Female Infertility

Age is a major factor in female fertility. As a woman approaches her mid-30s, her fertility begins to decline. This decline in fertility is because there are fewer eggs in the ovaries and the quality of the eggs diminishes as a woman gets older.

Not only does age affect a woman’s ability to get pregnant and carry the pregnancy to term, but age can also affect the pregnancy itself by increasing the risk of genetic abnormalities in the embryo.

In order to conceive, a woman must ovulate (release an egg from the ovary into the fallopian tube). Ovulation is connected to a woman’s menstrual cycle, or period, which takes place every 28 – 34 days, depending on the individual. Women who experience a period more than every 35 days, or not at all, are probably ovulating infrequently or not at all. Problems with ovulation (anovulation) are a common cause of infertility, accounting for approximately 25% of all female infertility cases.

The causes of ovulatory problems can include:

- Thyroid conditions
- High prolactin Levels
- Polycystic ovary syndrome (PCOS)

Ovulation can be determined through charting, over-the-counter ovulation predictor kits, and additional hormonal testing. If a woman is not ovulating or ovulating irregularly, our physicians may prescribe fertility medications to stimulate ovulation.

Open and functioning fallopian tubes are necessary for conception to occur. Certain risk factors can affect tubal function and account for 35% of female infertility. They include:

• Previous Pelvic Infections
• Previous Pelvic-Abdominal Surgery
• Endometriosis

The test that is typically performed to assess tubal patency, or open fallopian tubes, is a hysterosalpingogram (HSG), which is an X-ray picture of the pelvis. A thin tube-like instrument passes into the cervix, then an X-ray dye is injected into the uterus. As the dye enters the uterus and fallopian tubes, an assessment can be done on the uterine and fallopian tube anatomy.

The cervix is located in the lower part of the uterus. Conditions of the cervix can affect fertility but are rarely the sole cause of infertility. The following can contribute to cervical health:

• Abnormal pap smear(s)
• Prior cervical biopsies
• Cervical surgery (cone biopsy)
• “Freezing” and/or laser treatment of the cervix
• Patient’s mother took DES (diethylstilbestrol) while she was pregnant

Cervical problems are generally treated with antibiotics, fertility medications or by intrauterine inseminations (IUI).

The uterus (womb) is where the fertilized egg implants and develops. Uterine abnormalities can account for 20% of female infertility and include:

• Uterine scar tissue (Asherman’s Syndrome)
• Polyps (bunched-up pieces of the endometrial lining)
• Fibroids
• Abnormally shaped uterine cavity

Problems within the uterus may interfere with implantation of the embryo or may increase the incidence of miscarriage. The test(s) typically performed to assess the uterine cavity include a hysterosalpingogram (HSG) or sonohysterogram (SHG or SIS). Similar to the HSG, a thin tube-like instrument passes into the cervix with a sonohysterogram. Small amounts of saline are injected into the uterus under ultrasound guidance to assess the uterine cavity. This is the preferred test for uterine abnormalities.

Surgery may be required to further evaluate and possibly correct uterine cavity abnormalities.

Miscarriage is one of the most devastating experiences that can happen to a woman. Approximately 2 out of every 10 pregnancies may result in a miscarriage. After having one miscarriage, most women go on to have a healthy pregnancy.

Women are considered to have recurrent pregnancy loss (RPL) when they have two or three miscarriages in a row. Only about 1% of women have three consecutive miscarriages or more. In about two out of three cases, we are able to determine the cause of recurrent pregnancy loss.

The causes of recurrent pregnancy loss include:

• Genetic-chromosomal defects
• Age
• Uterine abnormalities
• Incompetent cervix
• Hormonal defects
• Autoimmune disorders
• Clotting disorders

Treatments vary depending on the cause of recurrent pregnancy, including hormonal-anticoagulant medications, surgery, IVF and preimplantation genetic testing.