Treating Female Infertility

Infertility -- The inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term.

The woman's reproductive system complements the man's, but keeps time to a different schedule. Under the supervision of the gonadotropin hormones FSH and LH, one of the two ovaries normally produces a mature egg each month. Once released from the ovary, the egg must be gathered into the fallopian tube for its journey through the tube to reach the uterus. If the egg meets healthy sperm on its way, it may become fertilized. When the fertilized egg implants in the uterus, pregnancy has begun.

When the hormones in your body become unbalanced, many conditions can result, such as premenstrual syndrome, dysmenorrhea (painful periods), or amenorrhea (an absence of periods). Endometriosis, some ovarian cysts, and uterine fibroids (growths) contribute to or are also influenced by hormones.

Dysfunctional uterine bleeding is a possibility when a hormonal imbalance occurs for various reasons. Lack of ovulation is a common cause of hormonal imbalance and dysfunctional bleeding (as well as of infertility and sometimes of amenorrhea). Normally, an LH surge triggers ovulation and progesterone production increases in the ovary. The progesterone level then rises until about a week before the end of the menstrual cycle, at which point it drops. The drop helps cue the body that it is time to shed the uterine lining. However, if ovulation hasn't occurred, the progesterone level may not drop.

Some women do not properly develop and release a mature egg every month as they should normally (anovulation).

Some women never develop and release an egg without medication (anovulatory). These women will have no menstrual periods for several months or years at a time (amenorrhea). Often, when they do have a period it is quite heavy. In some cases, the woman may even require medical attention because of the degree of blood loss.

Some women ovulate once or twice a year and need medication to stimulate egg development to occur in every menstrual cycle to increase the chance for pregnancy.

Usually the doctor can tell from discussing the details regarding previous menstrual cycles whether there is likely to be an ovulation disorder. In addition, blood testing at various times of the menstrual cycle and sometimes an ultrasound study of the ovaries can clarify whether ovulation is occurring.

Tubal factor infertility accounts for about 20-25% of all cases of infertility.



This category includes cases in which the woman has completely blocked fallopian tubes and also women who have either one blocked tube or no tubal blockage but tubal scarring or other tubal damage.

Tubal factor infertility is usually caused by either pelvic infection, such as pelvic inflammatory disease (PID) or pelvic endometriosis. Sometimes it can be caused by scar tissue that forms after pelvic surgery.

In cases of relatively minor tubal damage it is sometimes difficult to be certain that the infertility problem is solely due to the tubal damage and there are not other significant contributing causes to the problem conceiving. In general, the standard testing is performed on all couples and if no other cause is found to explain the infertility the presumptive diagnosis can be tubal factor, or if the degree of tubal scarring is very minimal, a diagnosis of unexplained infertility may be warranted.

A luteal phase "defect" is when the length of time between ovulation and menses is under 10 days (some say 12) and/or the lining of the uterus does not develop enough to sustain a pregnancy. A common treatment for a luteal phase problem is progesterone supplementation in the form of suppositories, injections, pills, or a combination of the above. The progesterone must be started at the time of conception (ovulation) in order to be useful. Some physicians recommend improving the number or quality of ovulation, and use medications such as Clomid, Metrodin, Pergonal, and/or hCG injections.

Some women with anovulation have a condition known as polycystic ovarian syndrome (PCOS) . These women usually have irregular menstrual cycles, increased body hair, and infertility.

PCOS affects from 5 to 10 percent of American women of reproductive age (as many as 5 million in all). The ovaries of women with PCOS appear to be filled with numerous small cysts. The cyst-like appearance results from an accumulation of immature ovarian follicles, the bubble-like structures which, upon maturation, rupture and give rise to the egg cell.

The features of PCOS may include failure to ovulate or menstruate, abnormally high levels of insulin, obesity, high blood pressure, hardening of the arteries, and high triglyceride levels. (Triglycerides are fatty substances used for energy storage, and high triglyceride levels may increase the risk for coronary artery disease.) PCOS patients also have high levels of the male hormone testosterone, which may cause them to grow excess facial or body hair.

An investigational drug that helps insulin to function more efficiently appears to combat infertility in women with polycystic ovary syndrome, the most common cause of female infertility, according to a research team funded in part by the National Institute of Child Health and Human Development (NICHD). The drug, D-chiro-inositol, occurs naturally in fruits and vegetables and appears to have no side effects in the comparatively small number of PCOS patients who took part in this preliminary trial.

Ovulation induction involves the use of medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of women who have anovulation and infertility. These women do not regularly develop mature follicles without help from medication.



Ovulation induction is somewhat different from controlled ovarian hyperstimulation which involves use of some of the same medications to stimulate development of multiple mature follicles and eggs in order to increase pregnancy rates with various infertility treatments.

Aspirin is a commonly used over the counter medication which has traditionally been used as an analgesic and fever reducer. In recent years, however, more attention has been paid to its anticoagulative properties. People with a history of heart problems often take a precautionary aspirin per day; individuals experiencing suspected myocardial infarction are also frequently given aspirin in the prehospital care environment.

The anticoagulative properties of aspirin have also been studied in the field of reproductive endocrinology. Low dosage aspirin is a common treatment component for women who are positive for antiphospholipid antibodies. Recently, its use in a more general infertility population has also been studied.