For more information about male infertility and fertility issues for both men and women, please learn more about the Reproductive Medicine Center
The Causes and Treatment of Infertility in Women
Estil Strawn, MD
Medical College of Wisconsin Reproductive Endocrinologist;
Director, Reproductive Medicine Center;
Named one of the “Best Doctors in America®” by Best Doctors, Inc.
In the United States, infertility affects more than six million women and their partners, about 10 percent of the population who are in reproductive years. Through medical intervention, however, many of these couples will eventually become parents. Estil Strawn, MD, outlines common causes of infertility, how they are most commonly treated and when couples should seek treatment.
Q. What are the main causes of infertility in women?
It is important to understand that about 40 percent of infertility in couples is male related and about 40 percent is female related. Other cases are due to a combination of male and female factors or to unknown causes. So, if there are fertility concerns, both partners should undergo complete medical exams and history.
In men and women, multiple factors can account for difficulty in getting pregnant. But in women, infertility causes generally fall into four categories: 40 percent are related to ovulation, 40 percent are tubal factors, 10 percent are hormonal problems and 10 percent are unexplained.
Q. How do you treat infertility in women?
When there is an ovulation problem, the woman may not produce eggs each month, and without eggs, fertilization cannot occur. This is often related to a history of irregular menstrual periods. Oral medications, such as clomiphene citrate, can help stimulate ovulation and establish regular periods. Hormonal problems, such as an underactive or overactive thyroid, can also affect ovulation and can also be treated with medication. In very rare cases, there may be a disorder of the immune system, which is more complex and requires very specialized treatment.
Tubal factors are usually the result of blocked or damaged fallopian tubes. Many conditions can lead to blockage or damage, including pelvic inflammatory disease and endometriosis. If the fallopian tubes are blocked or damaged, eggs can't travel through the tubes into the uterus. Often, the tubes can be opened through an outpatient procedure called laparoscopy. If the damage is minimal, the procedure is very successful. When the damage is more extensive, more high-tech solutions are required.
In unexplained infertility, we don't have clear-cut answers as to why a couple is having problems getting pregnant. Some of these couples can be treated with a combination of clomiphene citrate and intrauterine insemination. In this procedure, the male produces semen, which is processed to select the best moving sperm. It is then placed in the woman's uterine cavity so it will pass more rapidly to the fallopian tubes and fertilize an egg.
In other cases of unexplained fertility or when a woman's fallopian tubes cannot be corrected through surgery, we try assisted reproductive technology, the most common of which is in vitro fertilization or IVF. In IVF, eggs are harvested from the women's ovaries and fertilized by the man's sperm in the lab. The resulting embryos are then transferred into the women's uterus.
Although more high-tech solutions like IVF have helped many women get pregnant, the vast majority of infertility problems in women can be treated with medication or simple surgery.
Q. When should a couple be concerned about infertility?
When a couple decides they want to get pregnant, they should be using no form of birth control and have intercourse at least two times a week. If the woman is 33 or younger and pregnancy does not result within a year, a couple should seek medical attention. If the woman is 34 or older, the couple should seek medical attention if pregnancy does not result within six months.
There are other circumstances that also affect when a couple should begin fertility treatment. If the man or woman has a history of sexually transmitted disease, they should have an evaluation after six months, even if they are 33 or younger. And if the woman is 34 or older, they should be evaluated even sooner. Also, if the woman has had any kind of surgery on her ovaries, fallopian tubes or uterus, an evaluation should be sought after three or four months if pregnancy does not result.