What is it?
- Female infertility means that you have had regular sex for 1 year without birth control and have not gotten pregnant. Birth control includes birth control pills, diaphragm, condoms, or rhythm. Infertility also means being unable to carry a pregnancy long enough so the baby can survive after birth.
- Infertility is not the same as being sterile. Sterility is when you cannot get pregnant and the cause cannot be fixed. Fifteen percent to 20% of healthy adults have fertility problems. With help, many fertility problems can be treated.
Myths About Infertility: There are many myths or wrong information about the causes of infertility. Following are some of these myths and the real truth about infertility:
- Infertility is a psychological problem. Actually, a physical problem is found to be the cause of 80% to 90% of all cases of infertility.
- Being infertile is a sexual problem. In fact, most couples with impaired infertility do not have any problem having intercourse (sex).
- Adopting improves a couple's chance of conceiving. Unfortunately, no improvement in fertility has been found in couples who adopted than in couples who did not adopt.
- There are many other religious and cultural issues about infertility as well. Talk to your caregiver if you are worried about any of these or other myths about being infertile.
What is the female reproductive system? A woman's reproductive system includes the uterus, fallopian tubes, ovaries, and vagina.
- The uterus is the pear-shaped organ in your abdomen (belly) where a baby grows during pregnancy. It is also called the womb. The cervix is the opening at the bottom of the uterus.
- The ovaries are two egg-shaped organs on each side of the uterus. The ovaries make and release a female sex cell or egg each month. This is called ovulation (ah-vew-lay-shun). About 10 to 14 days later you will menstruate (have your period) if your egg was not fertilized. This means that you are not pregnant.
- You have two fallopian tubes or "tubes." The egg travels from the ovary into a fallopian tube. The egg may be fertilized if sperm are in the tube from recent sex. If fertilized with sperm, the egg travels down the tube and attaches to the endometrium (n-doe-mee-tree-um). This is the lining of the uterus. It is called implantation when the egg attaches to the endometrium.
- The vagina , or birth canal, is the canal leading from the cervix to the outside of your body.
How does the reproductive system work?
- Hormones are special chemicals that your body makes. The job of hormones is to control how different parts of your body work. Hormones made during the first half of the menstrual cycle cause the endometrium to thicken. This prepares the endometrium for the fertilized egg.
- Different hormones are made during the second half of the menstrual cycle. These hormones help to feed the embryo (m-bree-o) after implantation. The embryo is a fertilized egg during the early weeks of growth.
- Hormone levels decrease if an egg is not fertilized with sperm. This causes the menstrual period to begin again.
Following are some of the many causes of impaired fertility:
- Ovulation problems.
- Cervical mucus problems.
- Fallopian tube problems.
- Egg implantation problems.
- Endometriosis (end-o-mee-tree-o-sis). This is when tissue inside the uterus grows outside the uterus.
- Being 30 years old or older. Fertility decreases naturally later in life.
- Pelvic infections, such as pelvic inflammatory disease (PID) that cause scarring in the abdomen and female organs.
- Too much smoking, alcohol, or stress. Drug abuse may also make infertility problems worse.
- Being overweight.
Often there are factors with both partners when infertility is found to be a problem. Finding out what problems may be causing your infertility takes time and money and may cause emotional stress. This makes it very important for both partners to want to find a reason for the problem.
You and your partner may choose to have a fertility workup. A caregiver called a reproductive endocrinologist or "RE" will do your fertility workup. Then you, your partner, and your RE will decide what treatments, if any, are needed.
Sometimes no cause of infertility can be found. You and your partner may choose to stop fertility treatments. Following are some other options for you and your partner to consider:
- Adoption. Adopting a baby may be the answer for couples who decide not to do infertility treatments. It may take several years to adopt a baby because more single mothers are deciding to keep their babies.
- Foster care. Being a foster parent is when you take care of a baby or child from Social Services in your home. You may have the child for a short or long time until Social Services can find a permanent home for the child. Being a foster parent gives you a chance to see if you want to be a parent. You may be able to adopt a child if you decide that is best for you.
- Surrogate mother. Another woman (surrogate) may be made pregnant with the semen from the infertile woman's husband by insemination. Or, an egg from the infertile woman may be fertilized in vitro with her own husband's sperm. Then the fertilized egg is put into the surrogate mother's uterus.
Fertility Workup: Caregivers will take a health history from you. This includes past pregnancies, length of infertility, and sexual history. You and your partner will both have a physical checkup and may have any of the following tests:
- Basal body temperature (BBT): Your body's basal temperature drops and then goes up within 1 day of ovulation. Caregivers may want you to take your temperature before getting out of bed in the morning for 2 to 3 months.
- Blood and urine tests: Hormone levels will be checked in your blood and urine. These tests help to tell caregivers when you ovulate. Blood is drawn at different times during your cycle. This helps your RE find out if the right amounts of hormones are present at the right times during your cycle. Special hormones are needed to help you get pregnant and others to help you stay pregnant.
- Cervical mucus characteristics: The mucus around the cervix is usually watery, thin, and clear. The mucus increases and thickens right before ovulation. You may be taught how to check your cervical mucus. The time when there is the greatest chance of getting pregnant is when the mucus can be stretched 5 or more centimeters (cm). This is called "spinnbarkheit."
- Colposcopy: A tool called a colposcope is used to look closely at the cells and tissue of your cervix and vagina. The colposcope is a metal tube with a tiny magnifying glass and light on the end. Some cells from inside your cervix may be scraped off and sent to a lab to be examined. You may also have a biopsy of your cervix or vagina. This is when a small piece of tissue is removed and sent to the lab for tests.
- Hysterosalpingography or HSG: This is a procedure using x-rays to look at the inside of the uterus. Dye can be used to see if the fallopian tubes are patent (open). Caregivers will also check for other problems, such as tumors.
- In vitro test of cervical mucus penetration by sperm: In vitro means a test or procedure that is done outside the body in a small glass dish. This test shows if your partner's sperm can swim through and survive in your cervical mucus.
- Laparoscopic surgery: This is surgery done to look at the outside of the uterus, ovaries, and fallopian tubes. A scope is put into your abdomen through a small incision at your umbilicus or belly button. Dye may be used to see if the tubes are open. A hysteroscopy may be done at the same time as the laparoscopy. A scope is put into your uterus through your vagina and cervix. This lets caregiver look at the inside of your uterus.
- Postcoital test of interaction between sperm and cervical mucus: This test is done 2 to 12 hours after intercourse. The test helps show if the woman's cervical mucus and the man's sperm are OK together. It can also show if there are sperm antibodies present. These antibodies see the sperm as bad so they attack and kill the sperm. Either the man's or the woman's body may make these sperm antibodies.
- Serum progesterone levels: This test measures the amount of the hormone progesterone in the blood. Progesterone helps make the woman's body ready to accept the fertilized egg.
- Sperm agglutination tests: This test finds out if the sperm are clumping together as a result of antibodies or infection.
- Sperm immobilization tests: This test is done to check how well sperm swim toward the egg.
- Timed endometrial biopsy: A biopsy is a test to take a sample of the endometrium (inside lining of the uterus). The sample is looked at under a microscope to see if the endometrium is ready for a fertilized egg to implant.
- Ultrasound: This test bounces sound waves off the organs inside your body. The bouncing of the sound waves makes a picture shown on a TV-like screen. This test can be used to look at the uterus, tubes, and ovaries.
Treatment Options: There are many ways to treat infertility. Caregivers will tell you the risks and benefits of each treatment. Talk to your partner openly and make treatment decisions together.
Embryo transfer: Another woman is artificially inseminated with your partner's sperm. The fertilized egg is removed from her uterus about 4 days later. The egg is then placed in your uterus. This method may be used if you have bad scars inside your abdomen. Or, embryo transfer may be used if you do not have ovaries or your ovaries do not work.
Insemination: Insemination is when sperm is collected and processed. The sperm is placed into your vagina, cervical canal, or directly into your uterus. Artificial insemination (AI) is when the sperm used comes from your partner. It is called therapeutic donor insemination (TDI) when sperm is used from a sperm bank. The choice of where the sperm comes from depends upon your fertility problem.
Laparoscopy: This surgery may be needed for problems in the abdomen or uterus, such as septate uterus or ovarian cysts. Scars from previous surgery or diseases, such as endometriosis, may be removed during surgery.
Medicine may be used to treat some infertility problems, such as hormone replacement therapy, and antibiotics or chemotherapy medicine for infections.
Other ways to get pregnant: There are 3 different ways caregivers can help you get pregnant. Before all 3 methods, a woman must take fertility medicines that cause many eggs to grow at once. Eggs are taken from her ovary before ovulation.
- In-vitro fertilization. Your egg is put into a special dish with sperm in the lab. The eggs are fertilized by the man's sperm while in the dish. One or more embryos (fertilized eggs) are then put directly into your uterus. This kind of procedure can be done even if your fallopian tubes are blocked or damaged.
- Gamete Intrafallopian Transfer or GIFT. A few of your eggs are mixed with sperm and are put inside one of your fallopian tubes. The eggs become fertilized in your tubes and travel into your uterus. You must have at least 1 healthy tube to have a GIFT procedure.
- Zygote (zi-goat) Intrafallopian Transfer or ZIFT. Your eggs are mixed with sperm in the special dish in the lab. The eggs are fertilized by the man's sperm while in the dish. The fertilized embryos are put into the opening of your fallopian tube and travel through the tube into your uterus. You must have at least 1 open healthy tube to have a ZIFT.
- Lose weight if you are overweight. Being overweight may cause fertility problems.
- Do not drink alcohol. Alcohol may affect fertility and should not be used during pregnancy.
- If you smoke, quit. Smoking may decrease fertility.
- Do not eat food or drink liquids that contain caffeine. High amounts of caffeine may decrease fertility.
Herbs and Supplements:
Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.
- Vitex (Vitex agnus - castus) has been used for many years, but has not been studied in women who have problems getting pregnant.
- Multivitamins have been used, but have not been studied in women who have problems getting pregnant.
- Acupuncture may help infertility.
- Relaxation therapies may help infertility.
- Hypnosis may help infertility.
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
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