Female Infertility

What Is Female Infertility?

When you're having problems conceiving, it can turn an exciting time full of promise into a stressful time filled with doubt. Infertility is a challenge you face if you're younger than 35 and haven't been able to get pregnant after trying for one year, if you're older than 35 and haven't conceived after more than 6 months, if you've lost two or more pregnancies to miscarriage or you have tried other fertility treatments without results.

You should seek help sooner if you have irregular menstrual cycles or have had gynecological issues such as endometriosis, pelvic surgery, tubal pregnancies or infections.

There are several steps in the process of becoming pregnant, and your body could be having trouble with one or more of these steps, including egg production, fertilization and implantation.

What Causes Infertility?

Problems with ovulation are the most common reasons for infertility in women. A woman's age, hormonal imbalances, weight, exposure to chemicals or radiation and cigarette smoking all have an impact on fertility. Other reasons include:

• Cervical mucus issues.
• Endometriosis.
• Damage to the fallopian tubes.
• Poor nutrition.
• Polycystic ovary syndrome.
• Uterine fibroids.

What are the Risk Factors of Infertility?

There are some general factors that affect your ability to ovulate, conceive or deliver a child successfully. These include:

• Anovulatory menstrual cycles: abnormal cycles of varying degrees, often characterized by the absence of ovulation and/or luteal phases.
• Autoimmune disorders.
• Blood clotting disorders.
• Uterine defects.
• Blockage of the cervix.
• Eating disorders.
• Endometriosis.
• Exposure to the drug diethylstilbestrol (DES).
• Chronic diseases such as diabetes.
• Pelvic inflammatory disease (PID).
• Many sexual partners.
• Sexually transmitted diseases.

Diagnosis of Female Infertility

Diagnosis and Evaluation

Diagnostic procedures can identify the causes of infertility. Sometimes, diagnosis can be easy — just a matter of conducting a few simple tests. Other times, pinpointing the cause requires time and patience. And, in some cases, no cause of infertility can be found.

A diagnostic evaluation often begins with a physical exam and a thorough health history. Afterward, the physician may further evaluate using one or more of the following methods:

• Confirming ovulation
• Conducting a blood test: A blood test will determine if there is normal ovulation physiology. Ovulation dysfunction can result from hormonal deficiencies, congenital defects, and age.
• Assessing ovarian reserve: A physician evaluates the follicle stimulating hormone (FSH) level. A blood test is performed that can determine the number/quality of eggs remaining in a woman's ovary.
• Measuring hormone levels: A common cause of infertility is polycystic ovary syndrome (PCOS). This syndrome is genetically linked to hormonal imbalances thereby causing a condition that prevents ovulation.
• Performing a post-coital test: After intercourse, the cervical mucus is analyzed to see how well sperm survive in a woman's reproductive tract.
• Taking a biopsy of the endometrium (lining of the uterus): This test further investigates problems with ovulation or hormones.

Depending on the patient's condition, additional detailed tests may be performed to determine the cause of the infertility. Penn Fertility Care understands that the process of diagnosis and treatment selection may be emotionally demanding and requires the most sympathetic of approaches, with attention to the emotional needs of the couple.

Treatment at Penn

Hormone Therapy to Induce Ovulation

Medications may be used to induce ovulation in those who are not ovulating or are ovulating irregularly. Additionally, hormone therapy can be used to alleviate other endocrine (glands that produce hormones) problems.

The causes of ovulation failure are numerous. The most common cause is polycystic ovary syndrome (PCOS). Learn more about Penn Fertility Care's dedicated PCOS Center and the excellent success rates seen at Penn.

In Vitro Fertilization

In vitro fertilization (IVF) is the preferred or most common infertility treatment used when the fallopian tubes are severely damaged or absent, and for unexplained or male factor infertility. Due to its high success rate, IVF has been used more frequently in recent years as a first line of therapy for all causes of infertility.

The following steps are taken when performing in vitro fertilization:

• The ovaries are stimulated to produce multiple egg-containing follicles.
• Progression of follicular development is followed by evaluating hormone levels and performing ultrasounds at the appropriate times.
• A transvaginal ultrasound guides the retrieval of the eggs.
• The recovered eggs are immediately transferred to the laboratory where they are cultured and fertilized.
• On a predetermined date, the developing preembryos are inserted into the uterus.

These procedures involve a variety of carefully choreographed procedures to insure the best success. The procedure itself, including the laboratory work, is performed in Penn Fertility Care's central state-of-the-art facility.

Surgical Options

Surgery is used to remove adhesions (scar tissue) or endometriosis, which block the fallopian tube or interfere with its ability to pick up an egg. Advanced techniques have improved our ability to do this, often with a non-invasive laparoscopic approach or with a microsurgical approach to reconstruct the fallopian tubes or the uterus.

Microsurgical repair is an option for reversing tubal sterilization and often provides a high success rate without the use of in vitro fertilization. When the fallopian tubes are extensively damaged, or when it is unlikely that they will respond to surgical treatment, in vitro fertilization is the most expeditious approach.

If there is extensive tubal damage, the affected fallopian tube is usually removed before proceeding to IVF. This helps to achieve greater success for the IVF procedure. For endometriosis, the laparoscopic approach with laser treatment is often effective.

Learn more about Penn's pelvic and reproductive surgery options.

Intrauterine Insemination (IUI)

Ovulation induction may be used in combination with intrauterine insemination (IUI). IUI is a relatively "low-tech" assisted reproductive technology (ART) in which washed sperm is deposited into the uterus and fallopian tubes, where fertilization occurs.

In addition, this process bypasses hostile cervical mucus and assists in overcoming sperm count and motility problems. Intrauterine insemination was pioneered by the Penn team and was extensively evaluated in a multi-center study published in the New England Journal of Medicine.

Egg Donation

In rare cases with premature ovarian failure, the ovary is no longer releasing eggs because the supply of eggs has been exhausted. Although no treatment is available to reverse this process, it is important to recognize this condition. Some patients will seek counsel and advice to cope with this diagnosis.

When the patient is unable to produce a pregnancy with her own eggs, the use of donor eggs can be considered as an option.

Learn more about egg donation

Penn Programs & Services for Female Infertility