A B C D E F G H I J K L M N O P R S T U V W

INFERTILITY (FEMALE)

What is Infertility ?

Primary infertility is when a woman has never been pregnant. In secondary infertility she has conceived before, but is now having difficulty. If a woman is over 35 or suspects she may have a problem, advice is needed after trying for about 6 months. Younger women are usually encouraged to wait for 12 months. The main causes of infertility in women are: not making an egg (anovulation); damage or blocking of the tubes; endometriosis; problems with intercourse and incompatibility between the sperm and the secretions at the neck of the womb (this is called cervical hostility). In some cases no cause can be identified. A male cause of infertility is present in up to 40% of couples.

How does Infertility occur ?

ANOVULATION This most commonly occurs because part of the brain called the hypothalamus is not working properly. It is the usual cause of infertility in women with anorexia or chronic stress. It can also occur if you are underweight, undernourished or suffering from some chronic illness. The pituitary gland in the brain is also very important for ovulation. Sometimes women stop periods and ovulating because the pituitary produces too much of a hormone called prolactin. This hormone makes even non-pregnant women produce breast milk (galactorrhoea). The ovary can also be at fault, commonly in polycystic ovarian disease. The closer a woman is to the menopause, the less efficient ovulation becomes. BLOCKING OF THE TUBES This can be caused by infection (salpingitis), previous surgery to the tubes or a previous ectopic pregnancy. PROBLEMS WITH INTERCOURSE This can be because the man is impotent. It can be because it is too painful for the woman, perhaps due to something physically wrong. It can also be that she is afraid and unable to relax. CERVICAL HOSTILITY is caused by infections, abnormal hormone levels or the development of anti-bodies to partners sperm.

Why does Infertility occur ?

About one in four of all couples investigated for infertility do not have a definite diagnosis made. This does not mean there is no reason, only that one cannot explain the cause. Women become less fertile as they get older. As couples tend to delay a family until their 30s, so treatment is less successful. Damage to the tubes is associated with sexually transmitted diseases. The pituitary may produce too much prolactin because of a small benign growth or as a side-effect of some medicines.

Treatment Involved for Infertility

The male partner will be asked to have two semen analyses. A post-coital test is done a few hours after intercourse at, or just before, ovulation. Blood tests are done to check hormone levels. A raised blood level of the hormone, progesterone, in the second half of the cycle confirms release of the egg (ovulation). Temperature charts are no longer routinely used to monitor ovulation. Blood levels of prolactin may be measured if the woman is not having regular periods. Regular ultrasound scans (using sound waves to make a type of radar picture) are used to assess ovulation. A laparoscopy (telescopic examination through the navel) will check the tubes and gives more information about ovulation and endometriosis. An x-ray called a hysterosalpingogram may be used instead to check the health of the tubes. This does not need an anaesthetic but may be painful. It must be done in the first half of the menstrual cycle. ANOVULATION Bromocriptine or a similar drug is given where the blood prolactin level is high. It is taken usually at night with a bed-time snack and continued until conception. Other oral fertility tablets include clomiphene, tamoxifen and cyclofenil. These are usually taken for 5 days starting on the second day of the period. If these are unsuccessful, a more potent fertility drugs can be given by injection. The injections are usually daily but may be alternate days. Scans, and maybe blood tests, are essential and are done very frequently to check how many eggs are developing. Finally, a hormone called GnRH (gonadotrophin-releasing hormone) can be used and this is quite complicated. A needle is inserted under the skin of the arm. It is connected to a small computerized pump worn on a belt or under the clothing. This gives a very small infusion every 90 minutes. TUBAL DISEASE A few minor adhesions can be divided at the time of laparoscopy. Surgery can be used to open up blocked or damages tubes. IVF is generally more successful in treating infertility due to tubal disease. ARTIFICIAL INSEMINATION Donor sperm may be used if the man has no sperm of his own. Artificial insemination using the husband's sperm is sometimes tried in cases of unexplained infertility or cervical hostility but the success rate per treatment is low. ENDOMETRIOSIS Gamete intra-fallopian transfer (GIFT) and in vitro fertilization (IVF). These techniques are not always available in the National Health Service. Both involve treating with fertility drugs and deliberately trying to produce more eggs than necessary. The eggs are collected by laparoscopy, sometimes simply through a needle. In GIFT, one or two eggs, together with some of the husband's sperm, are replaced in the tubes at the same laparoscopy. In IVF, the eggs are kept each in a separate container. The husband's sperm are added to each egg. If fertilization occurs, two or three eggs are replaced in the womb a day or two later. Spare eggs can be fertilized, frozen, and used in the future. For more details, see IVF and assisted conception.

During Treatment for Infertility

All patients on fertility drugs should be seen by the clinic regularly. Bromocriptine may induce nausea and headaches. Ovulation should start within a few weeks of treatment. Other fertility drugs, especially if injected, run the risk of multiple pregnancy. Overstimulating the ovaries with fertility drugs may cause quite bad lower abdominal pain. This is due to ovarian cysts and fluid inside the abdomen (ovarian hyperstimulation syndrome) and may require treatment in hospital. Regular scans during treatment help to prevent this. After tubal surgery one should try to conceive as soon as possible. There is a risk of ectopic pregnancy. As soon as pregnancy is suspected, report to the doctor.

After Treatment for Infertility

If infertility is not explained but still no conception occurs, the doctor might suggest IVF. There is some evidence that women who have had unsuccessful treatment with infertility drugs may have an increased risk of ovarian cancer later in life.

If Infertility is Left Untreated

Where the tubes are blocked, pregnancy is impossible without treatment. All other types of female infertility may produce surprising, unexpected pregnancies after treatment has been abandoned!

Effects on Family of Infertility

Infertility treatment is a gross intrusion into a couple's private life. Tremendous support is needed between partners and whatever counselling services are available.