Most couples who have unprotected sex at least twice per week are able to become pregnant within one year. If pregnancy does not occur after one year, the man and woman are diagnosed as having an infertility problem.
Infertility can stem from the man, the woman or both partners. In some couples, no cause of infertility can be found. In other couples, more than one cause exists.
Normal aging reduces a woman's ability to become pregnant. Ovulation is the process of forming and releasing an egg. With age, ovulation becomes slower and less effective.
Aging begins to reduce fertility as early as age 30. Pregnancy rates are very low after age 44. This is true even when fertility medications are used.
The primary symptom of infertility is difficulty getting pregnant. Various causes of infertility may result in additional symptoms.
Any of the following problems may cause infertility:
Infrequent ovulation. When your periods occur more than a month, or sometimes are absent, you have infrequent ovulation.
Common causes of infrequent ovulation include:
Body stresses such as:
Unusually ambitious exercise training
Rapid weight loss
Low body weight
Some hormonal abnormalities such as:
Polycystic ovary syndrome
Hormonal abnormalities can delay or prevent the ovaries from releasing an egg. Symptoms that suggest a hormone abnormality include:
Unexpected weight loss or gain
Excessive hair growth or hair loss
Ovarian cysts. Cysts in the ovary can cause pelvic pain. They also can interfere with the normal process of ovulation.
Scarring in the fallopian tubes. This can prevent pregnancy by stopping the egg from traveling into the uterus.
Damage can result from:
A previous surgery
A previous ectopic (tubal) pregnancy
Pelvic inflammatory disease (PID). PID is a bacterial infection in the pelvis. It often scars, damages or blocks the fallopian tubes.
Abnormalities in the shape or lining of the uterus.
Fibroid tumors or uterine polyps sometimes result in:
Heavy menstrual bleeding
Enlargement of the uterus
Scar tissue can develop within the uterus as a complication of:
Surgical procedures such as a dilation and curettage (D&C)
Such scar tissue can lead to infrequent periods or minimal menstrual flow.
The first step in diagnosing female infertility is determining whether ovulation is occurring at predictable intervals. When an egg is released, it causes a shift in the body's sex hormones.
This shift in sex hormones can be detected with these tests:
Early-morning core body temperature. You use a precise (basal body) thermometer to take your temperature first thing every morning. You will detect a slightly higher temperature after ovulation.
Ovulation predictor test. This is an over-the-counter urine test. It can predict egg release. A positive test means you have ovulated recently or are about to ovulate.
Vaginal mucus. You may be able to recognize changes in the appearance and consistency of your vaginal mucus. These changes signal hormone shifts that show ovulation has occurred.
Your doctor will examine your vagina and pelvic organs. A sample of mucus from your cervix and vagina may be tested for possible infection.
If necessary, blood tests may be used to:
Confirm normal ovulation
Show whether the ovaries are functioning well enough to release eggs
Measure the function of your thyroid, pituitary and adrenal glands
Other tests may also help to determine the cause of infertility. These examine the physical structure of pelvic organs.
Hysterosalpingogram. This is an X-ray study in which a liquid dye is injected into your uterus. It reveals problems such as polyps and fibroid tumors in the uterus. It can also reveal partial or complete blockage of the fallopian tubes.
Ultrasound. An ultrasound reveals the shape and size of the uterus. It gives some information about the uterine cavity or inner lining. An ultrasound can identify the shape and size of the ovaries and the presence of developing cysts.
Hysteroscopy and laparoscopy. These are surgical procedures performed by a gynecologist. Both procedures use a small video camera to view the pelvic organs.
During a hysteroscopy, your doctor can see the inside of your uterus. He or she can obtain biopsies. In some cases, the doctor can remove polyps, fibroids or scar tissue.
Laparoscopy allows your doctor to view the outside of your uterus and inspect your ovaries. Sometimes, it is possible to remove ovarian cysts or scar tissue during a laparoscopy.