Female Infertility

Description
Infertility is defined as the inability to become pregnant after trying for 1 year with the same person without using contraception of any sort. The condition affects about 5.3 million Americans or 9% of the reproductive-age population, according to the American Society for Reproductive Medicine (ASRM). Conventional therapies, such as medication to induce ovulation or surgery to open blocked fallopian tubes, are used to treat 85% to 90% of infertility cases, according to ASRM. Infertility affects males and females in roughly equal numbers. Doctors generally diagnose infertility and initiate diagnostic testing after 1 year of unsuccessful, well-timed attempts at getting pregnant.

Causes
# Contraceptives
# Decreased libido/sexual activity
# Sexual technique problems
# Sex not timed with ovulation
# History of miscarriages
# Mother's use of DES
# Tobacco use
# Excess alcohol consumption
# Recreational drugs
# Prescription drugs (that decrease male potency)
# History of pelvic inflammatory disease
# Thyroid problems
# Excessive exercise

Testing

Basic Testing
# General physical examination for both partners
# Both partners should be checked for sexually transmitted diseases such as chlamydia, syphilis, and gonorrhea.
# Basal body temperature monitoring for women (see below)
# Post sexual intercourse testing on day 12 or 13 of cycle: Cervical mucous should be abundant, clear, and elastic. Also mucous is examined under the microscope.
# Serum progesterone blood level on day 21 of the cycle
# Thyroid function testing

More Advanced Testing
# Hystero-salpingography: Oil dye is injected into uterus and uterus and tubes are evaluated for blockage with x-rays.
# Measure luteinizing hormone and follicle-stimulating hormone levels to determine ovarian function.
# Measure prolactin levels, as abnormal levels may indicate a problem or lack of ovulation.
# Endometrial biopsy to evaluate the lining of the uterus
# Laparoscopy: A scope is passed through belly button to evaluate for endometriosis or tubal adhesions.

Treatment

Specific Causes:
# Timing: Use a basal temperature testing or ovulation predictor kit to predict ideal time to have sexual relations, usually 24 to 48 hours before ovulation.
# Treat cervicitis with antibiotics.
# Treat thyroid problems appropriately.
# Excess exercise: decrease exercise
# Surgical treatment of ovarian tumors, tubal obstruction, tubal adhesions, or endometriosis
# Low progesterone level is an indication the woman is not ovulating on a monthly basis.

General treatments:
# Clomiphene citrate to induce ovulation (5% of pregnancies will result in twins, and rarely multiple births)
# Bromocriptine: treatment for elevated prolactin levels
# In vitro fertilization: Egg and sperm are brought together in the laboratory and then implanted in the uterus. This method is much more expensive than medications such as Clomiphene citrate.