Infertility and Women

Dr. Nicholas Kaloudis

Infertility is the inability of a sexually active couple, not using any birth control, to get pregnant after one year of trying.

For pregnancy to occur, several things have to happen:

An egg must develop in the woman’s ovary.

The ovary must release an egg each month(ovulation). The egg must then be picked up by one of the fallopian tubes.

A man’s sperm must travel through the uterus to the fallopian tube to meet and fertilize the egg.

The fertilized egg must travel through the fallopian tube and implant in the lining of the uterus.

If any of these events does not happen or is disrupted, infertility will result.

About 40% of infertility cases are due to female infertility. From those, about 25% of women have infrequent or absent ovulation. These women usually have irregular periods or no periods at all. Ovulation can be disrupted by changes in the way certain hormones are released from the pituitary gland. These hormones, LH and FSH, signal an egg to develop and be released from the ovary.

Problems that interfere with normal LH and FSH release include injuries to the hypothalamus, pituitary tumors, being too thin, obesity, exercising too much, and extreme stress.

Other hormonal conditions that interfere with ovulation or affect fertility are: PCOS, an overactive or underactive Thyroid, Diabetes, early menopause, and Cushing’s Disease.

A woman’s ability to get pregnant can also be affected by her age, since the number and quality of her eggs gradually decreases beginning in the mid 30’s. Other factors include: problems with the reproductive tract, like blocked or damaged fallopian tubes, scarring of the uterine lining, polyps or fibroids in the uterus, and endometriosis.

Sexually transmitted diseases like chlamydia and gonorrhea can cause tubal blockages. Smoking, alcohol or using drugs like cocaine and marijuana. Certain medications like antidepressants, tranquilizers, narcotics, and anti-cancer drugs. Chronic medical conditions like kidney disease, liver disease, sickle cell disease, and AIDS.

Infertility is diagnosed, beginning with your doctor obtaining an extensive medical history about your menstrual cycle, past illnesses, STD’s, surgeries and medications that you are taking. The next step would be a pelvic exam to make sure your reproductive tract is normal, and blood tests to measure your hormone levels.

Treatment of infertility depends on the cause and your age. It falls into two main categories: one helps fertility through medications or surgery, and the other uses assisted reproductive technologies.

Fertility drugs such as Clomiphene and FSH and LH hormone injections are the main treatment for women with ovulation disorders. Women with no clear cause of their infertility might also use these medications. Sometimes doctors use drug treatment with intrauterine insemination (IUI), when sperm are released into the uterus, through a catheter inserted into the vagina. IUI is done at the time of ovulation.

Surgery may help women with fibroids, uterine polyps, scarring, or endometriosis. Surgery may also be an option for some women with blocked fallopian tubes, but it depends on your age and the type of blockage. You should be aware that surgery to unblock a fallopian tube may increase the risk of an ectopic pregnancy.

Assisted reproductive technology uses techniques such as mixing sperm with an egg outside the body (IVF), or injecting a single sperm into an egg, then transforming the resulting embryo back into the uterus.