In couples experiencing infertility, approximately 50% of the time there is a female problem.
Problems associated with female infertility include, but are not limited to:
Thyroid problems - both underactive and overactive can result in infertility. A TSH ( thyroid stimulating hormone) should be checked before testing for further issues.
Prolactin, another hormone secreted from the pituitary, if elevated can intervere with ovulation. As with the thyroid, this should be part of an initial assessment for female infertility.
Progesterone, peak secretion found in the luteal phase of a woman's cycle, is involved with the preparing of the uterine lining so that a fertilized egg can implant and grow. If the hormone is not adequate the embryo will not implant or result in a miscarriage.
Estrogen. Levels of estradiol, secreted from the ovary, should correspond with egg maturity and number. If this level is too low at time of ovulation, this has a poor prognosis for pregnancy.
Luteinizing Hormone(LH). This hormone "surges" or peaks pre-ovulation and causes among other things egg release from the follicular structure. If this hormone is too low, the woman may not get egg release.
Anovulation is when no egg is made without some type of medical stimulation. A woman is suspected of being anovulatory if she does not get menstrual periods on a regular basis. Women who do not naturally produce an egg can sometimes be stimulated to produce an egg with medication.
The fallopian tubes are the structures through which the egg passes to get to the uterus. They are also the structure to which the sperm need to swim to fertilize the egg. If the fallopian tubes are blocked, the sperm and egg can not meet and fertilization can not take place. Patency of the fallopian tubes should be part of a woman's initial work-up.
The uterine cavity should also be assessed for irregularities. If the uterine lining is irregular, there is a higher incidence of miscarriage.
A woman is most fertile at age 16 - 24 years. There is a mild decrease in her fetility between the ages of 24 - 35. Between the ages 0f 35 - 40 years there is a marked decline in fertility . After the age of 40, the pregnancy rates are profoundly diminished and a woman who desires pregnancy should seek aggressive help.
Smoking is associated with infertility. This data has come from the IVF centers who have found a decreased pregnancy rate between their non-smokers and smoking clients when they have been able to control for most other factors.
Obesity as well as under weight or malnourished women is associated with infertility. Occasionally, just bringing a woman's weight into a more normal range will improve her fertility enough to result in a pregnancy.
PCOS may present with one or more of the following symptoms: Elevated fasting insulin levels, obesity, hirsutism, acne, cystic appearing ovaries on ultrasound, a darkening of the skin in skin fold areas.
Endometriosis is when endometrial cells are found outside of the endometrial cavity. Endometrial cells on the ovary cause endometriomas that can interfere with a woman's ability to cycle normally. The reasons for this problem is not well understood. Symptoms of endometriosis include, but are not limited to: severe menstrual cramps and heavy and prolonged periods. If a woman has severe endometriosis, treatment of the disease may improve her fertility.
This is perhaps the most frustrating of all problems, since no clear cut reason can be found and treated. The male component should be evaluated carefully since 40% of infertile couples have a male issue.
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