Related Media: Diagnostic Pelvic Laparoscopy

Definition

Infertility is not being able to become pregnant after a year of regular, unprotected sex.

Female Reproductive Organs Copyright © Nucleus Medical Media, Inc.

Causes

Pregnancy happens when:

• An egg is released from the ovaries
• The egg travels to the fallopian tubes where the sperm can fertilize it
• The egg is fertilized and it moves down the fallopian tubes to the uterus
• It implants itself into the wall of the uterus and starts to grow

Sometimes, the cause of infertility in women is not known. In others, it may be due to:

• Problems with ovulation, such as:
  • Hormonal disorders
  • Polycystic ovarian syndrome
  • Ovulation disorder
  • Ovarian cysts
• Problems with the fallopian tubes, such as:
  • Pelvic inflammatory disease
  • Endometriosis
  • Previous surgeries which have changed pelvic structures or caused scar tissue in the pelvis
  • Ectopic pregnancies
  • Structural problems since birth
• Problems with the cervix or uterus, such as:
  • Fibroids
  • Endometriosis
  • Structural problems since birth

Risk Factors

This problem is more common in women who are at risk for any of the causes listed above. Other things that may raise the risk are:

• Obesity
• Being very underweight
• Smoking
• Alcohol use disorder
• Substance use disorder
• Stress

Symptoms

The main problem is not becoming pregnant after a year of regular, unprotected sex.

Diagnosis

You and your partner will both need to be seen by a doctor. The doctor will ask about past health and pregnancy attempts. A physical exam will be done. The doctor may check to see if you are ovulating. This can be done with:

• Blood and urine tests to check hormone levels
• A basal body temperature reading

Images may be needed of the uterus and fallopian tubes. This can be done with:

• Hysterosalpingography (HSG)
• Transvaginal ultrasound
• Hysteroscopy

Surgery may be needed to view the area. This can be done with laparoscopy.

Treatment

Any underlying causes will need to be treated. The goal of treatment is to improve the chances of pregnancy. Steps may include:

• Lifestyle changes, such as maintaining a healthy weight, not drinking alcohol or smoking tobacco, and lowering stress
• Medicines to promote ovulation
• Assisted reproductive technologies (ART), such as:
  • Artificial insemination—semen is collected in a lab and placed into the cervix or uterus
  • In vitro fertilization (IVF) —the egg and sperm are joined in a lab, allowed to fertilize, and then placed in the uterus

Women who are not helped by these methods may need surgery. It may be done to open blocked tubes, repair problems with organs, or to remove:

• Cysts
• Fibroids
• Scar tissue

Prevention

The cause of infertility is not always known. This means prevention steps cannot be found. Those with health issues like cancer should talk to their doctors about future fertility choices.