Becoming more informed about the causes of infertility in women is the first step to preparing yourself for the initial stages of fertility treatment and the real possibility of overcoming infertility.
Infertility in women is a more common problem than many people realize. It is generally defined as inability to become pregnant after at least one year of efforts. Statistics from the Centers for Disease Control and Prevention (CDC) indicate that approximately 10% of US American women between ages 15-44 encounter problems getting pregnant or sustaining pregnancies. Determining the causes of infertility in women is sometimes a lengthy and emotionally challenging process. Do not be discouraged if a conclusive diagnosis is not arrived at quickly. Educate yourself on the options available as you make decisions whether to pursue the stages of fertility treatment.
Polycystic Ovarian Syndrome (PCOS)
PCOS affects approximately 6% of women. This condition develops when ovaries produce excessive amounts of the male hormone testosterone, which lowers levels of the female follicle-stimulating hormone (FSH). If you have PCOS, your ovairan follicles are inhibited from releasing a mature egg, which causes the follicles to fill with fluid and become cysts. Without ovulation, progesterone production ceases, while estrogen production continues. Symptoms of PCOS may include irregular menstrual periods, excessive weight gain and hair growth, and acne.
Treatment:Although PCOS cannot be cured, clinical-quality supplements specially formulated to increase egg quality and ovary function have shown to be especially helpful for women with PCOS. Clomiphene citrate (Clomid), which acts upon the pituitary gland is also sometimes used. Metformin (Glucophage) may be prescribed to reduce male hormone production in some women with PCOS.
About 30% of women’s infertility cases are due to endometriosis, a noncancerous condition in which cells of the uterine lining (endometrium) are also growing on the ovaries or other areas. Endometrial cysts in your ovaries can prevent release of an egg. When formed in the fallopian tubes, the cysts can block passage of an egg. In severe cases, scar tissue spreads in the uterus, fallopian tubes, and ovaries, preventing transfer of an egg. There may be no symptoms for endometriosis other than inability to conceive. But, symptoms can include painful and irregular periods, chronic pelvic pain, severe pain during intercourse, bowel pain, and painful urination while menstruating.
Treatment: Laparoscopic surgery can be used to extract abnormal tissue that is blocking egg passages. Surgery to extract excess tissue in cases of endometriosis has shown to double patients’ potential for pregnancy. Surgery can remove uterine fibroids, polyps, or scarring, which can affect fertility.
Damaged fallopian tubes can block eggs from passing into the uterus and prevent sperm from reaching the egg. There are typically no symptoms other than infertility associated with this condition. Throughout the world, repeated or severe Pelvic Inflammatory Disease (PID) is one of the most common causes of tubal blockages resulting in women’s infertility. PID may cause formation of abscess, scarring, or tubal damage resulting in infertility or ectopic pregnancy (embryo development in a fallopian tube instead of in the uterus). The most common causes of PID are sexually transmitted diseases (STDs), with Chlamydia causing 75% of infertility in the fallopian tubes, and Gonorrhea causing most other cases.
Treatment: Surgery may be recommended to remove tubal blockages and repair fallopian tubes. However, rates of successful conception after these types of surgery are low. Additionally, surgeries in fallopian tubes come with increased risk of tubal pregnancy. Still, surgery may be the most promising option to eliminate polyps, scarring, or uterine fibroids that appear to be impacting fertility. In vitro fertilization in conjunction with surrogacy is sometimes the most viable option in such cases.
Poor Egg Condition
Eggs that become damaged or develop chromosomal abnormalities cannot sustain a pregnancy. This problem is usually age-related, as egg quality declines significantly in the late 30s and early 40s. Fertility begins to decline when women reach their mid 30s, and sharply decline after their late 30s. At this stage of life, fewer eggs remain, fitness of the eggs is diminishes, and ovaries’ ability to release eggs is reduced. Risk of abnormalities in chromosomes increases, raising the risk of miscarriage or birth defects.
Treatment:Using a donor egg or embryo, or surrogacy may be necessary. About 33% of women who use donor eggs or embryos in IVF treatments have successful pregnancies. In some cases, prescription medications or medical treatment is needed. However, many women benefit from a nutritional regimen that includes recommended prenatal vitamins. Nutritional supplements, including vitamins, minerals, and antioxidants can help balance hormone levels, which can promote regularity of the menstrual cycle.
Various conditions (most often hormonal) such as Hyperprolactinemia can prevent release of a matured egg from an ovary. This occurs when the hormone prolactin, generated by the pituitary gland to stimulate breast milk production, is produced in excessive amounts. Excessive prolactin reduces gonadotropin hormones and thereby inhibits ovulation. Symptoms may include no menstrual periods or infrequent periods with light or exceptionally heavy bleeding.
Approximately one percent of women are affected by another ovulation problem, known as Premature Ovarian Failure (POF), which is due to depletion of ovarian follicles prior to age 40. POF causes include deficiencies in pituitary, adrenal, or thyroid function, among others. This usually results in premature menopause.
Treatment:Medications like Clomiphene Citrate, Gonadotropins, and Human Chorionic Gonadotropin (hCG) are hormones that are injected into the ovaries to stimulate egg growth and ovulation. Note that there is a 10% probability of having twins when using Clomiphene and a 30% probability of having multiple births for women who conceive using hCG hormones. Approximately two-thirds are twins, and one-third triplets or greater numbers.
Other treatments include Bromocriptine and Cabergoline, which are oral medications used to reduce excessive levels of prolactin that may be inhibiting ovulation. For overweight women, changes in diet and/or lifestyle can improve general reproductive health in ways that may increase odds of successful ovulation. For some women, use of assisted reproductive technology (ART), such as intrauterine insemination (IUI), also known as artificial insemination, may be recommended if you have ovulation problems.
If you would like more information about the causes of infertility in women, contact the Woman’s Clinic at (501) 664-4131 to schedule an appointment and learn about your treatment options.