Female infertility treatment has such a huge breakthrough, at IHR we give every family the greatest chance of success to achieve their dream of becoming parents.
The causes of female infertility are multifaceted, and may extend to either of the partners — or even both. Indeed, the root issues of infertility can be related to both sexes: approximately 60 percent of infertility is caused by female conditions, while approximately 40 percent is male related. It is also worth noting that in 25 percent of infertile couples both partners will have a fertility problem. The IHR experts work closely with couples undergoing the many different types of assisted fertility treatments available. We are renowned for our specialized knowledge and high infertility success rates even in difficult cases. IHR's expertise in female infertility lies in our willingness and ability to individualize our approach to best suit each and every one of our patients. If you have any questions as you review the material on female infertility, please contact us for a FREE Female Infertility E-Mail Consultation.
IHR's approach to working through issues associated with female infertility is to 1) work with the patient to discover the actual cause(s) of the infertility, 2) discuss our findings with the patient and help them understand the available treatment options, and 3) provide the selected infertility treatment with a determination to achieve a successful solution.
IHR's IVF Program is solid and successful and is one of the most requested treatment options selected by our patients. Also, our egg donor program has accumulated signficant rates of success. As well, our facility has experience and solutions to diagnose and treat a full range of female infertility issues. There are many potential causes of infertility that need to be considered in women having difficulty becoming pregnant. These causes can generally be lumped into problems with egg production, tubal problems, and uterine problems. Each of these potential problems are evaluated before initiating fertility treatment.
Ovulation Dysfunction and Infertility
Normal ovulation is essential for producing a mature egg that can be fertilized. Disorders in ovulation can impair conception and cause infertility. Women having problems with ovulation will not generally have menses at regular intervals. Keeping a journal of menses can be a very helpful tool to evaluate ovulation. Regular menses is very predictive of regular ovulation. Many women use menstrual calendars in combination with basal body temperature charts and ovulation predictor kits. While these can be useful aids in evaluating potential causes of infertility, they can easily become cumbersome and costly. This is especially true with the new electronic ovulation "computers" that monitor a woman's fertile window. We do not advise you purchase ovulation monitoring devices. Well spaced intercourse during the middle of a menstrual cycle can be just as effective.
Ovulation occurs 14 days before the first day of menses. Women can predict their fertile window by taking the number of days between the start of menses and the start of the next menses and subtract 14. For example, a woman with 32 days between menses would be most fertile on day 16 (counting the first day of flow as day 1).
Women not having regular menses will most likely experience difficulty getting pregnant. The lack of menses indicates a lack of ovulation. This makes timing ovulation and intercourse practically impossible. The most common cause of anovulation (absence of menses) or oligoovulation (infrequent ovulation) is polycystic ovarian syndrome (PCOS). Other causes include premature ovarian failure (POF), age related fertility, and endocrine abnormalities such as elevated prolactin or thyroid levels. For more information view Ovulatory Dysfunction and Infertility.
Tubal Factor Infertility
Fallopian tubes can become blocked by several different mechanisms. Some of the more common reasons include infections (pelvic inflammatory disease, or PID), surgery, and endometriosis. Blockage of the fallopian tubes can prevent the sperm and egg from uniting and forming a pregnancy. This blockage can also prevent the normal transport of an embryo and increase the likelihood of an ectopic pregnancy (pregnancy inside the tube). Microsurgery is a type of surgery that uses an operative microscope or magnifying lenses to help amplify the surgical field. Microsurgery may be able to repair damaged fallopian tubes and IVF offers a way to bypass fallopian tubes. For more information view Tubal Factor Infertility.
Endometriosis and Infertility
Endometriosis is a chronic condition where endometrial tissue (the cells that line the inside of the uterus) implants outside of the uterus. This can be associated with chronic pelvic pain and infertility. There are many theories as to why endometriosis causes infertility problems. One of the more current theories is the displaced tissue causes an inflammatory reaction that kills sperm and eggs. Stopping menses is an effective method of controlling endometriosis though this is not a cure. Laparoscopy and ablating (destroying) the endometriosis is another therapeutic option though it too is not a cure. In Vitro Fertilization offers a very effective way of "bypassing" endometriosis. Women often experience several years of relief from the discomforts of endometriosis following pregnancy.
Endometriosis is found in as many as 35% of women having laparoscopy for evaluation of their infertility. It can be a cause for pelvic pain as well as infertility. Other locations include incisions from previous surgeries, the vagina and cervix, as well as the bowel and bladder. Very unusual locations are also possible but not as common. Specialist vary tremendously on their opinions as to what should be done for the infertile couple with endometriosis. There is supportive evidence for most of the different treatment types which makes things even more confusing for patients seeking "the right thing". Our program has very good success achieving pregnancy in patients with endometriosis without subjecting patients to extensive and invasive procedures. For more information view Endometriosis and Infertility.
Immunological infertility is sometimes diagnosed when the woman's immune system produces "anti-sperm antibodies" that attack her partner's sperm. Anti-sperm antibodies can occur in both men and women. Antibodies are protein molecules that are attracted to a specific site on the sperm. Once attached, they may interfere with the sperm's activity in any of several ways. They may immobilize sperm, cause them to clump together, limit their ability to pass through the cervical mucus, or prevent them from binding to and penetrating the egg. Anti-sperm antibodies are frequently seen in men after vasectomy, testicular injury or infection. The cause of anti-sperm antibodies in the woman is unknown. A trial of ovulation induction and insemination followed by in vitro fertilization with ICSI (a process that involves injecting a sperm directly into an egg) seems to be the best treatment available. For more information view Immunological Infertility.
Hormones act as the body’s very own integrated "thermostat" – hormones keep the concentrations of the various chemicals in our system in check, to make sure that our different systems operate most effectively. Timing of movement is really important when it comes to hormones. Women with hormone infertility often fail to produce a fertilisable egg during their menstrual cycle. Women with hormone infertility issues will generally experience irregular menstruation. An irregular period should always be a cause for concern anyway, and any woman experiencing this should probably seek medical advice as soon as possible. Hormonal infertility is one of the very common reasons that couples fail to conceive. Rather than being curable by a surgical intervention, this cause of infertility may take time to fix and longer-term treatments to overcome, but the outcomes are generally good for most couples. The first step is addressing any conditions which are apparent before the couple even tries to conceive. For more information view Hormonal Infertility.
Unexplained infertility is a diagnosis of exclusion. This means that all other causes within reason have been ruled out. Many times a presumptive diagnosis of unexplained infertility is given when the evaluation is not completed due to a low likelihood that further testing will find an abnormality. Examples of tests often deferred are laparoscopy and endometrial biopsies in women without symptoms. Unexplained infertility can be very frustrating because people want answers. Fortunately, treatment options offer significant improvements in couples with unexplained infertility. For more information view Unexplained Infertility.
Tubal Reversal and Infertility
Tubal ligations cause interruptions in the fallopian tube that prevent sperm and egg from meeting. These procedures can be reversed and offer couples a means of conception. There are many considerations when deciding between IVF and tubal reversal. IHR has extensive experience performing the surgery and can provide you more information about your options. For more information view Tubal Reversal and Infertility.
Recurrent Losses and Infertility
A miscarriage is the loss of a pregnancy. Miscarriage occurs in 15 percent to 20 percent of pregnancies, usually during the first 13 weeks, and sometimes before you even realize you are pregnant. If you had three or more miscarriages, you are considered to have recurrent pregnancy loss. The risk for a miscarriage increases with age. (Your eggs get older too.) If you are under 35, you have a 15 percent chance of miscarriage, but if you are over 45 your chance of having a miscarriage goes up to 50 percent.
Genetic problems with the embryo account for more than half of miscarriages in the first 13 weeks of pregnancy; chromosomal issues prevent the fetus from developing properly and surviving. Genetic problems happen by chance and have nothing to do with either parent. Although this type of miscarriage is unlikely to happen more than once, the chance increases with age. For more information view Recurrent Losses and Infertility.
Advanced Age/Age Related Infertility
Many women are not aware of the extreme effect that age can have on fertility. Women are born with all the eggs they will ever have in their lifetime. This pool of eggs declines continuously throughout a woman's life. The effects can be seen in a woman's early 30's and becomes a common problem in women 35 and over. By the time a woman reaches 40 she will have a drastic reduction in her chances of becoming pregnant. This reduction in pregnancy is due to fewer available eggs and a reduction in egg quality. As the eggs age, the biologic process used to divide the cell becomes less efficient. This leads to non-viable eggs and an increase in chromosomal abnormalities. There are tests to estimate a woman's potential to produce eggs, and some promising DHEA treatment to overcome this decline in egg function. For more information view Advanced Age and Age Related Infertility.
Uterine Factors and Infertility
Structural abnormalities of the uterus can result in decreased pregnancy rates and increased miscarriage rates. In addition to causing infertility, uterine abnormalities may also cause pregnancy losses. Fortunately, many of these abnormalities can be corrected.
Fibroids and Infertility
Uterine fibroids are muscle tumors of the uterus that can interfere with pregnancy when they lie within the cavity of the uterus. Fibroids can also cause pelvic pain and irregular bleeding. In the absence of infertility or other problems, fibroids can usually be left alone.
Structural Abnormalities and Infertility
Several developmental abnormalities of the uterus can be discovered during an infertility evaluation. A unicornuate uterus, septum or septate uterus, and a bicornuate uterus are among the numerous structural anomalies. These problems arise when the uterus is being formed. A unicornuate uterus is when only one side of the uterus is formed normally. A bicornuate uterus is a uterus that has two sides of the uterus that are attached at the cervix but not at the top of the uterus. A septum is a normal shaped uterus that has a dividing membrane on the inside of the uterus. Hysteroscopy is useful in evaluating and treating these abnormalities. Other effective means of evaluating the uterus include saline contrast ultrasound and hysterosalpingogram (HSG). IHR has extensive experience and treatment for Structural Abnormalities Infertility.
Hydrosalpinx and Infertility
A hydrosalpinx is a blocked fallopian tube that has filled with fluid. Microsurgical repair called a neosalpingostomy can be an effective way to open the blockage and allow for pregnancy. There is an increased risk of ectopic pregnancies and a risk of the tube scarring shut after the surgery. IHR has extensive experience with microsurgical repair of fallopian tubes. IVF offers an excellent alternative to surgical repair of the fallopian tubes and the associated risk of ectopic pregnancy. When IVF is selected and hydrosalpinges are present, removal of the tubes is recommended in order to improve pregnancy rates. The fluid from the tubes is thought to impact pregnancy rates. Tubes can be removed by laparoscopy surgery.
IHR has treatments for a variety of conditions, including ovulatory dysfunctions, endometriosis, immunological infertility and many others. Perhaps less known is our work with individuals and couples who are considering assisted reproduction, but who are uncertain of their next step. We encourage anyone, before they make a decision, to consult with us. Currently, we are offering a FREE Female Infertility E-Mail Consultation.