Female infertility

Diagnosis

Fertility testing is often recommended to women who fails to get pregnant after actively trying for more than a year by having frequent unprotected sex with her spouse. Or after six months of trying for those who are 35 years of age or older. The doctor will perform a physical examination and take a thorough medical history evaluation of the couple. Determining the causes of the infertility will provide an effective treatment and give the couple the best opportunity of becoming pregnant.

Common fertility tests for women are:

• Ovulation test:
  Over-the-counter ovulation prediction kit are also readily available. The kit can pick up the spike in luteinizing hormone (LH) that happens just before ovulation. Progesterone is a hormone released after ovulation, and a blood test for it might show whether the person is ovulating. The levels of additional hormones, such as prolactin, may also be measured.
• Hysterosalpingography: This procedure helps locate any obstruction in the fallopian tubes. It involves injecting a dye into the uterus while watching it flow through the fallopian tubes. The process is seen and documented with an X-ray. A free-moving dye means that the fallopian tubes do not have blockages.
• Ovarian reserve testing: This test assesses the viable number of eggs a woman has in her ovaries and determines the ovarian function. These blood and imaging tests may be administered to women who are at risk of having a diminished egg production, especially those over the age of 35.
• Other hormone testing: The doctor may require thyroid and pituitary hormones testing. Over production and improper function of the thyroid or pituitary gland may stop ovulation. Right level of hormones is necessary to maintain the normal function of the ovaries.
• Imaging tests: A sonohysterogram, also called saline infusion sonogram (SIS) or hysteroscopy, is a test done to check for polyps, fibroids, or other structural irregularities in the uterine lining. During a transvaginal ultrasound, the uterus is filled with saline (water), which gives a clear image of the uterine cavity. Generally, a pelvic ultrasound tests for fallopian tube or uterine disease.
• Laparoscopy. This is commonly used to assess or treat endometriosis scarring, blockages, or abnormalities of the fallopian tubes, as well as other ovarian and uterus problems. During the procedure, a narrow-fitted tube with camera (laparoscope) is inserted into the small cut in the abdomen area which will allow doctors to see and assess the organs.
• Genetic testing. The test identifies any gene alterations, or genetic disorders that may be contributing to infertility.

Treatment

The series of tests will help the healthcare provider determine the exact cause of female infertility and provide a range of possible treatment to increase chances of pregnancy. Typically, the cause, age, duration of infertility and couple’s preferences affects the treatment options. Infertility is a complicated condition that will requires major financial, physical, mental, and time sacrifices for the couple. In some cases, the treatment can involve more than one method.

Common treatments for female infertility are medications, surgery, intrauterine insemination, or assisted reproductive technology. Gestational surrogacy and adoption may also be an option for those who wanted to start a family.

• Medications: Fertility drugs are the primary form of treatment for female infertility. It is used to control or induce ovulation. It also improves the quality and quantity of eggs of those who ovulates. Fertility drugs are designed like the natural chemicals, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), that promotes ovulation.

Fertility medications for women are:

• • Clomiphene citrate: Targets the pituitary gland which aims to increase the hormones necessary to assist the development and release of a mature egg (ovulation). This drug is not advisable to women who have primary pituitary or ovarian failure. Clomiphene is taken orally. In most cases, this is the first line of treatment for women under the age of 39 without PCOS.
  • Gonadotropins: Instead of releasing one egg every month, this treatment stimulates the ovary to release multiple eggs which gives higher chances for pregnancy. However, known concerns of using gonadotropins is the increased risk of multiple pregnancies and premature deliveries.

Human menopausal gonadotropin, or hMG (Menopur), and FSH (Gonal-F, Follistim AQ, Bravelle) are examples of gonadotropin-containing drugs. Human chorionic gonadotropin (Ovidrel, Pregnyl), a different gonadotropin, is used to mature the eggs and cause their release at the time of ovulation. These medications are administered through injection.

• • Metformin: Prescribed to women diagnosed with PCOS, insulin resistance which can be a contributing factor to infertility. The likelihood of ovulation may increase as a result of metformin’s ability to reduce insulin resistance.
  • Letrozole: Letrozole is an oral medication, ovulation-inducing drug widely used outside of its approved uses. It functions by briefly reducing the level of progesterone in a woman, which stimulates the brain to naturally produce more follicle-stimulating hormone (FSH). It is a member of the class of medications known as aromatase inhibitors and functions similarly to clomiphene.

It is frequently used to enhance the number of mature eggs generated in the ovaries in women with normal ovulation as well as to induce ovulation in women with PCOS.

• • Bromocriptine. Bromocriptine are drugs prescribed to women who experience ovulation issues as a result of excessive prolactin levels. These prescription drugs are consumed orally.
• Risks of fertility drugs: The infertility specialist will discuss the potential risks with using fertility medications, such as:
  • Pregnancy with multiples. A lot of fertility medications raise a woman’s chance of conceiving twins, triplets, or other multiples which can cause extra complications for the mother. The likelihood of premature birth (too early) is increased among multiple fetuses. There is also a higher risk of health and developmental issues in premature infants.

Statistically, injectable drugs improve one’s chance of multiples by up to 30%. The substantial risk of triplets or more is prevalent with injectable fertility drugs. However, less than 10% of multiple births are caused by oral drugs. If it happens, it is mostly twin pregnancies.

• • Ovarian hyperstimulation syndrome (OHSS). Few women may experience a reaction to the injected fertility drugs which can result in over production of eggs in the ovaries. The condition can develop from mild to severe OHSS.

In mild cases, swollen and uncomfortable ovaries are one of the signs and symptoms, along with mild abdomen discomfort, bloating, nausea, vomiting, and diarrhea. These symptoms typically resolve on its own. In severe cases, common symptoms are sudden weight gain, swollen, painful ovaries, fluid in the belly, and shortness of breath.

• • Long-term risks of ovarian tumors. According to some research, the duration of fertility drug use particularly one year or more without successful pregnancy may contribute to a higher chance of developing borderline ovarian tumor.

Further studies suggest that fertility drug use does not significantly contribute to risk of ovarian tumor. Careful assessment of drug use every few months and focusing on those that have the highest success rates is important especially in the first few treatment cycles.

• Surgery: If the medications and other treatments fail to fix the fertility issues, surgical treatment may be recommended. These are:
  • Laparoscopic or hysteroscopic surgery: This is a minimally invasive procedure to correct problems that cause infertility or miscarriage by have visibility go the organs and being able to repair the uterus when needed. The procedure can also remove endometrial polyps, fibroids tumors, scar tissues, and ovarian cysts.
  • Tubal surgeries. This procedure aims to repair or open blocked fallopian tubes. The doctor might advise a laparoscopy to remove scar tissues and repair the tubes. This surgery is not commonly recommended since in vitro fertilization (IVF) often results in higher pregnancy rates. The chances of getting pregnant with IVF after this operation may be increased by having your tubes near your uterus removed or blocked.
• Reproductive assistance: reproductive assistance methods are:
  • Intrauterine insemination (IUI). During the ovulation, the doctor will inject sperm into the uterus after washing it with a specific solution. This is often done while taking medications that triggers ovulation.
  • Assisted reproductive technology (ART). In vitro fertilization (IVF) is the most common ART. The embryos are produced in a lab by combining sperm and mature eggs. The embryo (or embryos) transferred into the woman’s uterus after three to five days. Embryos may also be kept for a later transfer.

ART can be financially and time consuming. Multiple blood tests and daily hormone injections are necessary during an IVF cycle. Success rates of IVF generally depends on the specialist, infertility diagnosis and age.