Infertility in Females - Causes and Testing

Reproductive Conditions

Some of the most common causes of female infertility are reproductive conditions. Diseases that affect the ovaries, uterus, fallopian tubes, and other associated organs can interfere with ovulation, fertilization, or implantation in a number of ways. While some women are diagnosed with a reproductive condition in their teens or early twenties, others are unaware of the problem until they try to become pregnant. During a female infertility assessment, certain symptoms or a family history will indicate testing for a reproductive condition. Treatment depends on the specific condition and its severity. Two of the most common reproductive conditions are endometriosis and polycystic ovarian syndrome.

Endometriosis

Endometriosis is a condition that occurs when segments of the uterine lining, or endometrium, grow on structures outside of the uterus. Endometriosis can result in female infertility and often causes severe menstrual cramps and other pelvic pain, fatigue, and abnormal menstrual bleeding.

Because the endometrial tissue outside of the uterus responds to hormonal changes the same way the lining inside the uterus does, by building up and breaking down with each menstrual cycle, tissue from the endometrial lesions is shed into the pelvic cavity and has no way to exit the body. This causes inflammation, scarring, and cysts that may result in pain and female infertility.

Diagnosis involves a laparoscopic physical examination, during which a camera, attached to a thin tube, is inserted through a small incision in the abdomen. This allows the physician to view the internal structures of the abdomen and pelvic region and determine the extent of the endometrial growth.

Depending on the severity of the problem, endometriosis may be treated with surgery, medication, or both.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS), another leading cause of female infertility, is an endocrine condition that interferes with ovulation. Due to the excess production of androgens (male hormones), women with PCOS often do not ovulate normally. Rather than a single ovarian follicle developing and releasing a mature egg each cycle, multiple ovarian cysts form but do not release any eggs. Common symptoms of polycystic ovarian syndrome include irregular menstruation and signs of hyperandrogenism, such as excess body hair, acne, and thinning hair on the head. Obesity and insulin resistance are also closely associated with PCOS.

While polycystic ovarian syndrome cannot be cured, its effects can be minimized with long-term treatment. To overcome female infertility due to PCOS, clomiphene citrate is usually prescribed to restore normal ovulation. When obesity is a factor, dietary changes and weight loss will frequently cause normal menstruation and ovulation to resume spontaneously.

If dietary changes and clomiphene citrate are ineffective, the patient and physician will discuss alternative treatment options. Due to the high risk of ovarian hyperstimulation syndrome (OHSS) in women with polycystic ovarian syndrome, in vitro fertilization (IVF) may not be recommended.

Ovulation Disorders

Irregular or absent ovulation may be the result of premature ovarian failure, a condition such as polycystic ovarian syndrome, or a different type of hormonal imbalance. Depending on the severity and source of the problem, ovulation disorders can be among the easiest or most difficult types of female infertility to treat. Hormonal imbalances, once identified, can usually be corrected through medication. Fertility drugs can also be administered to stimulate the ovaries and cause one or more eggs to be released. If the ovarian reserve (egg supply) is low, however, ovarian stimulation is unlikely to be helpful. In vitro fertilization with donor eggs is an alternative option that may be indicated in such cases.

Physical Barriers

Another common cause of female infertility is a blockage or barrier in the fallopian tubes or uterus that prevents the egg from coming into contact with sperm or implanting into the uterine lining. Such a blockage may be due to a congenital abnormality, post-surgical adhesions, or any condition that produces scar tissue. Minimally invasive surgery to remove the barrier is one potential treatment option for this type of female infertility. In vitro fertilization (IVF), which was developed for the purpose of helping women with tubal blockages to become pregnant, is also highly effective. Even if a physical malformation of the uterus makes it impossible for the patient to carry a pregnancy, IVF with a gestational carrier will allow the patient to have a biological child of her own.

Hormonal Imbalances

Hormones can be thought of as a chemical communication system used by the body to regulate growth, reproduction, and other processes. When too much or too little of any given hormone is produced, whether as a result of a condition like polycystic ovarian syndrome or a glandular malfunction, these processes are not carried out correctly and problems arise. A hormonal imbalance can cause female infertility by disrupting ovulation, preventing the thickening of the uterine lining, or otherwise preventing a pregnancy from becoming established. Fortunately, once identified, a hormonal imbalance can usually be corrected through medication, lifestyle or dietary changes, or a combination of both.

Age-Related Infertility

Women over the age of 35 often suffer from age-related infertility as their egg reserve declines and hormonal changes make conception and pregnancy more difficult. Unlike some types of female infertility, age-related problems are progressive. The longer the patient waits before seeking treatment, the less likely it becomes that assisted reproductive technology will be helpful.

In some cases, in vitro fertilization (IVF) can be effective for the treatment of age-related female infertility. However, if the ovarian reserve is too low to allow for the collection of a sufficient number of eggs, IVF with egg donation may be indicated instead.

Fertility Testing for Women

Before fertility problems can be treated, the source of the problem must be identified. In women, a series of screening tests and physical exams can help to determine what is preventing pregnancy from taking place. These fertility testing procedures are performed at our Fort Lauderdale, Florida-area practice to help us recommend the most effective method to overcome infertility.

Clomiphene Citrate Challenge Test

The clomiphene citrate challenge test (CCCT) is a fertility testing method that is used to assess a woman's ovarian reserve, or egg supply. It begins with a blood test on day three of the menstrual cycle (day one is when menstruation begins) to measure the amount of follicle stimulating hormone (FSH) being produced by the body. Then, on days five through nine, the patient takes a daily dose of clomiphene citrate, an ovarian stimulation medication commonly sold as Clomid®. On day ten, another blood test is performed. If either test shows elevated levels of FSH, this indicates a low ovarian reserve.

Hormonal Workup

The female reproductive system relies on the production and release of several different hormones, each at precisely the right time every cycle, in order to function properly. If any one of these hormones is out of balance, due to an underlying disease or glandular problem, the whole system can be disrupted.

During fertility testing, blood tests are routinely administered to check the levels of estrogen, progesterone, FSH, and LH in the system. Because these hormones fluctuate throughout the menstrual cycle, several blood samples may need to be taken over a number of days in order to make a thorough evaluation of a patient's endocrine function.

Ultrasound

Safe, effective, and completely non-invasive, an ultrasound exam uses sound waves to create an image of the body's internal structures. During an abdominal ultrasound, a special gel is applied to the abdomen and the ultrasound probe is moved over the area as the images on the ultrasound screen are evaluated. A transvaginal ultrasound is similar, but involves the use of a different probe that is inserted inside the vagina. A transvaginal ultrasound often provides a clearer picture of the pelvic structures than abdominal ultrasound.

As a fertility-testing tool, ultrasound can be used to identify such problems as polycystic ovarian syndrome, uterine fibroids, ovarian cysts, adhesions or other scar tissue, poor follicular development, and abnormalities of the uterus or fallopian tubes.

Hysterosalpingogram

IVF FLORIDA Reproductive Associates has improved service delivery and convenience by adding radiology services to the list of services delivered on site. We perform hysterosalpingograms (HSG) in our office in Margate, as well as at Northwest Medical Center and Memorial West. The addition of the HSG suite means one stop shopping for women having the HSG procedure in Margate. Simply check in, have a pregnancy test, and have the HSG procedure all in one convenient location, without having to travel to a hospital. Our HSG service is faster, much less expensive, more convenient and potentially less traumatic than a hospital based study. Generally, our physicians can perform the procedure is 15 minutes or less, dramatically reducing the overall time your patient spends waiting for the procedure.

About the Procedure

Designed to detect blockages in the fallopian tubes, a hysterosalpingogram is a fertility testing technique that involves the injection of a special dye into the uterus through the cervical opening. The progression of the dye is then monitored via x-ray. If there are no blockages present, the dye will fill the uterus, move through the fallopian tubes and out into the abdominal cavity. If a blockage exists, the dye will stop, indicating both its presence and its location.

A hysterosalpingogram can also be used to evaluate the size and shape of the uterus and detect such conditions as a bicornuate or septated uterus, both of which can cause recurrent miscarriage.

Diagnostic Laparoscopy or Hysteroscopy

Sometimes the only way to thoroughly assess the condition of the internal organs is to visually examine them. Minimally invasive surgical techniques allow physicians to diagnose and treat such conditions as endometriosis, uterine fibroids, and adhesions through minute incisions that take significantly less time to heal than traditional surgical incisions. These fertility testing procedures are usually performed while the patient is under general anesthesia.

Laparoscopy involves the insertion of a small camera on the end of a thin tube into the abdominal cavity, revealing the exterior of the uterus, fallopian tubes, and ovaries. After an incision is created beneath the navel, carbon dioxide gas is used to gently inflate the abdomen, providing a clearer view of the internal structures. Once the examination is complete, the gas is released and the incision is closed.

Hysteroscopy allows physicians to view the inside of the uterus to check for uterine fibroids, polyps, and other conditions. By slightly dilating the cervical opening and inserting the camera through the cervix, physicians can perform this procedure without creating any incisions at all.

Contact Our Fort Lauderdale-area Practice in Florida

To learn more or to schedule a fertility testing consultation, contact our Fort Lauderdale, Florida-area practice.