FERTILITY PROBLEMS IN WOMEN

General Information

DEFINITION--The inability to become pregnant after 1 year of sexual activity without contraception. Infertility occurs in 10% of all couples.

BODY PARTS INVOLVED--Genitals; endocrine system; brain.

SEX OR AGE MOST AFFECTED--Females between puberty and menopause.

SIGNS & SYMPTOMS--Inability to conceive.

CAUSES

Minor anatomic abnormalities of the reproductive system. Emotional stress. Repeated weight-gain/weight-loss cycles. Hormone dysfunction, especially thyroid disorders. Vaginitis; ovarian cysts; endometriosis; tumors. Disorders of the cervix, such as infection, laceration from previous childbirth or narrowing of the cervical opening for any reason. Amenorrhea (lack of menstrual periods) caused by strenuous exercise programs or nutritional disorders (bulimia or anorexia nervosa). Chemical changes in the cervical mucus. The use of some medications, including oral contraceptives. Many women cannot conceive for many months after discontinuing use. > Disorders probably not related to infertility include: a tilted uterus; small fibroid tumors of the uterus; or inability to achieve orgasm.

RISK INCREASES WITH

• Stress.
• Marital discord and infrequent sexual intercourse.
• Abuse of drugs, like heroin.

HOW TO PREVENT

• Obtain treatment for any treatable disorder that causes infertility.
• Avoid preventable causes of infertility, especially poor nutrition.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies, such as: blood studies; Rubin's insufflation tests (See Glossary); culdoscopy (See Glossary); and studies of mucus of the cervix.
• Surgical diagnostic procedures such as laparoscopy (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Psychotherapy or counseling, if marital problems exist.
• Surgery to correct anatomical abnormalities of the reproductive system.
• In-vitro fertilization; eggs from the female are harvested, impregnated with sperm from the male and implanted in the uterus.

POSSIBLE COMPLICATIONS--Psychological distress, including feelings of guilt, inadequacy and loss of self-esteem.

PROBABLE OUTCOME--

• Many fertility problems are minor and reversible. Approach treatment with optimism.
• Research is offering new options to couples.

How To Treat

GENERAL MEASURES--

• Keep a basal body-temperature chart to become familiar with your ovulation pattern. Ask your doctor for instructions.
• Have intercourse just before ovulation, which can be determined from the chart.
• Don't use a lubricant during sexual relations. Lubricants may interfere with sperm mobility.
• Your partner should withdraw his penis quickly from your vagina after ejaculation. If left in, it reduces the number of sperm that can swim toward the egg.
• After your partner's ejaculation, place pillows under your buttocks to provide an easier downhill swim for the sperm.
• Avoid physical exhaustion prior to intercourse.
• Maintain a positive attitude. Worry and tension contribute to infertility.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Hormones for a hormone imbalance.
• Clomiphene, a gonad stimulant. Recognize that fertility drugs may cause multiple births.

ACTIVITY--Work and exercise moderately. Overexercising may contribute to infertility.

DIET--Eat a normal, well-balanced diet. If you are overweight, try to achieve your ideal weight (see Weight-Loss diet in Appendix).

Call Your Doctor If

• You want help for infertility.
• Conception doesn't occur within 6 months, despite recommendations and treatment.
• New, unexplained symptoms develop. Hormones used in treatment may produce side effects.