Infertility in Women

Essentials

  • Overview: Nearly 12% of reproductive-age women in the United States are affected by infertility, or the inability to conceive after one year of trying (six months for women age 35 and older). Infertility can be caused by female infertility, male infertility or a combination of both.
  • Causes: Common causes of infertility in women include ovulation disorders, age, structural issues of the reproductive system and hormonal imbalances.
  • Symptoms: Although the primary symptom of infertility in women is the inability to conceive, some causes of infertility carry additional symptoms such as irregular menstrual cycles, painful periods or unwanted hair growth.
  • Treatments: After infertility testing, our doctors will partner with the woman to develop a personalized treatment plan, with options ranging from simple treatments like ovulation induction alone or ovulation induction combined with IUI to more complex treatments such as IVF.

 

What is infertility in women?

Infertility in women occurs when female infertility factors are the partial or sole cause of a couple’s inability to conceive after a year of trying to become pregnant without any form of contraception. After age 35, a woman is considered to have infertility if she and her partner are unable to conceive after six months of unprotected sex.

The Center for Disease Control and Prevention (CDC) has found that 12% of reproductive-age women in the United States are affected by infertility, finding it difficult to conceive or carry a pregnancy to term.

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Causes of infertility in women

Common causes of female infertility include ovulation disorders, age, structural issues of the reproductive system and hormonal imbalances. Women can also be diagnosed with unexplained infertility, which means the reproductive system seems to be working normally and testing cannot decipher the cause of infertility in the woman or her partner.

Ovulation disorders

The American Society for Reproductive Medicine (ASRM) estimates that 40% of female infertility is caused by ovulation dysfunction or disorders. To become pregnant, a woman’s ovary must produce and release a mature egg. When this doesn’t happen each month or doesn’t happen at all during a menstrual cycle, it is called anovulation.

This can be caused by problems in the ovaries or abnormal levels of reproductive hormones. In some cases, the cause of ovulation dysfunction is unknown.

Common ovulation disorders include the following.

 
Polycystic ovary syndrome (PCOS) usually includes irregular or absent menstruation, hormonal issues like acne and/or unwanted hair growth and/or loss, and multiple ovarian follicles seen at the time of ultrasound imaging.
Hormone imbalance occurs when a woman’s reproductive system produces more than or less than the amount of the various hormones needed to conceive.    
Hypothalamic dysfunction, sometimes called hypothalamic amenorrhea, is when the brain doesn’t properly signal the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), impairing fertility. This can occur with significant weight loss, excess stress or excessive exercise, along with additional factors.
Premature ovarian failure occurs when the supply of eggs in the ovary runs very low or even out, causing a cessation of estrogen production and bringing an early onset of menopause. This is often seen in women with autoimmune disorders, certain genetic disorders, or who have undergone chemotherapy or radiation; but it can also happen without an obvious cause.

Age

Studies show about one-third of couples in which the woman is over the age of 35 will experience some form of infertility. A woman’s fertility begins to decline as she ages, due to the finite number of eggs in her ovaries diminishing with time.

The eggs that do remain also loose quality with age, making egg fertilization for pregnancy more difficult. Lesser quality eggs can also lead to a higher risk of miscarriage when fertilized to become an embryo. Once the loss of egg quantity and quality reaches a critical point, it is known as diminished ovarian reserve.

Structural issues of the female reproductive system

The most common types of structural issues found in the female reproductive system involve the fallopian tubes or uterus and include the following.

  • Endometriosis affects 1 in 10 women of reproductive age, according to the American College of Obstetricians and Gynecologists. It is a process in which the cells that line a woman’s uterine cavity (endometrial cells) take up residence outside of the uterine cavity, usually in the pelvis. Their presence sets up an inflammatory response and can lead to scarring and structural damage of the pelvic areas.
  • Fibroids (benign muscle tumors) and uterine abnormalities can interfere with successful embryo implantation in the womb, thus preventing pregnancy. Uterine abnormalities are congenital malformations of the uterus (problems with uterine shape) such as septate uterus, while fibroids are noncancerous growths within the uterus.
  • Ovarian cysts are pockets or fluid-filled sacs on the surface or inside of the ovaries. Usually, ovarian cysts are harmless and cause little discomfort and pain. However, if the ovarian cyst ruptures, serious symptoms can occur in including pelvic pain, bloating and a heaviness in the abdomen. Ovarian cysts can sometimes affect a woman’s fertility.
  • Fallopian tube damage can be caused by infection such as chlamydia, previous surgery in the abdomen or pelvic areas, endometriosis or unknown factors. Fallopian tube damage is sometimes related to a previous ectopic pregnancy, which is a dangerous nonviable pregnancy that develops outside the uterus, in the fallopian tube.
  • Pelvic inflammatory disease (PID) may build up scar tissue and create structural issues in the pelvic area. PID is usually caused by sexually transmitted diseases (STDs) or infections (STIs).

Hormonal imbalances

Hormonal imbalance often occurs when the female reproductive system produces more than or less than the amount of hormones a woman needs to become pregnant and maintain a pregnancy. Disorders like anovulation and PCOS are often the result of a hormone imbalance in women. Hormones also control the menstrual cycle, which is pivotal in conception.

What is secondary infertility?

Secondary infertility occurs when a woman or couple has had one successful pregnancy through natural methods but then experiences the inability to become pregnant again after a year of trying. The same causes of primary infertility in women noted above can also cause secondary infertility. Secondary infertility may be due to female infertility, male infertility factors or both.

Signs of infertility in women

The primary symptom of infertility in women is the inability to become pregnant. In some cases, a woman may experience irregular or absent periods. This includes cycles that last longer than 35 days or run less than 21 days. A painful period (dysmenorrhea) can also be a sign of underlying endometriosis.

Obesity and abnormal hair loss and growth often accompany diagnoses such as PCOS, which can hinder conception. Another sign of infertility in women is recurrent miscarriages, which can be caused by chromosomal abnormalities in the embryo or structural issues within the reproductive system. Recurrent pregnancy loss is defined as two or more consecutive miscarriages.

When should I see a fertility specialist if I am having trouble conceiving?

  • You are younger than 35 and have not had pregnancy success after a year of trying.
  • You are 35-40 and have been trying to become pregnant for six months or longer.
  • You are over the age of 40.
  • You are experiencing irregular, absent or very painful periods.
  • You have experienced recurrent miscarriages.
  • You have previously been diagnosed with endometriosis or another fertility-inhibiting condition.
  • You have undergone cancer treatments.

 

Female fertility tests

The Fertility Institute offers a variety of infertility testing to women struggling to conceive. Our fertility specialist will have a detailed conversation with the woman and her partner if possible to review health and sexual history, along with reproductive goals and any conditions or symptoms that may impact fertility.

After this conversation, our provider may perform a physical examination to determine if there are any obvious causes of the struggle to conceive. The woman’s overall health will also be evaluated during this exam.

If needed, the doctor may conduct additional testing. These tests may include

  • Checking the ovarian reserve with bloodwork (anti-Müllerian hormone) and ovarian follicle count.
  • Imaging the ovaries and uterus using transvaginal ultrasound and testing the fallopian tubes for patency using a test called a hysterosalpingogram (HSG).
  • Evaluating for ovulatory function utilizing an ovulation predictor kit and a mid luteal phase progesterone assessment.

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Treatments for infertility in women

After fertility testing results are in, our specialist will work with the woman to develop a personalized infertility treatment plan.

Low-tech fertility treatments

Simpler and less aggressive, but still successful, fertility treatment options include:

  • Lifestyle changes such as maintaining a healthy body mass index (BMI), tobacco cessation or decreasing excessive exercise.
  • Ovulation induction, or controlled ovarian stimulation (COS), using medication that stimulates the ovaries to release eggs.
  • Intrauterine insemination (IUI), which directly inserts sperm into the uterus so it can more easily reach an egg in the fallopian tubes for fertilization.

Laparoscopy & hysteroscopy minimally invasive fertility surgery

Minimally invasive surgery can address issues like uterine fibroids or polyps and can often be performed at the same time as a diagnostic laparoscopy. The Fertility Institute doctors can perform minimally invasive surgery, including procedures such as microsurgery, laser surgery and laparoscopic laser surgery.

IVF, PGT & INVOcell

More complex, aggressive treatments may be needed such as in vitro fertilization (IVF), which uses advanced techniques to fertilize an egg with sperm in our in-house laboratory. The fertilized egg develops into an embryo, which is then transferred into the woman’s uterus. In some cases, we may recommend preimplantation genetic testing (PGT) during the IVF process to choose the best possible embryo to implant, reducing the chance of pregnancy miscarriage or birth defects in a child.

The Fertility Institute of New Orleans is also the only clinic in Louisiana to offer INVOcell, a new fertility treatment using an intravaginal culture (IVC) procedure. This places a device with both sperm and eggs into the woman’s vagina for fertilization and incubation. This process is a less expensive alternative to IVF.

For our female patients

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