infertilities

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if the woman is over age 35). If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from age, physical problems, hormone problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs. In primary ovarian insufficiency, the ovaries stop functioning before natural menopause. In polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or they may not release a healthy egg.

About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.

If you think you might be infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technologies. Happily, many couples treated for infertility are able to have babies.

Dept. of Health and Human Services Office on Women's Health

Infertility is a term doctors use if a man hasn't been able to get a woman pregnant after at least one year of trying. Causes of male infertility include:

• Physical problems with the testicles
• Blockages in the ducts that carry sperm
• Hormone problems
• A history of high fevers or mumps
• Genetic disorders
• Lifestyle or environmental factors

About a third of the time, infertility is because of a problem with the man. One third of the time, it is a problem with the woman. Sometimes no cause can be found.

If you suspect you are infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technology. Happily, many couples treated for infertility are able to have babies.

NIH: National Institute of Child Health and Human Development

Infertility means not being able to become pregnant after a year of trying. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility.

Infertility is fairly common. After one year of having unprotected sex, about 15% of couples are unable to get pregnant. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause can be found.

There are treatments that are specifically for men or for women. Some involve both partners. Drugs, assisted reproductive technology, and surgery are common treatments. Happily, many couples treated for infertility go on to have babies.

NIH: National Institute of Child Health and Human Development

The uterus, or womb, is the place where a baby grows when a person is pregnant. The uterus is lined with tissue (endometrium). Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in other places in your body. These patches of tissue are called "implants," "nodules," or "lesions." They are most often found:

• On or under the ovaries
• On the fallopian tubes, which carry egg cells from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

The cause of endometriosis is unknown.

Endometriosis can affect anyone who menstruates. Certain factors can raise or lower your risk of getting it.

You are at higher risk if:

• You have a mother, sister, or daughter with endometriosis
• Your period started before age 11
• Your monthly cycles are short (less than 27 days)
• Your menstrual cycles are heavy and last more than 7 days

You have a lower risk if:

• You have been pregnant before
• Your periods started late in adolescence
• You breastfeed your babies

The main symptoms of endometriosis are:

• Pelvic pain, which often happens during your period.
• Infertility

Other possible symptoms include:

• Painful menstrual cramps, which may get worse over time
• Pain during or after sex
• Pain in the intestine or lower abdomen
• Pain with bowel movements or urination, usually during your period
• Heavy periods
• Spotting or bleeding between periods
• Digestive or gastrointestinal symptoms
• Fatigue or lack of energy

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging tests.

The most common surgery to diagnose endometriosis is a laparoscopy. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin near your belly button. Your provider can make a diagnosis based on how the patches of endometriosis look. They may also do a biopsy to get a tissue sample.

There is no cure for endometriosis, but there are treatments for the symptoms. Your provider will work with you to decide which treatments would be best for you.

Treatments for endometriosis pain include:

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and a prescription medicine specifically for endometriosis. Providers may sometimes prescribe opioids for severe pain.
• Hormone therapy, which stops the ovaries from making hormones. This may slow the growth of the endometrial tissue and may prevent new areas from growing. Types of hormone therapy include:
  • Birth control pills.
  • Progestin therapy.
  • Gonadotropin-releasing hormone (GnRH) medicines (GnRH agonists and antagonists). These medicines cause a temporary menopause. After your stop taking the medicines, your menstrual periods will start again, and pregnancy is possible.
• Surgical treatments for severe pain, including procedures to remove the endometriosis patches or cut some nerves in the pelvis. The surgery may be a laparoscopy or major surgery.

Treatments for infertility caused by endometriosis include:

• Laparoscopy to remove the endometriosis patches
• In vitro fertilization

NIH: National Institute of Child Health and Human Development

Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring in these organs. This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses, and other serious problems. PID is the most common preventable cause of infertility in the United States.

Gonorrhea and chlamydia, two sexually transmitted infections (STIs), are the most common causes of PID. Other bacteria can also cause it. You are at greater risk if you:

• Are sexually active and younger than 25
• Have more than one sex partner
• Douche

Some women have no symptoms. Others have pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination. Doctors diagnose PID with a physical exam, lab tests, and imaging tests. Antibiotics can cure PID. Early treatment is important. Waiting too long increases the risk of infertility.

NIH: National Institute of Allergy and Infectious Diseases

Polycystic ovary syndrome (PCOS) is the name for set of symptoms that are related to an imbalance of hormones. PCOS affects the ovaries, as well as many other parts of the body.

People with PCOS usually have at least two of these problems:

• Not ovulating. Normally, your ovaries make the egg that is released each month as part of a healthy menstrual cycle. This is called ovulation. But with PCOS, the egg may not develop as it should, or it may not be released during ovulation. Your periods may be irregular, or you may not have them at all.
• High levels of androgens. Androgens are hormones that are important for normal male sexual development. Women normally make smaller amounts of androgens. Having higher levels of androgens can cause you to have extra body or facial hair (called hirsutism).
• Cysts in one or both ovaries. Cysts are growths that are small, fluid-filled sacs.

The exact cause of PCOS in unknown. Research has shown that different factors may play a role, including:

• Genetics. PCOS tends to run in families.
• Imbalances in androgen levels.
• Insulin resistance. This is a condition in which your body can't use insulin properly. Insulin is a hormone that helps move blood glucose (sugar) into your cells to give them energy. Insulin resistance can lead to high blood glucose levels.

PCOS often develops as young as age 11 or 12, around the time of your first period. But you can develop it later.

The symptoms can vary from person to person. Some people have few or even no symptoms. They may not realize they have PCOS until they have trouble getting pregnant. Other people may have more severe symptoms.

The symptoms of PCOS may include:

• Irregular or missed menstrual periods.
• Too much hair on the face, chest, stomach, or thighs.
• Obesity, weight gain, or trouble losing weight.
• Severe acne which may be hard to treat.
• Oily skin.
• Patches of thickened dark skin (called acanthosis nigricans).
• Infertility. PCOS is one of the most common causes of infertility. But many people with PCOS can still get pregnant.

PCOS is linked to many other health problems, including:

• Insulin resistance, which can lead to prediabetes and type 2 diabetes.
• Heart disease. Having PCOS increases your risk, and this risk goes up as you age.
• High blood pressure.
• High LDL ("bad") cholesterol and low HDL ("good") cholesterol. This increases your risk of heart disease.
• Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep.
• Depression and anxiety.

Although there are links between PCOS and these conditions, researchers do not know whether:

• PCOS causes some of these problems
• Some of these problems cause PCOS, or
• There are other conditions that cause both PCOS and these other health problems

Not everyone who has PCOS will have all these problems. However, you and your health care provider may want to monitor your health for signs of them, so they can be treated early.

There is no specific test for PCOS. To find out if you have PCOS, your provider:

• Will do a physical exam, which will include looking for the physical signs of PCOS.
• Will ask about your medical history and family health history.
• May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
• May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
• May order blood tests, including tests to check your hormone levels.

There is no cure for PCOS, but treatments can help you manage your symptoms. The treatments may include:

• Lifestyle changes, which can help reduce many symptoms. They can also lower your risk for or help manage related health problems. These changes include:
  • Maintaining a healthy weight
  • Getting regular physical activity
  • Eating healthy foods
• Medicines:
  • Hormonal birth control, such as pills, shots, and IUDs, can make your period more regular. They may also help remove acne and extra facial and body hair. But you would only use them if you don't want to get pregnant.
  • Anti-androgen medicines, which block the effect of androgens. This can help reduce hair loss on your head, the growth of facial and body hair, and acne. Providers do use them to help with these symptoms, but anti-androgen medicines are not approved by the U.S. Food and Drug Administration (FDA) to treat PCOS. These medicines can cause problems during pregnancy. Your provider may have you take them with birth control (to prevent pregnancy).
  • Insulin-sensitizing medicines, which are medicines that are used to treat type 2 diabetes. They improve insulin resistance and keep your blood glucose levels steady. They may also lower your androgen levels. They are not approved by the FDA to treat PCOS. But they may help with your symptoms.
  • Medicines for acne. These medicines come in pills, creams, or gels.
• Treatments for hair removal, such as facial hair removal creams, laser hair removal, and electrolysis.
• Fertility treatments if you are having trouble getting pregnant. They include medicines and procedures such as in vitro fertilization (IVF).

Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both eggs and sperm. It works by removing eggs from the ovaries. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the parent's body. In vitro fertilization (IVF) is the most common and effective type of ART.

ART procedures sometimes use donor eggs, donor sperm, or previously frozen embryos. It may also involve a surrogate or gestational carrier. A surrogate is a person who becomes pregnant with sperm from one partner of the couple. A gestational carrier becomes pregnant with an egg from one partner and sperm from the other partner.

The most common complication of ART is a multiple pregnancy. It can be prevented or minimized by limiting the number of embryos that are put into the parent's body.

Chlamydia is a common sexually transmitted infection (STI). It is caused by bacteria called Chlamydia trachomatis. Anyone can get chlamydia. It often doesn't cause symptoms, so people may not know that they have it. Antibiotics can cure it. But if it's not treated, chlamydia can cause serious health problems.

You can get chlamydia during oral, vaginal, or anal sex with someone who has chlamydia. A pregnant person can also pass chlamydia to the baby during childbirth.

If you've had chlamydia and were treated in the past, you can get re-infected if you have unprotected sex with someone who has it.

Chlamydia is more common in young people, especially young women. You are more likely to get infected with chlamydia if you don't consistently use a condom or if you have multiple partners.

Chlamydia doesn't usually cause any symptoms. So you may not realize that you have it. But even if you don't have symptoms, you can still pass the infection to others.

If you do have symptoms, they may not appear until several weeks after you have sex with someone who has chlamydia.

Symptoms in women include:

• Abnormal vaginal discharge, which may have a strong smell
• A burning sensation when urinating

If the infection spreads, you might get lower abdominal (belly) pain, pain during sex, nausea, and fever.

Symptoms in men include:

• Discharge from your penis
• A burning sensation when urinating (peeing)
• Pain and swelling in one or both testicles (although this is less common)

If the chlamydia infects the rectum (in men or women), it can cause rectal pain, discharge, and bleeding.

There are lab tests to diagnose chlamydia. Your health care provider may ask you to provide a urine sample. Or your provider may use (or ask you to use) a cotton swab to get a sample from your vagina to test for chlamydia.

You should go to your provider for a test if you have symptoms of chlamydia or if you have a partner who has an STI. Pregnant people should get a test when they go to their first prenatal visit.

People at higher risk should get checked for chlamydia every year:

• Sexually active women 25 and younger
• Older women who have new or multiple sex partners or a sex partner who has an STI
• Men who have sex with men (MSM)

In women, an untreated infection can spread to your uterus and fallopian tubes, causing pelvic inflammatory disease (PID). PID can cause permanent damage to your reproductive system. This can lead to long-term pelvic pain, infertility, and ectopic pregnancy. Women who have had chlamydia infections more than once are at higher risk of serious reproductive health complications.

Men often don't have health problems from chlamydia. Sometimes it can infect the epididymis (the tube that carries sperm). This can cause pain, fever, and, rarely, infertility.

Both men and women can develop reactive arthritis because of a chlamydia infection. Reactive arthritis is a type of arthritis that happens as a "reaction" to an infection in the body.

Babies born to infected mothers can get eye infections and pneumonia from chlamydia. It may also make it more likely for your baby to be born too early.

Untreated chlamydia may also increase your chances of getting or giving HIV.

Antibiotics will cure the infection. You may get a one-time dose of the antibiotics, or you may need to take medicine every day for 7 days. It is important to take all the medicine that your provider prescribed for you. Antibiotics cannot repair any permanent damage that the disease has caused.

To prevent spreading the disease to your partner, you should not have sex until the infection has cleared up. If you got a one-time dose of antibiotics, you should wait 7 days after taking the medicine to have sex again. If you have to take medicine every day for 7 days, you should not have sex again until you have finished taking all of the doses of your medicine.

It is common to get a repeat infection, so you need to get tested again about three months after treatment.

The only sure way to prevent chlamydia is to not have vaginal, anal, or oral sex.

Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading chlamydia. If your or your partner is allergic to latex, you can use polyurethane condoms.

Centers for Disease Control and Prevention

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40.

Many women naturally experience reduced fertility when they are about 40 years old. They may start getting irregular menstrual periods as they transition to menopause. For women with POI, irregular periods and reduced fertility start before the age of 40. Sometimes it can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

In about 90% of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries. Your eggs grow and mature inside them. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:

• Genetic disorders such as Fragile X syndrome and Turner syndrome
• A low number of follicles
• Autoimmune diseases, including thyroiditis and Addison disease
• Chemotherapy or radiation therapy
• Metabolic disorders
• Toxins, such as cigarette smoke, chemicals, and pesticides

Certain factors can raise a woman's risk of POI:

• Family history. Women who have a mother or sister with POI are more likely to have it.
• Genes. Some changes to genes and genetic conditions put women at higher risk for POI. For example, women Fragile X syndrome or Turner syndrome are at higher risk.
• Certain diseases, such as autoimmune diseases and viral infections
• Cancer treatments, such as chemotherapy and radiation therapy
• Age. Younger women can get POI, but it becomes more common between the ages of 35-40.

The first sign of POI is usually irregular or missed periods. Later symptoms may be similar to those of natural menopause:

• Hot flashes
• Night sweats
• Irritability
• Poor concentration
• Decreased sex drive
• Pain during sex
• Vaginal dryness

For many women with POI, trouble getting pregnant or infertility is the reason they go to their health care provider.

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including:

• Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
• Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
• Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol in the arteries. These factors increase your risk of atherosclerosis (hardening of the arteries).
• Infertility.
• Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
• Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.

To diagnose POI, your health care provider may do:

• A medical history, including asking whether you have relatives with POI
• A pregnancy test, to make sure that you are not pregnant
• A physical exam, to look for signs of other disorders which could be causing your symptoms
• Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
• A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles

Currently, there is no proven treatment to restore normal function to a woman's ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

• Hormone replacement therapy (HRT).HRT is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. HRT improves sexual health and decreases the risks for heart disease and osteoporosis. You usually take it until about age 50; that's about the age when menopause usually begins.
• Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
• In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
• Regular physical activity and a healthy body weight.Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
• Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

NIH: National Institute of Child Health and Human Development

Uterine fibroids are the most common benign tumors in women of childbearing age. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. The cause of fibroids is unknown. Risk factors include being African American or being overweight.

Many women with fibroids have no symptoms. If you do have symptoms, they may include:

• Heavy or painful periods or bleeding between periods
• Feeling "full" in the lower abdomen
• Urinating often
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages or early labor

Your health care provider may find fibroids during a gynecological exam or by using imaging tests. Treatment includes drugs that can slow or stop their growth, or surgery. If you have no symptoms, you may not even need treatment. Many women with fibroids can get pregnant naturally. For those who cannot, infertility treatments may help.

NIH: National Institute of Child Health and Human Development