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Female Infertility Basics

These are some of the factors that contribute to normal fertility

Ovulatory Factors

A normally fertile woman releases an egg (oocyte) from the ovary at mid cycle. Inital blood tests will determine if the egg is released and normal levels of progesterone are produced to support an early pregnancy. If ovulation isn't occurring, the problem can often be addressed by a combination of life style changes and medication. Occasionally medical conditions may be responsible for a failure to ovulate, and these will be ruled out by a blood test.

Tubal Factors

Tubal disease can result in blocked tubes or tubes that are open but damaged. Intial screening for tubal problems is often carried out by means of a simple blood test. If more extensive testing is required, a hysterosalpingogram can be done. The hysterosalpingogram is a test where a dye is introduced into the uterus. It is done in radiology using a fluoroscope to monitor the progress of the dye. If the tubes are blocked or damaged, it can usually be determined by the hystersalpingogram. Occasionally laparoscopic surgery may be required to make the diagnosis, or to treat tubal disease. Most women with significant tubal disease choose to undergo in vitro fertilization, as in vitro fertilization bypasses the tubes completely.

Endometriosis

Endometriosis is the growth of uterine tissue outside of the uterus. The reason for the disorder is not known. It may cause significant pelvic pain, often with menses or intercourse. Most often it is diagnosed surgically with laparoscopy, although in some situations it may be diagnosed by ultrasound. It is commonly treated with medication and occasionally by surgery

Cervical Factors

Occasionally testing may show there is inadequate cervical mucus to allow normal sperm transport into the uterus. It is usually treated with intrauterine insemination. Popular opinion to the contrary, it is unusual for a woman's immune system to "attack" sperm and prevent pregnancy through this mechanism.

Uterine Factors

The woman may have uterine factor problems which include irregularities of the uterus, such as scar tissue or developmental abnormalities. If the problem involves a uterine factor, hysteroscopy or surgical repair may be recommended.

Aging

A woman's ovaries contain all the eggs she'll ever have 5 months prior to her delivery as a newborn. She continues to lose eggs over her reproductive life until at approximately age 50 her functional eggs are depleted, and her menses stop. This is menopause. There are age-related changes in the quality of her eggs, with the chance of pregnancy dropping, and the chance of  miscarriage increasing. Certain genetic conditions such as Down's Syndrome also increasing with age. The graph below illustrates the changes:

Aging & Reproduction