Female Infertility – Diagnosis and Treatment
Diagnosis
When a couple has trouble getting pregnant, doctors assess both partners. This process starts with a review of medical history and a physical exam.
Doctors check the menstrual cycle and hormone levels. They also perform specialized tests.
They may recommend several procedures:
Ovulation Checks: Ovulation prediction kits can be used at home to track LH hormone levels. Blood tests like the progesterone and prolactin tests confirm if ovulation is happening.
Egg Health Tests: Ovarian reserve testing checks the number and quality of eggs, especially for women over 35.
Other Hormone Assessments: Doctors measure hormone levels from the thyroid and pituitary glands to find any imbalances.
Imaging Studies: Pelvic ultrasound, saline infusion sonogram, or hysteroscopy can spot fibroids, polyps, or signs of endometriosis.
Sperm and Genetic Tests: Doctors evaluate sperm quality and may do genetic screening to find causes of infertility.
Physical Exam: This helps find any physical or anatomical problems.
X-ray Test for Uterus and Tubes (Hysterosalpingography)
Doctors use hysterosalpingography, a special X-ray study, to check for blockages or structural issues in the uterus and fallopian tubes. In this test, they gently place a thin tube (catheter) into the cervix.
A liquid dye is injected through the catheter. The dye outlines the inside of the uterus and fallopian tubes, making them visible on X-ray images.
Doctors watch the dye to see if it moves freely through the uterus and out the ends of the fallopian tubes.
What hysterosalpingography can help detect:
| Detects Blockages or Problems in: | Also Useful For Finding: |
|---|---|
| Fallopian tubes | Uterine polyps |
| Uterus shape | Fibroids |
| Tubal scarring | Adhesions |
If results show a blockage, doctors may order more detailed tests like laparoscopy or hysteroscopy.
Sometimes, hysterosalpingography can help open minor blockages in the fallopian tubes. This test gives doctors important information to guide further treatment.
Treatment
Medicines to Help with Ovulation
Doctors often use prescription medications to help women ovulate. These drugs mimic or influence natural hormones that signal the ovaries to release eggs.
Some common types include:
| Medicine Name | How It Is Taken | Who It’s For | Main Purpose |
|---|---|---|---|
| Ovulation-Inducing Hormone Modulator | Oral (pill) | Women under 39, not PCOS | Stimulates hormone release for ovulation |
| Injectable Reproductive Hormones | Injection | Women who need more eggs | Helps ovaries make multiple eggs |
| Insulin-Sensitizing Agent | Oral (pill) | PCOS, insulin resistance | Lowers insulin to help with ovulation |
| Aromatase Inhibitor | Oral (pill) | Younger women, PCOS | Increases hormones to trigger ovulation |
| Dopamine Agonist | Oral (pill) | High prolactin levels | Lowers prolactin to restore ovulation |
- Ovulation-Inducing Hormone Modulators: These oral drugs help the body release hormones that stimulate egg development and ovulation. They are often used first, especially in women under 39 who do not have polycystic ovary syndrome (PCOS).
- Injectable Reproductive Hormones: These medicines are given by injection and help the ovaries mature several eggs at once. They include combinations of hormones like follicle-stimulating hormone (FSH), human menopausal gonadotropin (hMG), or human chorionic gonadotropin (hCG), which help eggs grow and trigger their release.
- Insulin-Sensitizing Medications: These are used when high insulin levels affect ovulation. They are often prescribed to women with PCOS to help improve how the body responds to insulin and to restore a regular cycle.
- Aromatase Inhibitors: These oral drugs lower estrogen levels and indirectly stimulate the body to produce hormones that promote ovulation. They are often used in younger women with PCOS.
- Dopamine agonists: If high prolactin levels are interfering with ovulation, these medications help lower prolactin and support the return of regular ovulation.
Side Effects and Possible Problems with Ovulation Drugs
Fertility drugs can cause certain risks. One risk is having more than one baby at a time.
Oral drugs like Clomid cause twins in fewer than 1 in 10 cases. Injectable medicines raise the chance of twins, triplets, or more, up to 30%.
Other possible issues include:
Ovarian Hyperstimulation Syndrome (OHSS): The ovaries may swell and cause pain, bloating, nausea, or vomiting. Most women have mild symptoms that go away, but in rare cases, the problem becomes serious and can cause rapid weight gain, large ovaries, or trouble breathing.
Long-Term Risks: Studies show these drugs do not seem to cause long-term health problems. Women who do not become pregnant after using them for over a year may have a slightly higher risk of ovarian tumors later on, but this may also be linked to infertility itself.
Key Points:
- More eggs mean a higher risk of multiple babies and early delivery.
- Women should watch for signs of OHSS and report them.
- Regular doctor visits during treatment help lower risks.
Surgical Solutions for Infertility
Doctors may use surgery if a physical problem in the reproductive system is found. Surgery is less common than before but still useful in some cases.
| Surgery Type | What It Treats | How It Helps |
|---|---|---|
| Laparoscopic | Fibroids, polyps, adhesions | Removes blockages, improves uterus shape |
| Hysteroscopic | Uterine polyps, fibroids | Clears growths from uterus |
| Tubal surgeries | Blocked or damaged tubes | Opens tubes or gets them ready for IVF |
Laparoscopy and Hysteroscopy: These minimally invasive surgeries let doctors remove growths like fibroids or polyps. They can also fix scarring (adhesions) inside the pelvis or uterus.
Tube Repairs: If the fallopian tubes are blocked or filled with fluid, doctors may suggest surgery to open or remove them. Sometimes, removing damaged tubes helps improve the chances of success with in vitro fertilization (IVF).
Advanced Methods to Assist Reproduction
When medicines or surgery do not work, other methods may help.
Intrauterine Insemination (IUI)
Doctors place healthy sperm directly into the uterus when a woman is likely to ovulate. IUI can help women with mild fertility problems or unexplained infertility.
Assisted reproductive technology (ART)
The main type is in vitro fertilization (IVF). This method includes several steps. Doctors give hormone shots to mature eggs. They collect eggs from the ovaries.
The eggs are mixed with sperm in a lab to create embryos. Embryos are then placed in the woman’s uterus.
IVF is common for women with blocked fallopian tubes, trouble with ovulation, or when other treatments have not worked. Sometimes, donor eggs are used if a woman cannot use her own eggs.
People Who May Need IVF or ART:
- Women with damaged or blocked tubes
- Women who do not ovulate with other treatments
- Couples with unexplained infertility
- Couples who choose to use donor eggs
Important Terms:
- Ovulation Induction: Using drugs to make the ovaries release eggs.
- Oocyte Donation: Using eggs from another woman.
- In Vitro Fertilization (IVF): Fertilizing eggs outside the body.
Coping and Support
Managing infertility can feel overwhelming, both physically and emotionally. Reliable information helps individuals and couples understand their options.
Talking with a doctor about treatments can make the process clearer and reduce stress. Connecting with others can help. People may talk with loved ones, join support groups, or seek help from counselors.
Online forums can offer privacy and support from others who have faced similar struggles.
Taking care of health is important. Regular exercise and a healthy diet may help maintain a healthy weight, which can improve fertility for some people.
Here is a quick list of helpful coping actions:
- Educate yourself about treatments.
- Reach out for support.
- Stay physically active.
- Eat a balanced diet.
- Be open to different family-building options, like adoption.
If pregnancy remains difficult, considering other parenting options early can help reduce disappointment and stress.
Getting Ready for Your Visit
Steps You Can Take Before Seeing the Doctor
To prepare for your visit, keep a record of menstrual cycles, symptoms, and when intercourse happens for a few months. Write this down on paper or use an app.
Make a list of all medicines, vitamins, herbs, and supplements, including the amount and how often you use them. Include over-the-counter products.
Bring copies of medical records, test results, or treatments from your primary care doctor or other clinics. Bring a notebook or device for notes, as doctors often share a lot of new information.
Prepare questions ahead of time and list them by importance. Some topics to ask about include:
- Timing and Frequency: How often and when should intercourse happen when trying to conceive?
- Lifestyle: Are any lifestyle changes or habits helpful?
- Testing: What exams or tests might be needed?
- Treatment: Are any medications or treatments recommended?
- Side Effects: What side effects could the treatments cause?
- Success Rates: What is Healthnile’s success rate for similar situations?
It is always okay to ask about anything else that is on your mind or unclear.
What the Healthcare Provider Might Ask
During the appointment, the doctor will likely ask questions. The doctor may focus on your personal and family medical history.
You might also discuss details about reproductive health. Some topics that could come up include:
- How long you have been trying to get pregnant
- How often you have intercourse
The doctor may ask about any past pregnancies and their outcomes. You may need to talk about any pelvic or abdominal surgeries.
The provider could ask about past treatment for reproductive health conditions. You may also be asked about the age when your periods started.
The doctor might want to know the usual time between your periods. They may also ask about symptoms before your period, such as soreness, swelling, or cramps.
The doctor will want information about both partners. Being ready to discuss these topics can help the visit go more smoothly.
