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Houston Fertility Journal

    5 Common Signs of Infertility in Women

    May 4, 2018, 1:37:44 PM / by Center of Reproductive Medicine   

    Center of Reproductive Medicine

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    Once you have decided to start a family it’s crushing when it becomes difficult. This is your time, and we get that. You are ready to have a child and you want to do everything you can to make it happen. It is not abnormal to have difficulty conceiving. According to The Mayo Clinic, 10-15% of couples in the US are infertile. There are many reasons a woman could be struggling. If you are wondering whether or not you are one of these women, consider if the following conditions might have some relation to you.

    #1 - Polycystic Ovarian Syndrome

    PCOS is a common health problem in women due to reproductive hormones being out of balance. Such hormonal imbalances create issues in the ovaries which hinder the possibility of conception. Because of this, the egg is not able to travel healthfully through a normal menstrual cycle. PCOS most commonly causes irregular periods which can lead to:

    • Infertility
    • The development of cysts in the ovaries

    The symptoms of PCOS include:

    • Irregular menstrual cycle
    • Too much hair
    • Acne
    • Thinning hair
    • Weight gain
    • Darkening of the skin
    • Skin tags

    The causes:

    • High levels of androgens
    • High levels of insulin

    Treatment:

    There are a variety of different treatments available for PCOS, including:

    • Weight loss: Reducing calorie intake and simple sugars, eating more lean protein and fiber, and adopting an exercise routine.
    • Birth control: The estrogen and progesterone pills in birth control help to regulate a woman’s hormones which will, in turn, make her periods more regular.
    • Surgery: The surgery for PCOS, ovarian drilling, is rarely used for treatment. Ovarian drilling is when a doctor makes small incisions in the abdomen by looking into a tiny camera to see the internal organs clearly. They will then make small burns on the enlarged ovarian follicles. Ovarian drilling is meant to reduce androgen and LH secretion in order to bring on ovulation.
    • Infertility treatment: If you are trying to have a child and have PCOS, a doctor may prescribe Clomid in hopes to bring on ovulation. An ovulation predictor kit can help indicate when is the best time for you to attempt conception, yet higher levels of LH in those with PCOS could make the kit’s reading inaccurate. Your doctor may also prescribe medications standardly used to treat diabetes due to the connection between PCOS and insulin resistance. If neither of these medications work, the next option is injectable hormones, such as Gonadotropins. When your doctor believes you are close to ovulating they will have you take the injection in order to trigger your ovulation within 36 hours. Then, depending on what you have agreed to be the best form of treatment, you may undergo Intrauterine Insemination or In Vitro Fertilization. You and your doctor will identify which treatment would be most helpful to you based on your condition.

    #2 - Fallopian Tube Damage

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    Issues in the fallopian tubes are usually due to inflammation. This may be from blockage, damage or scarring which can cause infertility. Usually, damage in the fallopian tubes comes about through:

    • Sexually transmitted disease
    • Pelvic inflammatory disease
    • Surgery required for ectopic pregnancy

    The causes:

    • Endometriosis
    • Previous pelvic infection
    • Ectopic pregnancy
    • Surgery

    Signs of endometriosis:

    • Fatigue
    • Lower back pain
    • Heavy periods or spotting in between
    • Pain during urination
    • Pain during bowel movements
    • Intense abdominal pain
    • Pain during intercourse

    Infertility treatment for endometriosis: It is not uncommon for women to be able to conceive on their own even if they have endometriosis. If you are experiencing trouble, however, endometriosis could have something to do with your difficulty. Infertility doctors may do a laparoscopy, the process of inserting a small camera through a tube into your abdomen, in order to check for unusual endometrial tissue.

    They may also want to double check with a biopsy. Treatments for endometriosis are similar to those with PCOS, as medications may be used to induce ovulation and then you and your doctor will decide if artificial insemination is the next necessary step.

    Infertility treatment for those with fallopian tube issues: In order to test for fallopian tube blockage or damage your doctor may perform a laparoscopy or hysterosalpingogram (HSG). In an HSG test the doctor inserts liquid dye through the vagina and into the uterus with a catheter.

    They will then be able to view any issues by observing the way the dye flows into the abdomen on your X-rays. If issues are found, the doctor may recommend surgery. If you are experiencing normal ovulation cycles, artificial insemination can achieve pregnancy and surgery would not be necessary.

    #3 - Cancer Treatment

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    If you have had cancer or are undergoing treatment this could be the cause of issues in the reproductive system. Chemotherapy drugs that are most likely to cause infertility are:

    • Busulfan
    • Carboplatin
    • Carmustine
    • Chlorambucil
    • Cisplatin
    • Cyclophosphamide
    • Dacarbazine
    • Doxorubicin
    • Ifosfamide
    • Lomustine
    • Mechlorethamine
    • Melphalan
    • Procarbazine
    • Temozolomide

    It is recommended by most doctors that you should wait at least 6 months to try to get pregnant after you finish cancer treatments. It is thought that the body requires sometime to return make to it’s normal way of functioning. This includes cycling through any eggs that may have been damaged by the chemo. If you achieve pregnancy with eggs that are damaged, the result could mean genetic problems in the baby or miscarriage.

    Egg freezing to ‘preserve fertility’: Women may choose to freeze their eggs before going into treatment in order to use them for IVF after recovery. This provides more options for fertilization if the eggs have been affected by the chemotherapy treatments. Egg freezing takes about 2 weeks as you would need to go through the stimulation cycle and then have the egg retrieval procedure. Because of this, your doctors will have to discuss with you whether waiting to begin chemo is a wise option for you or if it is too risky.

    Premature menopause: Chemotherapy can cause your period to stop for an extended period of time. The periods usually commence after the treatment has been finished for 3-4 months. Though the period has returned, it does not necessarily mean that fertility has as well. Because of this, women may be at risk for premature menopause, also known as premature ovarian insufficiency.

    #4 - Premature Menopause

    Early menopause is the loss of menstruation and depletion of ovarian follicles in a woman before she reaches 40 years of age. Symptoms of premature menopause include:

    • Heavy or very light periods
    • Irregular periods
    • Hot flashes
    • Vaginal Dryness
    • Bladder sensitivity
    • Dry skin, eyes, or mouth,
    • Lowered sex drive
    • Inability to sleep

    Infertility treatment for premature menopause: There are a variety of infertility treatments for women with premature menopause and, once again, your doctor will help you decide which one makes the most sense for you. The standard options in this situation include:

    • IVF
    • Artificial insemination
    • Using an egg donor
    • Using a surrogate
    • Testing for fallopian tube blockage
    • Tubal ligation reversal
    • Tube cannulation
    • Other fallopian tube procedures

    #5 - Age

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    It is becoming increasingly common for women in this day and age to wait on pregnancy until they reach their 30s. Young women are taking the time they need to experience their independence and develop their careers before they take on the responsibility of becoming a parent. This is a respectable approach, no one should ever attempt to get pregnant before they feel ready. Unfortunately, the ‘biological clock” factor is a real thing. As women get older:

    • It can become more difficult to achieve pregnancy. Women reach their fertility peak in their 20s. After that, it gradually begins to decline and around age 35 the decline becomes more rapid. Once you reach the age of 40, the chances of getting pregnant drop to about 5 percent.
    • Fertility continues to decrease as the egg supply runs out. Another reason for the decline in fertility is that the chances for genetic imbalances within the embryos go up dramatically after the age of 35. Embryos may still be produced but then degenerate before they can implant into the uterus. If they do implant, they may result in a genetically abnormal pregnancy that could end in a miscarriage.

    Infertility treatments: According to the American Society for Reproductive Medicine, if a couple has not achieved pregnancy after 1 year of unprotected sex, they should start to seek professional assistance. However, if the woman is over 35 she is recommended to seek assistance earlier. The recommended time to try naturally is 6 months. At this age, time has become a lot more precious and you will want to begin treatments as soon as possible.

    Most US IVF clinics have an age limit, only allowing those at the highest age of 45 to undergo IVF with eggs from their own reserve. Some facilities will allow women up to the age of 50 to receive treatment if they are using donor eggs. Depending on your specific age and condition of health, the usual options for infertility treatments include:

    • Fertility drugs
    • Artificial insemination
    • Donor sperm
    • Donor eggs
    • Surrogacy
    • In vitro fertilization
    • Reproductive surgery

    Finding Your Doctor

    If you are considering infertility treatment, consider the infertility clinic options in your area very carefully. It is easy to rush this process, especially once you have come to the decision that treatment may be something you require. However, you must be sure that you are receiving aid from a doctor that is truly equipped to give you the help that you deserve. As you browse the internet for perspective clinics, make sure to:

    • check that your sources are trustworthy
    • look at the hours of operation and consider how they will align with your schedule
    • try to find the insurance plans they accept and payment plans they may offer
    • map out the location and ensure that it’s not too far for you to travel on a regular basis
    • evaluate the success rates and what they are based on

    Once you have narrowed it down to a few promising options, set up a consultation with at least 2 of them so you can get a feel of the support you would be receiving and have something to compare each one to. Be prepared with questions to ask the specialist so you can truly explore what each clinic can offer you. Some examples of questions you may want to ask include:

    • What tests will I need to undergo to determine my state of fertility?
    • What do you believe my chances are of getting pregnant?
    • What treatments do you offer here and which do you most recommend?
    • How long is the entire treatment process going to take?
    • Will there be any side effects?
    • How much will everything cost and do you offer any payment plan options?
    • Are there any support groups you are affiliated with or do you offer couple counseling to help us get through this process?
    • Will I always be seeing the same doctor?

    For each clinic, make a pros and cons list to help you come to a decision. Remember, this is you and your partners decision. Do not rush into anything with a clinic if anything gives you pause. Trust your gut and make sure that you are certain as you move forward and agree to begin treatment.

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