Infertility

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What is infertility?

Infertility affects one in eight couples is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you should consider an infertility evaluation. However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse rather than a year, so as not to delay potentially needed treatment. If you have a reason to suspect an underlying problem, you should seek care earlier.  One third (30%) of infertility can be attributed to male factors, and about one third (30%) can be attributed to female factors.  In about 20% of cases infertility is unexplained, and the remaining 10% of infertility is caused by a combination of problems in both partners.

What are some common problems in women that can result in infertility?

Anovulation – Anovulation means lack of ovulation, or absent ovulation. Ovulation, which is the release of an egg from the ovary, must happen in order to achieve pregnancy. If ovulation is irregular, but not completely absent, this is called oligovulation. Both anovulation and oligovulation are kinds of ovulatory dysfunction. Ovulatory dysfunction is a common cause of female infertility, occurring in approximately 25% of infertile women.

Polycystic Ovary Syndrome (PCOS) – Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects 5-10% of women.  PCOS or Polycystic Ovarian Disease (PCOD) is characterized by menstrual dysfunction (usually oligomenorrhea or amenorrhea starting at menarche) and hyperandrogenism, usually associated with hirsutism. Obesity may or may not be present. Blood testosterone is usually either normal or moderately elevated, and sex hormone binding globulin is almost always reduced, resulting in an elevated serum level of free testosterone.

Abnormal Body Weight – Obesity immediately brings to mind associations with hypertension, diabetes and heart disease. Yet, most people are surprised to learn that there is an association between obesity and infertility. Epidemiological data confirm that obesity accounts for 6% of primary infertility, and even more surprising, that low body weight in women accounts for 6% of primary infertility. Thus, 12% of primary infertility results from deviations in body weight from established norms, and that this infertility can be corrected by restoring body weight to within normal established limits. More than 70% of women who are infertile as the result of body weight disorders will conceive spontaneously if their weight disorder is corrected through a weight-gaining or weight-reduction diet as appropriate.

Endometriosis – Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.

Fibroids – Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. Fibroids that change the shape of the uterine cavity (submucous) or are within the cavity (intracavitary) decrease fertility by about 70% and removal of these fibroids increases fertility by 70%. Other types of fibroids, those that are within the wall (intramural) but do not change the shape of the cavity, or those that bulge outside the wall (subserosal) do not decrease fertility, and removal of these types of fibroids does not increase fertility.