How common is female infertility?

According to the Centers for Disease Control women’s fertility is a common issue for many couples. In fact, roughly 12.3% of women in the United States (ages 15-44) have difficulty becoming pregnant or staying pregnant. This accounts for about 7.5 million women.^[2]

What is the definition of infertility?

Infertility is defined as the inability to become pregnant after one year of trying. In women 35 or over, this timeframe is shortened to six months. Women who can conceive, but have difficulty staying pregnant may also be considered infertile.

The Pregnancy Process

There are several steps involved in conception. A breakdown can occur during any part of the pregnancy process, resulting in infertility.

1. Initially, a woman must ovulate, releasing an egg from one of her ovaries.
2. The newly released egg must travel through the fallopian tube toward the uterus.
3. Male sperm must fertilize the egg as it progresses to the uterus.
4. The fertilized egg must implant in the uterus.^[4]

About one-third of infertility issues between couples are due to infertility in the woman. Another one-third is due to infertility in the man. In the rest of cases, issues involve both partners, or are not identifiable at all.

Signs of Female Infertility

Generally a woman is considered infertile if she does not become pregnant after one year of having regular unprotected sex.

What causes women’s fertility issues?

There are many reasons a woman may be infertile. Many of them involve difficulties surrounding ovulation. Without a viable egg for fertilization, pregnancy cannot occur. Signs a woman is infertile because she is not ovulating include, the absence of a menstrual period, or an irregular menstrual period.

Causes of infertility may involve the following:

Endocrine dysfunction—As part of the endocrine system, a cascade of hormones including gonadotropin-releasing hormone, follicle stimulating hormone, luteinizing hormone, estrogen, and progesterone are necessary to regulate menstruation and support pregnancy. If these become imbalanced, irregular ovulation may occur or cease altogether.

PCOS—Polycystic ovarian syndrome is the most common reason for problems with ovulation. This occurs due to a hormone imbalance that does not allow for the release of an egg each month.

POI—Primary ovarian insufficiency occurs when ovaries no longer function before a woman reaches 40 years of age. This is not the same as early onset menopause.

Blockage in fallopian tubes—Women may be infertile due to blocked fallopian tubes as a result of pelvic inflammatory disease, endometriosis, or surgery (to remove an ectopic pregnancy).

Uterine problems of a physical nature—Some women have scar tissue, adhesions, or polyps in the uterus.

Uterine fibroids—These are tissue and muscle masses found on the uterine walls that are non-cancerous.

Cervical issues—Some medical conditions may prevent sperm from travelling through the cervical canal.

Risk Factors Affect Women’s Fertility

The following factors may undermine a woman’s ability to become pregnant:

• Age
• Smoking
• Increased alcohol use
• Stress
• Poor nutrition
• Intense physical training
• Weight (over or under recommended weight)
• Sexually transmitted diseases (STDs)
• Hormone related medical problems including POS and POI ^[4]

Age and Female Infertility

In 1975, only 5% of women over age 30 became first time mothers. By 2010 that number increased to 25%.^[6] In fact, many women are well into their 30’s, (even 40’s) before becoming pregnant for the first time. About 20% of U.S. women will not have their first child until after age 35. One-third of these couples will struggle with fertility issues.

Age may affect a woman’s chances of having a baby for the following reasons:

• The ovaries may not be able to release eggs.
• There are a smaller number of eggs available for fertilization.
• The eggs have degraded.
• There is a greater likelihood of medical conditions that may affect fertility.
• There is a greater chance of miscarriage.

After one year of trying to become pregnant couples may seek help for infertility. According to studies, about 6.9 million women, or 11.3% aged 15-44 have sought medical attention for infertility issues.^[2]

How do doctors test for infertility?

Initially the doctor will do a physical exam on the woman and obtain the health and sexual history of both partners. The doctor will also test the man’s semen to examine the number, shape, and movement of sperm. Hormone tests for either partner may also be ordered at this time.

What tests help identify the cause of female infertility?

In women, physicians first determine whether ovulation occurs each month. This may be determined by tracking changes in body temperature or cervical mucus for several months, or by using an over-the-counter ovulation test kit. Doctors can also run blood tests or conduct an ultrasound on the ovaries to pinpoint ovulation. Conception occurs during a woman’s fertile “window”. This lasts for approximately 6 days, (5 days prior to ovulation, and the actual day of ovulation).^[1]

If ovulation is normal, doctors may order further tests including:

• Hysterosalpingography—This x-ray test allows the doctor to detect any blockages in the uterus or fallopian tubes that would prevent conception. It involves the use of a special dye injected through the vagina that will travel through the uterus and fallopian tubes.
• Laparoscopy—This allows a doctor to see the ovaries, fallopian tubes and uterus to check for disease or other physical irregularities. It is done by insertion of a laparoscope through a small cut in the lower abdomen.^[3]
  
• Transvaginal sonohysterography—This test utilizes ultrasound in conjunction with saline, which provides a more detailed view of the uterus. This is used to help diagnose PCOS.
• Hysteroscopy—This procedure involves the use of a hysteroscope (lighted camera) that can detect endometriosis, fibroids, polyps, pelvic scar tissue, and fallopian tube blockages. Some treatment of findings may be corrected at this time.

The Cause of Male Infertility

While there are several causes for infertility in men, the most common is a condition known as “varicocele”. This occurs when testicular veins are too large, causing the testicles to heat up. This can affect the shape and number of sperm viable for fertilization.

Some medical problems that prevent conception may be congenital while others result from illness or injury.

These may include:

Damaged sperm ducts—7% of males remain infertile due to poor transport of sperm from the testes through the penis.

Kleinfelter’s syndrome—An additional x chromosome causes testes to atrophy impairing sperm production.

Retrograde ejaculation—A small percentage of infertile males (1.5%) ejaculate semen into the bladder rather than through the urethra. This is due to the bladder sphincter that does not close during ejaculation.

Torsion—Tissue abnormality causes testes to twist inside the scrotum resulting in swelling.^[5]

Female Infertility Treatment Options

Since the birth of the first U.S. baby conceived using assisted reproductive technology (1981), fertility clinics nationwide have seen a steady increase in patients.^[7] Treatment modalities for infertile couples include drug therapy, surgery, artificial insemination, counseling/behavioral therapy, and other assisted reproductive technology (ART), including in vitro fertilization. The type of treatment prescribed is dependent on test results, the age and health of each partner, personal preference of the parties, and the length of time they have been having unprotected sex.

Several variables affect fertility and a couple’s ability to successfully conceive. It is important to consult with a medical professional to discuss available fertility treatments and procedures. Benefits, possible outcomes, side effects, risks, and dangers should be considered when making an informed decision about treatment.