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What is Female Infertility? Print E-mail
Written by Amanda Wattson, MD   
Thursday, 15 October 2009
Infertility is defined as a couple's inability to become pregnant after one year of regular, unprotected sex. Female infertility means the male is unable to impregnate the female because of female factors.
What is going on in the body?

Certain events must take place in a woman's body for pregnancy to occur:
- attachment of a fertilized egg to the lining of the uterus
- ovulation, which is the release of an egg from the ovary
- the uniting of the egg and a man's sperm

Factors that interfere with these events are known as female factors. The inability to get pregnant may be caused by conditions in either partner. It is estimated that 30% of infertility is caused by male factors. An additional 30% is caused by female factors. The remaining 40% is caused by a combination of female and male factors.
What are the causes and risks of the condition?

There are many female factors that can make a couple unable to become pregnant. These may include conditions such as the following:
- certain inherited conditions
- endometriosis, a condition in which tissue that normally lines the uterus grows in other parts of the body
- hormone imbalances, such as hypothyroidism
- polycystic ovarian syndrome, a condition that interferes with normal release of eggs

Diseases also can be a factor in infertility, for example:
- autoimmune disorders, in which the body produces antibodies to fetal tissue
- diseases such as diabetes
- eating disorders, such as anorexia nervosa
- pelvic inflammatory disease, which is an infection of the female pelvic organs
- sexually transmitted disease, such as chlamydia or gonorrhea

Additional factors in infertility include the following:
- chronic vaginal discharge
- congenital abnormalities of the uterus
- ectopic pregnancy, or implanting of the fertilized egg outside the uterus
- emotional stress
- excess caffeine and alcohol intake
- excess weight loss or weight gain
- exposure to diethylstilbestrol, also known as DES, as an infant in utero
- irregular periods or menstrual cycles
- previous elective surgical abortion or elective medical abortion
- scarring of the fallopian tubes from abdominal or pelvic surgery
- smoking
- strenuous exercise
- total lack of menstruation
- two or more previous miscarriages
- use of an intrauterine device also called an IUD, which is a form of birth control
- uterine fibroids or polyps

Women over the age of 35 are more likely to be infertile.

What are the treatments for the condition?

Treatment of infertility will depend on the cause. Without treatment, 15% to 20% of affected couples will eventually become pregnant. Treatment for female factors may include:
- eating a healthy diet
- exercising in moderation
- having surgery to treat certain problems, such as endometriosis
- learning about the best time to conceive
- limiting caffeine and alcohol intake
- making lifestyle changes, such as smoking cessation
- taking antibiotics for sexually transmitted diseases
- taking medications to cause ovulation, such as clomiphene and menotropins

If these treatments don't work, other means of fertilization may be considered, such as:
- artificial insemination. This involves placing sperm directly in the cervix or uterus.
- intracytoplasmic sperm injection. This involves placing individual sperm cells directly inside the woman's eggs.
- in vitro fertilization. This involves fertilizing the egg outside the womb and then returning it to the uterus.

What are the side effects of the treatments?

Following are some of the side effects of medications used to cause ovulation:
- abdominal pressure or fullness
- cysts on the ovaries
- headaches
- hot flashes
- mood changes
- multiple pregnancies, such as twins or triplets
- ovarian hyperstimulation syndrome, which causes fluid shifts in the body

Antibiotics may cause allergic reactions, stomach upset, and rash. Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia.
What happens after treatment for the condition?

Within a year after infertility is diagnosed, 80% to 85% of couples who have treatment get pregnant. It may take several attempts before a couple gets pregnant. Partners must decide how many and what kind of procedures they are willing to undertake.

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