Infertility

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Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year. If you and your partner are attempting to have a child or to expand your family, the difficulties encountered may be complex and can be caused by a number of factors.

Both male and female factors can contribute to infertility. Female factors may involve problems with ovulation, the reproductive organs, or hormones

Lifestyle factors play an important role in increasing your likelihood of having a baby. Small changes can make a big impact. Read more about the lifestyle changes that may improve your chances of fertility. There are also many different types of treatment that can help restore fertility, such as medications, surgery, or assisted reproductive technology (ART).

For those who are thinking about seeing a doctor for fertility tests and would like to know what to expect, see our section Tests. Our overview will help prepare you for what’s in store.

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Most cases of female infertility are caused by hormone imbalances and problems with ovulation. Without ovulation, there are no eggs to be fertilised. Signs that a woman is not ovulating normally include irregular or absent menstrual periods. Causes of female infertility include:

  • Ovulation disorders: These hinder or prevent the ovaries from releasing eggs. An example is polycystic ovary syndrome (PCOS), a hormone imbalance problem which is often characterised by irregular menstrual periods. According to the Office on Women’s Health , PCOS is the most common cause of female infertility. Another example of ovulation disorders is hyperprolactinemia. This condition occurs when you have too much prolactin, the hormone that stimulates breast milk production. Other underlying causes of ovulation disorders may include excessive exercise, eating disorders, injury or tumors.
  • Primary ovarian insufficiency (POI): POI occurs when a woman's ovaries stop working normally and menstruation ends before age 40.
  • Blocked or damaged fallopian tubes: This can be due to pelvic inflammatory disease, endometriosis, sexually transmitted infections or surgery for an ectopic pregnancy.
  • Physical problems with the uterus or cervix: This can include problems with the opening of the cervix or cervical mucus, or abnormalities in the shape or cavity of the uterus.
  • Uterine fibroids: These are non-cancerous clumps of tissue and muscle on the walls of the uterus. Fibroids may distort the uterine cavity interfering with implantation of the fertilised egg.
  • Endometriosis: Endometriosis occurs when endometrial tissue implants and grows outside of the uterus. This often affects the function of the ovaries, uterus and fallopian tubes.
  • Pelvic adhesions: These are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.
  • Thyroid disorders: Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can interrupt the menstrual cycle or cause infertility.
  • Cancer and cancer treatment: Specific cancers, particularly female reproductive cancers, can severely impair female fertility. Cancer treatments, such as radiation and chemotherapy, may also affect a woman's ability to reproduce.
  • Other conditions: Other medical conditions associated with delayed puberty or the absence of menstruation may also cause infertility. Examples include celiac disease, Cushing's disease, sickle cell disease, kidney disease or diabetes.
  • Certain medications: The use of certain medications may cause temporary infertility. In most cases, however, fertility is restored when the medication is stopped.

For information about lifestyle factors that may affect female infertility, see Risk Factors.

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There are a number of lifestyle factors that can increase your risk of infertility. Below are risk factors some key risk factors:

  • Age: With increasing age, the quality and quantity of a woman's eggs begin to decline. Female fertility declines sharply after the age of 35. This makes conception more challenging and increases the risk of miscarriage.
  • Smoking: Smoking damages your cervix and fallopian tubes, and increases your risk of miscarriage and ectopic pregnancy.
  • Excess alcohol: Moderate to heavy drinking is associated with an increased risk of endometriosis and ovulation disorders.
  • Stress: Depression and stress may have a direct effect on the hormones that regulate reproduction and affect ovulation.
  • Excessive exercise: Too much exercise, to the point of lowering your weight levels below the healthy range, can contribute to infertility in women. Amongst others, research from the Norwegian University of Science and Technology shows that the body may not have enough energy to support both hard workouts and getting pregnant.
  • Being overweight or underweight: If you're overweight or significantly underweight, it can hinder normal ovulation. Getting to a healthy body mass index (BMI) has been shown to increase the frequency of ovulation and likelihood of pregnancy.
  • Sexual history: Sexually transmitted infections such as chlamydia and gonorrhea can cause fallopian tube damage. Having unprotected intercourse with multiple partners increases your chances of contracting a sexually transmitted disease (STD) that may cause fertility problems later.
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During the first visit, your doctor will most likely ask for both partners' health and sexual histories. This will include details about the medications you are taking, illnesses you’ve had and information about your sexual habits. He or she will typically conduct a general physical exam. For women, this includes a regular gynecological exam. Specific fertility tests for women may include:

  • Basal body temperature test: After a woman ovulates, her temperature increases slightly. Tracking basal body temperature is a way to find out whether you are ovulating each month. The most common way to perform this test is to write down changes in your morning body temperature every day for 2 to 3 menstrual cycles.
  • Blood and/or urine tests: If you have not had positive home ovulation tests, a blood test is performed to measure hormone levels. An elevated level of the hormone progesterone shows that you have ovulated. Urine test results can also confirm if and when you have been ovulating, as the test detects luteinizing hormone in the urine – a hormone which triggers the release of an egg.
  • Other hormone testing: Other hormone tests check whether there are abnormal levels of ovulatory hormones, thyroid and pituitary hormones that may disrupt reproductive processes.
  • Ovarian reserve testing: Ovarian reserve tests help determine the quality and quantity of the eggs available for ovulation. The American Congress of Obstetricians and Gynecologists recommend these tests for women over the age of 35 years or for those who have known fertility problems.
  • Hysterosalpingography: A hysterosalpingography is a special x-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes. This procedure evaluates the condition of your uterus and fallopian tubes, and can identify any blockages or other physical problems.
  • Imaging tests: Pelvic ultrasound or a hysteroscopy may be conducted to look for uterine or fallopian tube disease. Sometimes a hysterosonography is used to see details inside the uterus that are not seen on a regular ultrasound.
  • Laparoscopy: This minor surgery involves making a small incision in the lower abdomen and inserting a thin viewing device (laparoscope) to examine your fallopian tubes, ovaries and uterus. Doctors can often identify endometriosis, scarring, blockages or other physical problems by laparoscopy.
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Treatment of infertility will take into account the cause, how long you've been trying to get pregnant, as well as your age and your partner's age. Infertility treatment can involve a significant commitment financially, physically and psychologically.

There are many different types of treatment that can help a woman restore fertility, such as medications, surgery, or assisted reproductive technology (ART). Several different treatments may be combined to improve results. These include:

  • Fertility drugs: Fertility drugs that regulate or induce ovulation are the main treatment for women who are infertile due to ovulation disorders, such as polycystic ovary syndrome (PCOS). Speak with your doctor about the risks and benefits of the fertility drug options available to you.
  • Intrauterine insemination (IUI): In IUI, a large amount of healthy sperm is placed in the uterus as close to the time of ovulation as possible. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
  • Surgery: Uterine problems can be treated with surgery. Surgery may be able to repair blocked or damaged fallopian tubes and is also used to treat endometriosis, which is commonly associated with infertility.
  • Assisted reproductive technology (ART): ART includes all fertility treatments in which the egg and sperm are handled. This leads to the highest chance of pregnancy for most couples. In vitro fertilization (IVF) is the most common ART technique. In IVF, sperm is combined with the egg in a lab and the embryo is implanted in the uterus 3 to 5 days after fertilisation.
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