McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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What is infertility?

Infertility is the failure to become pregnant after 1 year of regular, unprotected sexual intercourse. One of every six couples are infertile.

How does it occur?

Often the reason a woman is infertile is that she is not ovulating (releasing eggs). This failure to ovulate may be caused by:

• a hormone imbalance
• overweight
• too much stress
• ovary problems, such as a tumor or cyst
• a menstrual cycle that is too brief
• weight loss for various reasons, including eating disorders such as anorexia and bulimia
• intense exercise, such as long distance running, that causes loss of body fat
• abuse of alcohol or drugs
• thyroid gland problems
• tumors in the pituitary gland.

A damaged fallopian tube or uterus can also cause infertility. These organs may be damaged from:

• a previous infection, such as a sexually transmitted disease or pelvic inflammatory disease
• a birth defect
• polyps in the uterus
• surgery to remove a tubal pregnancy
• endometriosis (tissue from the uterus growing outside the uterus)
• fibroids (a type of growth in the uterus that is usually not cancerous)
• a uterus with an abnormal shape or position
• adhesions (scar tissue) inside the uterus or in the pelvis
• DES syndrome, which you may have if your mother took the medication DES to prevent a miscarriage when she was pregnant with you.
• chronic medical illness.

You may have problems with your cervix, such as:

• cervical stenosis
• abnormal cervical mucus.

In rare cases, a woman's body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility.

You also become less fertile as you get older, especially after age 30.

How is the problem diagnosed?

You and your partner will have thorough physical exams. You will be asked about:

• your sexual history, including previous pregnancy, miscarriage, or abortion
• your history of medical conditions such as illnesses and infections
• your family history
• use of drugs and alcohol
• sexual intercourse practices, such as how often you have sex and whether you use lubricants
• genital or abdominal surgery
• circumcision
• genital development.

You may also have the following tests:

• urine and blood tests to check for infections and a hormone imbalance
• tests of samples of cervical mucus and tissue from the lining of your uterus to check for ovulation
• a count of your partner's sperm to see if the cause of infertility is too few sperm or abnormal sperm.

Your health care provider may tell you how to take and chart your body temperature each morning. A woman's temperature rises after ovulation. The chart helps check for ovulation.

You may have the following procedures to check for a blockage in the fallopian tubes or uterus, or adhesions:

• laparoscopy (a scope is inserted into your abdomen so the doctor may see the organs)
• injection of a blue-colored fluid through the cervix and uterus and into the fallopian tubes to help the doctor see if you have a blockage
• hysterosalpingogram (an x-ray of the uterus and fallopian tubes after they are injected with dye).

How is it treated?

If you have a disorder causing infertility, your health care provider will recommend treatment for it. Treatment may include medication, such as hormones or antibiotics, or surgery. Sometimes a combination of treatments for both partners is necessary.

Possible treatments include:

• Taking hormones for a hormone imbalance, endometriosis, or short menstrual cycle.
• Taking drugs to stimulate ovulation. (You may become pregnant with more than one baby if your ovaries are overstimulated by hormone treatment.)
• Having surgery to remove blockage or scar tissue from the fallopian tubes, uterus, or pelvis.

You may be asked to keep a record of your daily temperature to track ovulation. This will help predict when you are most fertile or if the drugs you are taking stimulate egg production.

If your partner's sperm count is low, artificial insemination is an option. The sperm is collected at several different times and then placed in your body during the most fertile time in your menstrual cycle. This procedure has varying success. Another choice is to use sperm donated by another man.

In vitro fertilization is another option. In this procedure the egg is fertilized with sperm in the lab and then put into your uterus or fallopian tubes. This procedure may be done if your partner's sperm count is low or your fallopian tubes are blocked or damaged. In vitro fertilization is expensive and success rates are often low. You may become pregnant with more than 1 baby at a time.

The period of investigation and treatment for infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help you get through any difficult times.

What can be done to help prevent infertility?

You may not be able to prevent infertility resulting from genetic problems or an illness. However, you can do the following to reduce your risk of developing disorders that might cause infertility:

• Prevent sexually transmitted diseases by using latex condoms and having sex only with your partner.
• Limit the amount of alcohol you drink.
• Avoid the use of street drugs (such as heroin) and overuse of prescription and nonprescription drugs.
• Maintain good personal hygiene and health practices.

Contact your health care provider about any signs of infection or hormonal change, such as:

• unusual discharge from the vagina
• abdominal pain
• fever
• abnormal bleeding
• a change in your menstrual periods
• discomfort during intercourse
• sores and itching in the vagina or rectal area.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.