a healthy egg.
  • Anatomical problems. Abnormal development or function of the female anatomy can prevent the egg and the sperm from meeting. The most common anatomical problem is blockage of the fallopian tubes. Another example of an anatomical problem is the presence of pelvic scar tissue from previous surgeries or infections.
  • Endometriosis. Endometriosis is a condition in which the tissue that lines the uterus develops outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down, resulting in internal bleeding that can cause scar tissue to form and can affect the function of reproductive organs.
  • Infection. Pelvic inflammatory disease (PID) is caused by bacterial infections, such as gonorrhea and chlamydia. PID can affect the uterus, fallopian tubes and/or the ovaries. It can lead to pelvic adhesions and scar tissue that develops between internal organs, which causes ongoing pelvic pain and the possibility of an ectopic pregnancy (when the fertilized egg implants outside the uterus).
  • Immunological problems. A problem with a woman's immune system can lead to pregnancy loss. Antibodies, which are immune or protective proteins, in a woman's system can fail to recognize a pregnancy, or there may be an abnormal immune response to the pregnancy. Women can also develop anti-sperm antibodies that attack and destroy sperm.

Infertility Treatments for Women

Types of treatments for women may include the following:

  • Ovulation medications. These medications help regulate the timing of ovulation and stimulate the development and release of mature eggs. They can also help correct hormonal problems that can affect the lining of the uterus as it prepares to receive a fertilized egg. Ovulation medications can stimulate more than one egg to be released, which increases the possibility of having twins and other multiples. Some of the common ovulation medications are:
    • Clomiphene citrate
    • Human menopausal gonadotropins. These are medications containing follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
    • Follicle-stimulating hormone (FSH)
    • Intrauterine insemination. For some conditions, including low sperm count and cervical mucus problems, a procedure that places specially washed and prepared sperm directly into the uterus through a small catheter (flexible tube) helps increase the chances for conception. This procedure is often used in combination with ovulation medications.
  • Surgery. Surgery may be used to treat or repair a condition that is causing infertility, such as fallopian tube blockage or endometriosis. Laparoscopy is a common surgical procedure that is often used as part of the diagnostic workup of infertility. In a laparoscopy, a small telescope inserted into the abdominal or pelvic cavity allows doctors to visualize internal organs. Some procedures to treat infertility can be performed using instruments inserted through the laparoscope.
  • Assisted reproductive technology (ART). Some couples need more extensive treatment in order to conceive. With most forms of ART, the sperm and egg are united in the laboratory, and the fertilized egg is returned to the woman's uterus where it can implant and develop. Although ART procedures are often costly, many are successful. The types of ART procedures include:
    • In vitro fertilization (IVF). IVF Involves extracting a woman's eggs, fertilizing the eggs in the laboratory with sperm, and then transferring the resulting embryo(s) into the woman's uterus through the cervix where it can develop. The process of transferring the embryo(s) is called embryo transfer. Most couples transfer two embryos; however, more may be transferred in certain cases. IVF is the most common form of ART, and 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. Doctors sometimes recommend IVF to treat couples with long-term unexplained infertility who have not been able to conceive using other infertility treatments.
    • Intracytoplasmic sperm injection (ICSI). ICSI is a procedure in which a single sperm is injected directly into an egg. This procedure is most commonly used to help with male factor infertility.
    • Donor eggs. This process involves an embryo formed from the egg of one woman (the donor) being transferred to another woman (the recipient) who is unable to conceive with her own eggs. The donor relinquishes all parental rights to any resulting offspring. ART using donor eggs is much more common among older women than among younger women. The likelihood 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. A procedure in which embryos are preserved through freezing (cryopreservation) for transfer at a later date. This procedure 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 the woman does not become pregnant.