Learn about infertility in women, including possible causes, what tests might be needed and fertility treatments available to help with getting pregnant.
Infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year with no success.
Infertility results from female factors about one-third of the time and both female and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.
Female infertility causes can be difficult to diagnose. There are many treatments, depending on the infertility cause. Many infertile couples will go on to conceive a child without treatment.
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There might be no other signs or symptoms.
When to seek help can depend on your age:
Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.
Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:
In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it's frustrating to get no specific answer, this problem can correct itself with time. But you shouldn't delay treatment for infertility.
The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.
Certain factors may put you at higher risk of infertility, including:
For women thinking about getting pregnant soon or in the future, these tips might help:
If you've been unable to conceive within a reasonable period of time, seek help from your doctor for evaluation and treatment of infertility. You and your partner should be evaluated. Your doctor will take a detailed medical history and conduct a physical exam.
Fertility tests might include:
Depending on your situation, rarely your testing might include:
A doctor or technician places a slender catheter inside your cervix. It releases a liquid contrast material that flows into your uterus. The dye traces the shape of your uterine cavity and fallopian tubes and makes them visible on X-ray images.
Infertility treatment depends on the cause, your age, how long you've been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.
Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques.
Medications that regulate or stimulate ovulation are known as fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.
Fertility drugs generally work like natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They're also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs.
Fertility drugs include:
Gonadotropins. These injected treatments stimulate the ovary to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle).
Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and trigger their release at the time of ovulation. Concerns exist that there's a higher risk of conceiving multiples and having a premature delivery with gonadotropin use.
Using fertility drugs carries some risks, such as:
Pregnancy with multiples. Oral medications carry a fairly low risk of multiples (less than 10%) and mostly a risk of twins. Your chances increase up to 30% with injectable medications. Injectable fertility medications also carry the major risk of triplets or more.
Generally, the more fetuses you're carrying, the greater the risk of premature labor, low birth weight and later developmental problems. Sometimes, if too many follicles develop, adjusting medications can lower the risk of multiples.
Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce ovulation can cause OHSS, which is rare. Signs and symptoms, which include swollen and painful ovaries, usually go away without treatment, and include mild abdominal pain, bloating, nausea, vomiting and diarrhea.
It's possible to develop a more severe form of OHSS that can also cause rapid weight gain, enlarged painful ovaries, fluid in the abdomen and shortness of breath.
Long-term risks of ovarian tumors. Most studies of women using fertility drugs suggest that there are few if any long-term risks. However, a few studies suggest that women taking fertility drugs for 12 or more months without a successful pregnancy might be at increased risk of borderline ovarian tumors later in life.
Women who never have pregnancies have an increased risk of ovarian tumors, so it might be related to the underlying problem rather than the treatment. Since success rates are typically higher in the first few treatment cycles, reevaluating medication use every few months and concentrating on the treatments that have the most success appear to be appropriate.
Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days due to the success of other treatments. They include:
The most commonly used methods of reproductive assistance include:
Dealing with infertility can be physically and emotionally exhausting. To cope with the ups and downs of infertility testing and treatment, consider these strategies:
For an infertility evaluation, you'll likely see a doctor who specializes in treating disorders that prevent couples from conceiving (reproductive endocrinologist). Your doctor will likely want to evaluate both you and your partner.
To prepare for your appointment:
Some basic questions to ask include:
Don't hesitate to ask other questions you have.
Some potential questions your doctor or other health care provider might ask include: