Female infertility

What is it?

Infertility means you cannot get pregnant even though you have been trying for some time: usually a year, or 6 months if you are over 35. Most cases in women come from problems with making eggs. Other causes are blocked or scarred fallopian tubes (the tubes that carry the egg to the womb), endometriosis, fibroids (non-cancerous growths in the womb) and thyroid problems. In about 1 in 4 couples no cause is found.

About a third of the time the problem is with the woman, a third of the time with the man, and the rest of the time with both or with no clear cause. About 11 in 100 women of childbearing age in the US have had fertility problems. Worldwide, about 1 in 6 people of reproductive age face infertility at some point in their life.

The first signs

Infertility is when you cannot get pregnant even though you have regular sex without contraception. Some health problems raise the risk of infertility, such as:

• periods that are irregular or have stopped;
• very painful periods;
• having had endometriosis or pelvic inflammatory disease (an infection of the womb and tubes);
• repeated miscarriages.

How doctors find out

You usually start with your family doctor (family doctor) after a year of trying, or sooner if you are 36 or older or have a known reason for concern, such as past cancer treatment. It is best if you and your partner go together, because the problem can be with either of you, or both. The doctor asks about past pregnancies, your periods, sex, contraception, medicines and lifestyle, and may examine your pelvis.

• blood tests to check whether you are releasing an egg, and hormone tests if your periods are irregular;
• a test for chlamydia, a sexually transmitted infection, using a swab or a urine sample;
• an ultrasound scan of the womb, ovaries and tubes;
• an X-ray with dye (hysterosalpingogram) to look for blocked tubes;
• a laparoscopy (keyhole surgery with a small camera) if a problem such as a blocked tube is likely.

You may then be sent to a specialist fertility team at a hospital or fertility clinic.

Jelenlegi kezelés

Fertility medicines, surgery or IVF, by cause

How does it usually go?

Many couples get pregnant in time. When the woman is under 40, more than 8 in 10 couples having regular sex get pregnant within a year, and about half of the rest do so in the second year. The longer you have tried, the lower the chance: after more than 3 years of trying, the chance of getting pregnant naturally in the next year is 1 in 4 or less. Age matters too: fertility falls with age much more in women than in men, and a woman's chance of getting pregnant drops a lot after 35.

Medicines: what helps, and what to watch for

Many fertility medicines help you release an egg if you do not do so regularly. Clomifene helps you release an egg each month; tamoxifen may be offered instead. Metformin helps especially in women with PMOS (polyendocrine metabolic ovarian syndrome, which used to be called polycystic ovary syndrome, PCOS). Medicines called gonadotrophins can help bring on egg release, and other medicines (GnRH medicines and dopamine agonists) may also be used. Bromocriptine is used when high levels of the hormone prolactin cause problems with egg release.

Good to know:

• if no cause has been found, medicines that stimulate the ovaries are not advised, because they have not been shown to raise the chance of pregnancy;
• side effects can include feeling sick, being sick, headaches and hot flushes;
• many fertility medicines raise the chance of twins, triplets or more, which brings more risks in pregnancy, such as the baby being born too early.

Everyday habits matter too

Several things can affect fertility:

• weight: a BMI of 30 or more lowers fertility, and being very underweight or overweight can upset egg release;
• smoking, including breathing in other people's smoke;
• alcohol: UK guidance is no more than 14 units a week, spread over 3 or more days;
• severe stress, which may affect egg release;
• sexually transmitted infections such as chlamydia.

There is no evidence that complementary therapies help with fertility.

Surgery and IVF, for some people

Surgery can help with some fertility problems:

• blocked or scarred fallopian tubes can be repaired; how well this works depends on how much damage there is, and it can raise the risk of an ectopic pregnancy (a pregnancy outside the womb);
• keyhole surgery (laparoscopy) can treat endometriosis and remove some fibroids;
• if medicines have not worked for PMOS, part of the ovary can be destroyed with heat or a laser (ovarian drilling).

Help to conceive is another option. In IUI, washed sperm is put into the womb through a thin tube. In IVF, eggs are collected and fertilised in a lab, and an embryo is put into the womb; one cycle takes 3 to 6 weeks. IVF has risks: the ovaries can produce too many eggs and become large and painful, carrying more than one baby brings risks for you and the babies, and the pregnancy can be ectopic. Donor eggs can also be used, usually with IVF.

Is there a cure?

Often, yes: many couples who are treated for infertility go on to have a baby. Once the cause is known, treatment can be medicines, surgery or assisted reproduction. Private treatment can be costly, and there is no guarantee it will work. In the US, IVF led to a baby in about 39 in 100 cycles for women under 35, and about 11 in 100 for women aged 41 to 42 (2014 figures).

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Források

Written in plain words by Frontlight from these pages:

1. MedlinePlus: Female Infertility
2. NHS: Infertility
3. Office on Women's Health (HHS): Infertility
4. NICHD: How common is infertility?
5. NHS: Infertility – Causes
6. WHO: Infertility – Fact sheet
7. NHS: Infertility – Diagnosis
8. NHS: Infertility – Treatment
9. NHS: IVF