| Infertility is the inability to get pregnant after a year of unprotected intercourse. About 10%-15% of couples of reproductive age -- or about one out of every 6 or 7 couples -- are affected by infertility. Although the number of women seeking infertility treatment has increased, there has been no change in the percentage of couples considered infertile. How Does Age Affect Fertility? The number of infertile couples rises with the increasing age of the woman. Women are born with a finite number of oocytes (eggs). Thus, as the reproductive years progress, the number and quality of the oocytes diminish. Compared with women aged 20-24, the fertility of women aged 30-34 is reduced by 14%, and those aged 35-39 by 31%. This reduction in fertility is noted to a much greater extent after age 40. What Causes Female Infertility? Female infertility can be caused by a number of factors, including the following: * Damage to fallopian tubes: Damage to the fallopian tubes (which carry the oocytes from the ovaries to the uterus) can prevent contact between the oocyte and sperm. Repetitive pelvic infections, endometriosis, and multiple pelvic surgeries may lead to scar formation and fallopian tube damage. * Hormonal causes: Some women have problems with ovulation. Synchronized hormonal changes leading to the release of an oocyte from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits, and blood tests to detect hormone levels. * Cervical causes: A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations (see below). * Unexplained infertility: The cause of infertility in 10%-15% of couples will not be determined using the currently available methods of investigation. These patients are considered to have unexplained infertility if conception has not occurred within 2-3 years. How Is the Cause of Infertility Determined? If female infertility is suspected, your doctor may order several tests, including: * A blood test to check hormone levels * An endometrial biopsy to check the lining of the uterus and look for signs of ovulation Two diagnostic tests that may be helpful in detecting pelvic adhesions (scar tissue) and tubal obstruction are hysterosalpingography and laparoscopy. * Hysterosalpingography (HSG): This procedure involves a series of X-rays taken of the reproductive organs. A dye is injected into the cervix and travels up to the fallopian tubes. The dye enables the X-ray to reveal if the fallopian tubes are open or blocked. * Laparoscopy: In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. How Is Female Infertility Treated? * Laparoscopy: Women who have been diagnosed with tubal or pelvic disease can either undergo surgery to reconstruct the reproductive organs or try to conceive through in vitro fertilization (IVF, see Below). Using a laparoscope inserted through a cut near the bellybutton, scar tissue can be removed, endometriosis treated, ovarian cysts removed, and blocked tubes opened. A hysteroscope placed into the uterus through the cervix can be used to remove polyps and fibroid tumors, divide scar tissue, and open blocked tubes. * Medical therapy: Women suffering from ovulation problems may be prescribed medications such as Clomid or Serophene or gonadtropins such as Gonal F, Follistim, or Humegon, which can lead to ovulation. Gonadotropins can induce ovulation when Clomid or Serophene do not work. These medications also can enhance fertility by causing multiple eggs to ovulate during the cycle (normally, only one egg is released each month). Gonadotrophin therapy may be offered for unexplained infertility or when other factors have been corrected without resulting in pregnancy. * Intrauterine insemination: Intrauterine insemination refers to an office procedure in which semen is collected, rinsed with a special solution, and then placed into the uterus at the time of ovulation. The sperm are deposited into the uterus through a slender plastic catheter that is inserted through the cervix. * In vitro fertilization: In vitro fertilization refers to a procedure in which oocytes (egg cells) are fertilized in a culture dish and placed into the uterus. The woman takes gonadotropins to stimulate multiple oocyte development. When monitoring indicates that the oocytes are mature, the oocytes are collected using a vaginal ultrasound probe with a needle guide. The sperm are collected, washed, and added to the oocytes in a culture dish. Several days later, approximately 3 embryos (fertilized oocytes) are returned to the uterus using an intrauterine insemination catheter. Any extra embryos can be cryo-preserved (frozen) for later use, upon the consent of the couple. * Oocyte donation: Oocyte donation helps women who do not have normally functioning ovaries (but who have a normal uterus) to achieve pregnancy. Oocyte donation involves the removal of oocytes from the ovary of a donor who has undergone ovarian stimulation with the use of fertility drugs. The donor's oocytes are then placed together with the sperm from the recipient's husband for in vitro fertilization. The resulting fertilized oocytes (embryos) are transferred to the recipient's uterus. Medical therapy and in vitro fertilization can increase the chance of pregnancy in women diagnosed with unexplained infertility.
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