All women are born with a fixed number of eggs for reproduction. As their age increases, the number and quality of eggs decreases.
Statistically, the chances of becoming pregnant decrease by about 3% to 5% per year once they reach the age of 30. After age 40, the decrease in fertility is considerably greater.
Conditions impacting female fertility
Besides the ongoing reduction in the number and quality of eggs a woman has after she reaches 30, other factors can negatively impact fertility such as:
- Fallopian tube damage
- Hormonal causes
- Cervical causes
- Uterine causes
- Unexplained causes
Diagnosing female infertility
Where the female is suspected of being infertile, physicians have several tests and procedures to confirm a diagnosis. These include:
- A blood test to check hormone levels and other conditions including among others, those affecting the thyroid
- An endometrial biopsy to check the lining of the uterus
- Additional diagnostic tests to determine if scar tissue or fallopian tube obstruction are present include:
- Hysterosalpingography: A procedure that uses either ultrasound or X-ray images of the reproductive organs to determine if the fallopian tubes are blocked.
- Laparoscopy: A minimally invasive procedure where a laparoscope is inserted into the abdomen through a small incision near the belly button to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis.
- Ovarian Reserve Testing: A test to determine a woman’s ovarian reserve to predict whether she can produce an egg or eggs of good quality as well as and how her ovaries are responding to hormonal signals from her brain.
- Urinary Luteinizing Hormone (LH) Testing: A specialized urinary test to help define the times of greatest fertility by predicting ovulation before it occurs.
Treating female infertility
Many fertility drugs to treat female infertility can increase the potential of having twins, triplets, or other multiples. Women should be aware that pregnancies with multiple fetuses can have more problems during pregnancy. Additionally, multiple fetuses have a high risk of premature birth and are at an increased risk of problems associated with overall health and development.
Some of the more common oral and injectable medications used by gynecologists to treat female infertility include:
- Clomiphene citrate (Clomid): This oral medication affects the pituitary gland causing ovulation. It is frequently used in women who have polycystic ovarian syndrome (PCOS) or other ovulation problems.
- Human menopausal gonadotropin or hMG (Repronex, Pergonal): This injectable medication is used with women who have pituitary conditions that preclude them from ovulating. It acts directly on the ovaries to stimulate ovulation.
- Follicle-stimulating hormone or FSH (Gonal-F, Follistim): Usually given by injection, FSH works much like hMG in that it causes the ovaries to begin the ovulation process.
- Gonadotropin-releasing hormone (Gn-RH) analog: Delivered via injection or nasal spray, these medications are used on women who don’t ovulate regularly. They are also helpful for women who ovulate before an egg is ready. They act on the pituitary gland and change when the body begins to ovulate.
- Metformin (Glucophage): Usually given orally, this medication is used with women who have insulin resistance or PCOS. It helps to reduce high levels of male hormones in women to help helping the ovulation process.
- Bromocriptine (Parlodel): This medication is used for women with ovulation problems due to high levels of prolactin that can cause menstrual disturbances. Given orally or as an injectable it lowers prolactin levels to allow the ovaries to function normally.
Experience does count in surgery in order to reduce recurrence of disease. The more experienced the surgeon, the more likely she will recognize and skillfully remove all disease, reducing the risk of recurrence.