FEMALE INFERTILITY
Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older).
Women who can get pregnant but are unable to stay pregnant may also be infertile. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).
Infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year with no success.
Infertility results from female factors about one-third of the time and both female and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
Female infertility causes can be difficult to diagnose. There are many treatments, depending on the infertility cause. Many infertile couples will go on to conceive a child without treatment.
Symptoms
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There might be no other signs or symptoms.
When to see a doctor
When to seek help can depend on your age:
- Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
- If you're between 35 and 40, discuss your concerns with your doctor after six months of trying.
- If you're older than 40, your doctor might suggest testing or treatment right away.
Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.
Causes
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:
- One of the two ovaries releases a mature egg.
- The egg is picked up by the fallopian tube.
- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
- The fertilized egg travels down the fallopian tube to the uterus.
- The fertilized egg attaches (implants) to the inside of the uterus and grows.
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.
Ovulation disorders
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.
- Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
- Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
- Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age 40.
- Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and can cause infertility. This can also be caused by medications you're taking for another condition.
Risk factors
Certain factors may put you at higher risk of infertility, including:
- Age. The quality and quantity of a woman's eggs begin to decline with age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
- Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It's also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.
- Weight. Being overweight or significantly underweight may affect ovulation. Getting to a healthy body mass index (BMI) might increase the frequency of ovulation and likelihood of pregnancy.
- Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
- Alcohol. Excess alcohol consumption can reduce fertility.
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