Your Guide to Female Infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. About 10% of couples in the United States are affected by infertility. Both men and women can be infertile. According to the American Society for Reproductive Medicine, 1/3 of the time the diagnosis is due to female infertility, 1/3 of the time it is linked to male infertility and the remaining 1/3 is due to a combination of factors from both partners. For approximately 20% of couples the cause can not be determined.

How Does Age Affect Fertility?

The number of infertile couples rises with increasing age. Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30. 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 eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and 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 egg 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.
• Unexplained infertility. The cause of infertility in approximately 20% of couples will not be determined using the currently available methods of investigation.

How Is the Cause of Infertility Determined?

If male infertility is suspected a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.

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

Two diagnostic tests that may be helpful in detecting 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.