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Female Factor Infertility

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Female factor infertility is the inability to conceive or carry a pregnancy to term due to one or more problems specific to females. For example, if a couple is struggling to achieve pregnancy and the male has adequate sperm count, motility, their inability to conceive may be caused by female factor infertility. There are several conditions that contribute to female factor infertility.

Secondary Infertility

Sometimes female infertility occurs after a woman has already given birth to one or more children. If a couple has already successfully conceived and delivered before, but is having difficulty becoming pregnant again, they may be experiencing secondary infertility.

Secondary infertility can be caused by a wide range of issues, including age, irregular ovulation, endometriosis, hostile cervical mucus, and an abnormal uterus or pelvis. Scar tissue from the previous pregnancy may be causing blockage to the fallopian tubes or cervix, resulting in female factor infertility.

Abnormal Uterus or Pelvic Area

Uterine and pelvic area abnormalities can affect a woman's chances of getting pregnant. In many cases, however, women can undergo infertility treatment to increase their chances of successfully conceiving.

  • Uterine Abnormalities: Sometimes female infertility is the result of an abnormal uterus. In order for conception and birth to take place, the uterus must be able to accept embryo implantation and nurture the fetus throughout pregnancy. Uterine fibroids, poor endometrial lining, endometriosis, or birth defects can adversely affect the uterus. Female factor infertility, including secondary infertility and infertility after miscarriage, that is due to uterine abnormalities like polycystic ovarian syndrome is often treatable, but requires the attention of a physician who specializes in female fertility.
  • Pelvic Area Abnormalities: Pelvic area abnormalities can be another cause of female factor infertility. These abnormalities include anatomical problems with the vagina or cervix, disease and blockage of the fallopian tubes, endometriosis, and adhesions and damage to the pelvic cavity. Pelvic adhesions can result from any kind of infection in the pelvis or abdomen, as well as from endometriosis, secondary infertility, and even trauma to the pelvic or abdominal area. Polycystic ovarian syndrome is another type of pelvic adhesion abnormality. Pelvic adhesions often develop without presenting any symptoms, and are only discovered after the female patient begins struggling with fertility.

Blocked Fallopian Tubes

It is estimated that up to 25 percent of all infertility cases are due to an obstruction of the fallopian tubes. Tubal factor infertility may be due to a blockage, scarring, or damage in one or both fallopian tubes which makes becoming pregnant difficult.

Causes of Tubal Obstruction

An obstruction in the fallopian tube prevents the egg from traveling toward the uterus, making conception impossible. The obstruction can be caused by a range of conditions, including:

  • Scarring from infection, such as pelvic inflammatory disease (PID)
  • Adhesions or scar tissue from previous abdominal/pelvic surgeries
  • Tubal ligation
  • Endometriosis
  • Ectopic pregnancy

Diagnosis of Tubal Obstruction

To test for tubal obstruction, your doctor will likely perform a hysterosalpingogram (HSG), a type of X-ray examination in which a dye is injected into the fallopian tubes to determine whether they are blocked. He or she may also perform a hysterosonogram, a type of transvaginal ultrasound test, in order to view the fallopian tubes. If further diagnosis is necessary, he or she may perform laparoscopic surgery involving the insertion of a small camera through an incision in the abdomen in order to view the tubes.

Treatment for Tubal Factor Infertility

There are several procedures to treat tubal factor infertility.

  • Recanalization: A procedure in which the doctor passes a tiny wire or other instrument through the uterus and into the fallopian tube to remove the blockage.
  • Laparoscopy: A surgical procedure in which a small incision is made in the abdomen in order to reach the fallopian tubes. A device called a laparoscope is used to view the tubes and remove any obstructions.
  • Salpingectomy: This procedure is used when only one tube is obstructed. It involves removing or sealing the damaged/blocked fallopian tube in order to give preference to the functioning tube.

If these treatments do not improve fertility, there are several infertility treatments, such as in vitro fertilization, that can help a couple conceive.

Endometriosis

Endometriosis is one of the most common causes of female factor infertility, affecting nearly 5 million women in the United States each year. Endometriosis is a chronic disease that causes tissue to build up outside of a woman's uterus. The tissue can attach to the ovaries, uterine wall, and fallopian tubes causing severe abdominal pain.

Endometriosis can also result in significant scarring of the reproductive organs, which sometimes contributes to female infertility. Endometriosis treatment includes several non-surgical and surgical options.

Non-Surgical Treatment Options

Hormonal medications can be used to halt or slow the progression of endometriosis. A common prescription used for endometriosis treatment is Gn-RH agonists, which control estrogen production - a contributing factor in the growth of endometrial tissue. Other prescription options can be discussed with your doctor or fertility specialist.

Surgical Endometriosis Treatment

Surgical treatment options are a bit more invasive, but can correct structural problems or abnormalities, including:

  • Diagnostic hysteroscopy
  • Laparotomy microsurgery
  • Laparoscopic surgery

Hostile Cervical Mucus

Hostile cervical mucus is one cause of female factor infertility, though the significance of mucus hostility is still disputed by fertility specialists. In a normal cycle, the cervix produces watery mucus just prior to ovulation. This mucus assists sperm in reaching the fallopian tubes and fertilizing the egg. If the cervical mucus is too thick or viscous, it can prevent sperm from passing through the cervix. Hostile cervical mucus can also cause secondary infertility, or the inability to conceive after previously successful pregnancies.

Causes of Hostile Cervical Mucus

Some of the common causes of hostile cervical mucus are:

  • Mucus containing antisperm antibodies
  • Abnormal sperm or seminal fluid
  • Inadequate estrogen stimulation and cervical functioning due to infection or damage

Prevention of Hostile Cervical Mucus

Because cervical mucus plays an important role in a woman's ability to get pregnant, those with hostile cervical mucus can take guaifenesin during ovulation to reduce the mucus' thickness. Guaifenesin is an ingredient in some over-the-counter cough syrups, including Robitussin.

Irregular Ovulation

Female factor infertility, including secondary infertility, can be caused by irregular ovulation, the absent or sporadic release of an unfertilized egg by the ovaries. Hormonal changes are usually the reason for ovulation problems. However, any number of factors can contribute to this condition, including premature menopause, polycystic ovarian syndrome (a condition caused by excess luteinizing hormone), chemotherapy, tumors, infections, heavy exercise or dieting, and hyperprolactinemia (excessive production of prolactin).

Symptoms of Irregular Ovulation

Absent or irregular ovulation is the leading cause of female infertility; in fact, nearly 40 percent of infertile women are affected by an ovulatory problem. There are several kinds of abnormal menstrual patterns that can indicate irregular ovulation might be occurring. These include:

  • Primary amenorrhea - lack of a first menstrual cycle
  • Secondary amenorrhea - lack of menses after initial menstruation
  • Polymenorrhea - more than one menstrual cycle within a 26-day period
  • Hypomenorrhea - significant reduction in the length and volume of menses

Medications and Infertility

In recent years, with advancements in pharmaceuticals and contraceptive devices, serious concerns over the possibility of a link between female infertility and prescription drugs or contraceptives have arisen. While there have been clear and indisputable connections made between miscarriage or birth defects and the use of such prescription drugs as AccutaneTM and Coumadin®, many myths about the impact of drugs and contraceptives on female infertility have been debunked.

  • IUDs: Although IUDs (intrauterine devices) and infertility have been linked for many years, the IUDs, themselves, do not cause infertility. Studies now show that when a woman contracts a sexually transmitted disease while using and IUD, the device facilitates in spreading the infection, which can eventually lead to infertility; however, it does not cause or invite the disease. Physicians recommend IUDs to couples in long-term, monogamous relationships with low risk of contracting sexually transmitted diseases.
  • Femara®: Cancer drugs, like Femara®, have also been linked with infertility. Femara® is used to treat breast cancer, but some physicians found off-label, non-FDA approved uses for it, including female fertility enhancement. If you or your partner have been prescribed Femara® and are now experiencing infertility, you should seek professional medical attention right away.
  • Contraceptives: As for links between female factor infertility and other contraceptives, none have been demonstrated definitively. To learn more about possible connections between prescription drugs and contraceptives and infertility, you should contact a female fertility specialist.

Miscarriage

The termination of a pregnancy is devastating to couples who wish to have a baby; worse yet is the prospect of female infertility after miscarriage. Unfortunately, such a fate is possible. This form of female factor infertility can be caused by hormonal, environmental, immunological, and even physiological problems. There is hope, however, with treatment from a female fertility specialist. If you are struggling to conceive after having a miscarriage, visit DocShop's Pregnancy Miscarriage section to find out how you can increase your chances of getting pregnant.

Polycystic Ovarian Syndrome

Believed to be one of the most common ovarian disorders and causes of female factor infertility in the United States, polycystic ovarian syndrome (PCOS) affects 5 to 10 percent of women of childbearing age.

A diagnosis of polycystic ovarian syndrome means that the patient's ovaries are covered with multiple cysts (small, non-cancerous, fluid-filled sacs). These cyst-covered ovaries do not produce enough of the hormones necessary for the maturation of ova, and the result is absent or irregular ovulation.

Symptoms of PCOS

Female infertility is not the only symptom of PCOS. Other signs of the disorder include:

  • Irregular ovulation, or amenorrhea
  • Hirsuteness
  • Acne and sebhorrea
  • Obesity
  • Male-pattern thinning of the hair
  • High cholesterol and blood pressure; type 2 diabetes
  • Frequent pelvic pain

PCOS Treatment

Treatment for polycystic ovarian syndrome largely depends on the requirements of the patient. If the patient wants to simply treat the symptoms of PCOS, such as hair growth or hair loss and irregular ovulation or menstruation, birth control pills, diabetes medications, and weight loss can help.

If the patient wants to treat female factor infertility, hormones and fertility drugs are administered to stimulate ovulation. Although female reproductive surgery is an option, it is not recommended unless all other treatments have been explored. Ovarian drilling can lead to the development of scar tissue and cause further damage to the pelvic area.

Premature Ovarian Failure

Premature ovarian failure (POF), also called primary ovarian insufficiency, occurs when a woman's ovaries stop working before the age of 40, and it can develop as early as the teenage years. It is not the same as premature menopause, which is when periods stop before the age of 40. Women with POF may still have their periods but they may be irregular. Women with premature ovarian failure may have few or no eggs, or have eggs that do not develop properly, and they may experience menopause-like symptoms, and have difficulty becoming pregnant.

Causes of POF

For most women, the cause of POF is unknown; however, there are a few conditions that may increase the risk of premature ovarian failure.

  • Genetics
  • Thyroid dysfunction
  • Immune system disorders
  • Eating disorders
  • Viral infection
  • Radiation or chemotherapy treatment
  • Hysterectomy
  • Turner Syndrome
  • Symptoms of POF
  • Women with premature ovarian failure often experience menopause-like symptoms, including:
  • Irregular periods or no period
  • Hot flashes
  • Night sweats
  • Trouble sleeping
  • Irritability
  • Vaginal dryness
  • Low sex drive

Diagnosis of POF

If you believe you are experiencing premature ovarian failure, your health care provider will perform a physical examination, a pregnancy test, and blood tests to rule out other possible causes for your symptoms. He or she will also check your blood level for follicle-stimulating hormone (FSH). High levels of this hormone, which signals your body to release an egg each month, may be a sign of POF.

Treatments for POF

The symptoms associated with premature ovarian failure are usually treated with hormone replacement therapy (HRT), or oral contraceptive pills. Unfortunately, there are no treatments currently available to help restore ovary function or fertility for someone with POF. However, many women with POF are still able to experience pregnancy. A small number of women with POF are able to conceive naturally because they are still producing some eggs, while others choose to become pregnant with donor eggs.

Uterine Fibroids

Uterine fibroids are growths that form within the uterus and are made up of muscle cells and other tissues. They are often referred to as tumors, but they are usually not cancerous, and can range from the size of a pea to the size of a grapefruit or larger. Fibroids are very common during the childbearing years, and it's estimated that 1 in 5 women over the age of 35 have them. Medical experts and researchers are not sure what causes fibroids, but they are likely the result of several factors interacting together, such as hormonal levels, genetics, and environmental factors.

Symptoms of Uterine Fibroids

Fibroids don't seem to directly cause fertility problems. However, depending on where the fibroid is located, it can interfere with sperm reaching the egg, prevent implantation of a fertilized egg in the uterus, or block a fallopian tube. Oftentimes, fibroids cause no symptoms. Some of the symptoms that women with fibroids may experience include:

  • Early onset of labor during pregnancy or multiple miscarriages
  • A full feeling in the pelvic area
  • Frequent urination or urinary incontinence
  • Constipation
  • Pain in the lower back or legs
  • Prolonged menstrual periods, or pain or heavy bleeding during periods
  • Bleeding between periods
  • Pain during sex

Fibroids rarely require treatment, but if they are suspected to be the cause of infertility, or if a woman is experiencing uncomfortable symptoms, there are treatments available to shrink or remove them.

Diagnosis of Uterine Fibroids

Your doctor can perform infertility tests to determine if you have fibroids. These tests may include an ultrasound, magnetic resonance imaging (MRI), X-ray, and CAT scan (CT). In some cases, surgical procedures, in which a small tube with a camera is inserted through the abdomen into the uterus (laparoscopy), or inserted directly into the uterus through the vagina (hysteroscopy), may be necessary to confirm the existence of fibroids.

Treatments for Uterine Fibroids

There are several treatments available to treat uterine fibroids. However, some make it difficult or impossible to become pregnant afterwards, so it is important to let your doctor know of your plans to have children in the future.

  • Medications: Treatments for mild symptoms due to fibroids include gonadotropin releasing hormone agonists (GnRHa), anti-hormonal drugs, and oral contraceptives.
  • Myomectomy: This surgical procedure removes the fibroids without removing healthy uterine tissue.
  • Hysterectomy: A hysterectomy surgically removes the uterus and is considered a cure for fibroids. However, it is not recommended for women who want to have children.
  • Endometrial Ablation: This procedure is used to stop heavy bleeding by using heat to destroy the lining of the uterus. It is not recommended for women who still want to become pregnant.
  • Myloysis: This is a laparoscopic procedure in which an electric current is used to destroy the blood vessels that feed the fibroids, thus shrinking and/or eliminating them.
  • Uterine Fibroid Embolization (UFE): The UFE procedure shrinks a fibroid by clotting the artery that feeds it. UFE may negatively affect fertility.
  • Focused Ultrasound: During focused ultrasound, doctors use high-frequency sound waves, guided by MRI, to target and destroy fibroids while preserving the uterus. It is approved by the FDA as a non-invasive treatment for fibroids.

Contact a Fertility Doctor

It is important to have your fertility problems diagnosed by a fertility specialist if you and your partner are having trouble conceiving. You can find a fertility doctor in your area through DocShop's online directory.

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