Infertility in women

The inability to have a baby after one year of trying, or six months if a woman is 35 or older, is the definition of infertility.

Women who can get pregnant but cannot stay pregnant also may be infertile.

If you find yourself in one of these situations, it's time for you and your partner to meet with an HonorHealth fertility specialist in the Phoenix area.

To help you reach your dream of starting or adding to your family, an HonorHealth reproductive specialist will evaluate you and your partner to determine if a physical or hormonal issue is causing the problem.

You'll receive a treatment plan tailored to your needs to help you achieve your dream.

Causes of infertility

About a third of causes for infertility can be attributed to females, about a third to males, and the final third to a combination of male and female factors. Sometimes, no cause can be found.

Conditions that can cause infertility in a woman include:

• Ovulation disorders: Ovulation is the release of an egg from the ovary. Most female infertility is caused by ovulation problems. You might not be ovulating normally if you don't have menstrual periods or have irregular ones. Your fertility specialist will check these factors:
  • Is an ovary releasing an egg each month?
  • Is the egg being pushed down a fallopian tube?
  • Is the egg made available for fertilization by sperm?
• Polycystic ovary syndrome: The most common cause of female infertility, it causes women not to ovulate or ovulate irregularly. Some women with this condition have elevated levels of testosterone, causing acne and excessive hair growth. Most women with the condition grow many small cysts on their ovaries, which lead to hormone imbalances.
• Anatomic issues: If the uterus has malformations, a woman can have miscarriages or premature delivery. Some women have a septum or membrane that results in two endometrial cavities.
• Premature ovarian insufficiency: Your ovaries no longer produce eggs before you're 40 years old, lowering estrogen production. Also sometimes referred to as premature menopause, the condition is typically caused by an autoimmune response, premature loss of eggs from your ovary, chemotherapy or genetics.

• Hypothalamic dysfunction: The pituitary gland produces two hormones, follicle-stimulating hormone, which helps control the menstrual cycle and egg production by the ovaries, and luteinizing hormone, which controls the length and sequence of the menstrual cycle. Several factors can affect production of these hormones:

  If you have this condition, you'll notice that you don't have periods or that they're irregular.

  • Physical or emotional stress
  • Very high or very low body weight
  • Significant weight gain or loss
• Excessive prolactin: Your pituitary gland may produce too much of the hormone called prolactin, reducing estrogen production. This can cause infertility.
• Medications: Medicine you're taking for another disease could be impacting your fertility.
• Fallopian tube damage: If your fallopian tubes are damaged or blocked, sperm can't get to an egg to fertilize it, and a fertilized egg can't get into the uterus. Fallopian tube damage can be caused by:
  • Pelvic inflammatory disease: Sexually transmitted infections such as chlamydia and gonorrhea cause an infection of the uterus and fallopian tubes
  • Prior surgery in the abdomen or pelvis: This can include surgery for ectopic pregnancy (when a fertilized egg develops in a fallopian tube instead of the uterus)
  • Pelvic tuberculosis: Uncommon in the U.S., it's a major cause of tubal infertility worldwide
• Endometriosis: When tissue that typically grows in the uterus develops in other locations in your abdominal and/or pelvic area, it's called endometriosis. The condition not only can cause scarring that can block your fallopian tubes, it also can affect the lining of your uterus and disrupt the implantation of a fertilized egg. Doctors believe that endometriosis also can damage the sperm or egg.
• Issues with the uterus or cervix: These can interfere with implantation of a fertilized egg or boost the chance of a miscarriage. Problems include:
  • Fibroids or myomas: These non-cancerous bundles of tissue and muscle on the walls of the uterus can block your fallopian tubes or interfere with implantation of a fertilized egg in the uterus. Endometrial scarring or inflammation inside the uterus also can prevent implantation.
  • Narrowing of the cervix: Also known as cervical stenosis, it can be caused by damage to the cervix or by a malformation you inherit.
  • Cervical mucus issues: A less than ideal type of mucus prevents sperm from traveling through the cervix to the uterus.
• Unexplained infertility: Sometimes a cause cannot be found. Infertility may be due to a combination of factors that can't be pinpointed.

Infertility risk factors

You're at higher risk of infertility due to:

• Age: Approximately one-third of couples in which the woman is older than 35 has fertility problems. Aging decreases a woman's chances of having a baby because she:
  • Has fewer eggs left
  • Has eggs that aren't as healthy
  • Is more likely to have health conditions that can cause fertility problems
  • Is more likely to have a miscarriage
• Smoking: It boosts your risk of miscarriage and ectopic pregnancy and damages your cervix and fallopian tubes. Doctors believe it ages your ovaries and depletes your eggs prematurely.
• Excessive alcohol use: It's considered excessive if you have more than one alcoholic drink a day
• Weight: Being overweight or significantly underweight can affect ovulation
• Excessive physical or emotional stress: It can result in amenorrhea (absent periods)

Diagnosing infertility

Your fertility specialist — a reproductive endocrinologist — on the HonorHealth medical staff may prescribe one or more of the following tests for female infertility. Some tests can be done at the doctor's office while others may need to be performed at an HonorHealth medical center:

• Ovulation testing: An over-the-counter kit used at home detects the surge in luteinizing hormone that happens before ovulation. A progesterone blood test taken at your doctor's office also can determine that you're ovulating. Your specialist also may check:
  • Other hormone levels and thyroid and pituitary hormones that control reproduction
  • Cervical mucus and tissue to see if ovulation is happening
• Hysterosalpingography: After X-ray contrast is injected into your uterus, an X-ray determines if there are abnormalities in the uterine cavity and fallopian tubes
• Hysteroscopy: A tiny telescope with a fiber light is placed through the vagina and cervical opening to search for uterine abnormalities
• Sonohystogram: This test combines an ultrasound with saline injected into the uterus to search for abnormalities or problems
• Urine and blood tests: These check for infections or hormone issues, including how your thyroid is functioning
• Imaging tests: They can include a pelvic ultrasound to detect fallopian tube or uterine disease
• Laparoscopy: This minimally invasive surgery uses a small incision. A camera is inserted to examine your ovaries, uterus and fallopian tubes in search of endometriosis, scarring, blockages and irregularities
• Genetic testing: It can help determine if a genetic defect might be causing your infertility

Depending on what the tests show, your HonorHealth fertility specialist will develop a personalized care plan with the goal of conceiving and having a successful pregnancy.