Female Infertility: When Nature Needs a Little Help

lewis“If there is anything I would want someone who reads this article to come away with, it is that infertility is not rare, and that many treatments are available. Medications or other simple measures are often effective in treating it. And even in the most complicated cases, there are usually treatment options.”

Heather Lewis, MD
OB/GYN Associates of Southern Indiana

allen“Certain tests, when performed to evaluate blockage in the fallopian tubes, have been known to free small adhesions in the tubes and open them, at least temporarily. That is sometimes enough to allow pregnancy to occur.”

Melissa Allen, MD
Board Certified OB /GYN
Women’s Healthcare of Southern Indiana

For as many as 15 percent of couples, having a baby isn’t quite as simple as letting nature take its course. Male factors, such as lack of sperm motility, account for about 25 percent of instances of infertility, while another 25 percent is unexplained. About half of the cases involve female factors.

Common Causes and Treatments

A number of factors can lead to infertility. An initial workup during a doctor’s visit to determine the cause usually includes lab tests that measure thyroid function and levels of certain hormones in the blood.The next step usually involves checking to see if the woman is ovulating.

Lack of Ovulation

If a woman is not ovulating, or releasing an egg, pregnancy is not possible. “The primary way to know if you are ovulating regularly is if you are having a monthly period,” explained Melissa Allen, MD, OB/GYN. “If a woman is not ovulating, we can prescribe a medication such as Clomid® to help induce ovulation.”

Uterine Abnormality

“The shape of the uterus can be associated with infertility,” said Heather Lewis, MD, OB/GYN. “A number of tests can be used to diagnose abnormality. They include ultrasound and hysteroscopy, which is the inspection of the inside of the uterus by means of a special endoscope.”

Tubal Blockage

If an egg cannot travel through the fallopian tube to the uterus, pregnancy will not occur. “Many things can cause blockage in the tubes,” Dr. Lewis explained. “Among them are prior surgeries; pelvic inflammatory disease and sexually transmitted diseases such as chlamydia; and even a previously ruptured appendix. Endometriosis, an overgrowth of the cells that normally make up the lining of the uterus, can also cause blockage when the cells implant in the fallopian tubes. Laparoscopy is one way of viewing the abdomen to evaluate endometriosis.”

“One of the tests that can be performed to see if tubes are open and to evaluate the shape of the uterus, is the hysterosalpingogram, or HSG,” said Dr. Allen. It is a radiologic procedure that involves injecting a dye into the uterine cavity. We then watch as it fills the uterus and travels through the tubes. If the tubes are open, the dye will spill out into the abdominal cavity.

Another test, called chromopertubation, involves injecting dye into the tubes to see if it travels all the way through.” She added, “Although these tests are done for evaluation purposes, the dye sometimes actually frees small adhesions in the tubes and opens them, at least temporarily, which can be enough to allow pregnancy to occur.”

When tubes are blocked and cannot be cleared, in vitro fertilization is necessary to achieve pregnancy. In vitro is a process in which one or more eggs is removed from the woman and mixed with sperm. When fertilization occurs, the fertilized egg is placed in the woman’s uterus in the hope that implantation and a healthy pregnancy will follow.

When is Lack of Conception Considered Infertility?

uterusAccording to Dr. Lewis, “Infertility is defined as 12 months or more of regular intercourse without conception for women 35 or younger, or 6 months for women 35 or older. There is about a 20 percent chance of conception per menstrual cycle. After 12 months, 93 percent of women will have conceived.”