If you’ve had to cope with recurrent pregnancy loss, you should know that you’re not alone. Today’s fertility doctors can determine the cause of your frequent pregnancy losses, and help you treat the source of the problem.
As a general rule, infertility is diagnosed after a couple has failed to naturally conceive a child after at least 12 months of regular unprotected sex. Within that generality, there are a few additional exceptions to consider. Due to the increased risk factors for complicated pregnancy or miscarriage, women between the ages of 35 and 40 should address their concerns with a doctor after six months of trying to become pregnant. Past 40 years of age or when one or both partners have previously diagnosed fertility issues, it may be prudent to begin treatment and/or testing immediately.
Ovulation is required in order to conceive naturally. In many cases, Irregularly timed periods or the complete absence of menstruation is the lone outward side of infertility. If your menstrual cycle spans 35 days or longer, less than 21 days, fluctuates or is nonexistent, it may be a sign you are not ovulating regularly.
Some degree of pain accompanying your period is to be expected. However, chronic excruciating pain that interferes with everyday life may be a sign of endometriosis, a more serious condition that renders a woman infertile due tol growth of the uterine lining outside the uterus.
Pain During Sex
Despite some lingering cultural misconceptions, it is not generally “normal” to regularly experience discomfort or pain during intercourse. To the contrary, this experience can be symptomatic of endometriosis, various hormonal imbalances or several other underlying conditions that contribute to a woman’s inability to become pregnant.
The loss of two or more clinical pregnancies qualifies a diagnosis of recurrent pregnancy loss, a condition with a defined cause in roughly only 50 percent of documented cases. Women who have spontaneously lost two or more pregnancies see their overall risk of future repeat miscarriage rise from the typical likelihood of 15 to 20 percent up to an elevated 40-percent. Risks continue to escalate as maternal age advances. Only approximately 5 percent of women experience at least two consecutive terminations and a mere 1 percent ultimately experience three or more.
As a woman ages, her prospects for becoming pregnant and carrying a child to a healthy birth decrease with each passing year after the age of 35. Egg production and quality both drop off sharply and the statistical frequency of miscarriage increases significantly.
Recognized as the leading cause of female infertility, polycystic ovary syndrome (PCOS) can trigger hormonal imbalances that interfere with healthy, normal ovulation. In addition to being associated with resistance to insulin, it often presents outwardly through unexplained weight gain, loss of sex drive, suddenly severe adult acne and unusual hair loss or growth patterns on the face and body.
Whereas male fertility can often be improved upon through reformed lifestyle choices and avoidance of certain environmental factors likely to increase risks of sterility, most causes of female infertility stem from medical issues that are difficult to consciously avoid, if not entirely impossible. The majority of cases are ultimately linked to damage to the uterus or fallopian tubes, cervical issues or abnormal ovulation. However, the inevitabilities of aging also take a pronounced toll by steadily limiting the quantity and quality of eggs released after a woman turns 35 while risks for at least one miscarriage rise appreciably.
Polycystic Ovary Syndrome (PCOS)
This condition aptly derives its name from the numerous small cysts that develop on the ovaries. While not directly harmful, these growths set off hormonal irregularities that not only interfere with normal reproductive function and can cause infertility but also give rise to the sudden onset of severe acne, unusual hair loss or growth patterns on the face and body and tapering off of a woman’s sex drive. Fortunately, long-term problems can often be prevented and symptoms kept in check with early diagnosis.
Hypothalamic Dysfunction / Functional Hypothalamic Amenorrhea
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are key compounds released by the pituitary gland to initiate ovulation. Unusually high or low body weight, suddenly losing or gaining substantial weight and excessive emotional or physical stress can trigger either of these conditions and result in disruptive FSH and LH imbalances that lead to absent or irregular ovulation.
Premature Ovarian Failure (POF)
An adverse autoimmune response or premature egg loss due to genetic causes or chemotherapy can result in an ovary no longer containing eggs before it would have naturally exhausted its reserves. This condition also limits the production of estrogen in women under the age of 40.
Too Much Prolactin
Under normal circumstances, the pituitary gland’s secretion of prolactin allows a woman to produce milk during pregnancy. Excess production of prolactin, known as hyperprolactinemia, can cause infertility by limiting estrogen production. Although sometimes linked to various medications, this condition is normally related to problems with the pituitary gland itself.
Diminished Ovarian Reserve (DOR)
Unlike the male testes, which can produce at least some sperm throughout almost the entirety of a man’s lifespan, each ovary naturally delivers a finite reserve of eggs. Fertility compromised by the ovaries’ decreased reproductive capacity inevitably occurs as a consequence of a woman getting older, most notably as she passes the age of 35. However, this condition can also arise as an effect of injury or disease.
Fallopian Tube Damage
Multiple circumstances can damage or block fallopian tubes to such an extent that sperm cannot reach an egg or a fertilized egg proceed into the uterus.
Pelvic Inflammatory Disease
Chlamydia and gonorrhea are just two of the sexually transmitted diseases (STDs) that can cause this infection of the fallopian tubes and uterus.
A buildup of clear or serous fluid can create a blockage causing a fallopian tube to severely distend bilaterally up to several centimeters in diameter.
Prior procedures performed within the pelvis or abdomen can leave behind permanent damage inevitably leading to infertility. This includes surgery to address ectopic pregnancy, a fertilized egg that implants and develops inside a fallopian tube before it can reach the uterus.
Rarely diagnosed in the United States, pelvic tuberculosis causes female infertility by creating tubal obstructions that prevent ovum and sperm from converging. These blockages make fertilization impossible.
Excess growth of the endometrium that implants and grows in locations other than the uterus and the surgical removal of this tissue can cause scarring that blocks the fallopian tubes and prevents the union of egg and sperm. It can also disrupt implantation of a fertilized egg within the lining of the uterus.
Chromosomally abnormal embryos have a notably low rate of successful implantation within the mother’s uterus. These embryos frequently miscarry even when they do successfully implant and babies carried to term often exhibit mental retardation, physical issues or developmental delays.
Such conditions often stem from:
Uterine Or Cervical
Benign Polyps Or Tumors
A number of otherwise benign growths can interfere with cervical or uterine function by blocking fallopian tubes and hindering implantation of fertilized embryos, resulting in a high likelihood of miscarriage.
Scarring or inflammation within the uterus can disrupt implantation.
Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
A narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus. It can result in not only infertility but possibly in the uterus filling with pus or blood. Surgically widening the cervical opening can often relieve symptoms.
Including an abnormally shaped uterus that complicates becoming pregnant and carrying a child to term
Uterine fibroids can diminish fertility as much as 70 percent, but chances of pregnancy can improve dramatically with proper treatment. However, these grows also frequently cause preterm delivery, abnormal positioning of the fetus, miscarriage and necessity of C-section birth.
Unusually thick and sticky, “hostile” cervical mucus
Unusually thick and sticky, “hostile” cervical mucus can limit fertility by making it exceptionally difficult for sperm to reach an egg. On the other hand, not producing enough fertile-quality cervical mucus of the correct consistency and pH deprives sperm of a valuable protective medium to swim through.
Luteal Phase Defect
An irregularity of the menstrual cycle, luteal phase defect is a treatable condition that develops when the endometrium lining of the uterus has not received adequate progesterone from the ovary or hasn’t responded to normal levels, leading to infertility and higher rates of miscarriage.
By her mid-thirties, the volume of quality eggs a woman’s ovaries have left to give drops off considerably and the likelihood of miscarriage substantially rises. By the age of 40, she will have only a roughly 5 percent chance of becoming pregnant.
Hormonal imbalances and ovulation issues caused by obesity can create a number of issues for women having their first baby. Infertility due to PCOS has also been linked to being severely overweight or obese.
Although it strangely has not been shown to affect conception among overweight or obese women, studies have shown that five or more hours per week of extremely vigorous exercise can result in a 42-percent-lower likelihood of a normal-weight woman with a body mass index under 25 becoming pregnant. Researchers tend to attribute this trend to intense physical exertion disrupting menstrual cycles when the pituitary gland interprets the physical strain as a less-than-optimal time to further stress the body and shuts down its signals to the ovaries. Some data also suggests that extreme exercise may impair implantation when an egg is fertilized.
Many women who suffer from anorexia, bulimia and other eating disorders struggle to conceive, due to a cessation of the menstrual cycle in the wake of malnutrition.
Illegal drugs including, but not limited to, cocaine and marijuana can detrimentally impact fertility by disrupting feedback loops that control regular menstrual cycles and increasing risks for miscarriage and birth defects.
Various STDs including Chlamydia and gonorrhea can cause disastrous internal scarring that blocks the fallopian tubes and prevents fertilization.
Poor Hygiene – Inadequate hygiene can jeopardize female fertility by increasing exposure to bacterial and viral infections.
Physical and emotional stress can trigger not only hormonal imbalances disastrous to optimal fertility but a reaction from the pituitary gland that shifts the menstrual cycle to save the body from the stress of reproduction as long as it is under duress.
Diabetes And Hypothyroidism
Hypothyroidism is an autoimmune disorder characterized by a significant lack of thyroid hormone release resulting in lethargy, weight gain, fatigue and mood swings. It is also a significant cause of female infertility that often accompanies diabetes, which itself can bear fertility issues frequently associated with the development of PCOS and onset of obesity.
In some instances, female infertility has no apparent cause. As frustrating as this scenario may be, the inability to have children may be a product of one mysterious factor or the combination of multiple lesser issues. The problem, whatever it may be, might self-correct over time. It may linger throughout a woman’s fertile years.
Female Testing For Infertility
Urine / Blood Tests
Examining these fluids can quickly reveal whether efforts to become pregnant are being hindered by hormonal imbalances.
Cervical Mucus & Tissue
The post-coital cervical mucus test is especially effective in determining whether your body provides ideal conditions for a sperm to freely through toward an egg. Administered just prior to ovulation, this process involves sampling and examining cervical mucus several hours after intercourse during the point in the menstrual cycle when the mucus should be most receptive to sperm.
Any of a number of available consumer ovulation tests can help couples who have tried unsuccessfully for some time to conceive narrow down the most fertile window in a woman’s cycle to have intercourse.
This noninvasive x-ray examination of the fallopian tubes and uterus can help diagnose and treat various reproductive issues using fluoroscopy imaging and a highly visible contrast material.
Fertility specialists employ this surgical procedure to examine the ovaries, fallopian tubes and uterus for telltale indicators of pelvic adhesions, ovarian cysts, uterine fibroids, endometriosis and other reproductive conditions that may jeopardize a woman’s fertility.
Ovarian Reserve Testing
Doctors can assess a woman’s overall reproductive potential by examining the health and quantity of her remaining follicles in one of several ways. For starters, FSH levels can be quantified on the second or third day of a normal menstrual cycle, along with the accompanying estradiol level to rule out a misleading degree of FSH in women whose early menstrual cycles exhibit high estrogen levels. In lieu of that, antral follicles can be counted using a transvaginal ultrasound.
A closer look at various hormone levels can prove instrumental in verifying the presence and extent of any chemical imbalances that might be limiting your capacity to conceive children:
Luteinizing Hormone (LH)
Produced in the anterior pituitary gland by gonadotropic cells that interact synergistically with FSH, an acute increase of this hormone sets off ovulation and corpus luteum development in females.
Follicle Stimulating Hormone (FSH)
This gonadotropin regulates the body’s development, pubertal maturation, growth and general reproductive processes alongside LH.
This estrogen derives its name from its key regulatory role in the female body’s menstrual and estrous cycles, specifically maintenance and development of such vital reproductive tissues as the uterus, vagina and breasts through puberty and onward throughout adulthood and pregnancy.
This is a hormone and endogenous steroid found in the female body, this substance plays an integral role in reproduction from the menstrual cycle through pregnancy and embryogenesis.
In addition to its role enabling many female mammals to produce milk, prolactin also plays a key part in more than 300 other physiological processes in numerous vertebrates.
Fertility specialists can diagnose several known thyroid disorders with potential to cause infertility by monitoring levels of the metabolically active “free” form of triiodothyronine (T3.)
In its reproductive capacity, testosterone optimizes cervical mucous production, increases pelvic circulation and accelerates libido briefly mid-menstruation to encourage fertility. Oppositely, testosterone deficiency has been previously linked to increased risk for heart complications after a hysterectomy.
This bioavailable hormone is distinguished by being easily used by the body and its lack of binding to albumin and sex hormone-binding globulin (SHBG.) Testing for elevated free testosterone levels can provide a leg-up on early diagnosis and treatment of PCOS, a condition frequently marked by obesity, acne, blood sugar problems, unusual hair growth, lack of menstruation and eventual infertility.
This hormone manufactured naturally in the adrenal glands kickstarts estrogen production in women, but its levels typically begin to drop sometime after the age of 30, leading to declining egg quality and diminished sex drive.
Like other androgens produced by a woman’s adrenal glands, fat cells and ovaries, androstenedione is a crucial catalyst that initiates pubescent development and a necessary element of estrogen synthesis.
Antimullerian Hormone (AMH)
Given that AMH comes from small ovarian follicles and its levels in the bloodstream decrease as the pool of microscopic follicles naturally declines with a woman’s advancing age, its overall content is believed to reflect a woman’s remaining ovarian reserve. High AMH values often also alert fertility specialists to the onset of PCOS and lower levels may point toward imminent menopause.
Clomiphene Citrate Challenge Test (CCCT)
The CCCT is an important part of assessing ovarian reserves and predicting prognoses for future pregnancy in patients 40 years of age and older. A fertility specialist measures FSH and estrogen levels with a blood test on the third day of a woman’s cycle and follows up with dosages of two clomiphene pills to be taken daily from fifth through the ninth days and a final FSH measurement on the tenth day. High FSH can point toward either few quality eggs remaining or an overall decreased reserve.
For women experiencing difficulty conceiving, ultrasound examinations can provide a noninvasive internal view of the pelvis and abdomen using SONAR-like sound waves that bounce off internal tissue and organs to generate reconstructed images instrumental in identifying pelvic abnormalities, verifying the presence and healthy structure of the uterus and ovaries while exposing any troublesome fibroids, cysts or tumors, estimate the number of follicles present in the ovarian reserve, and monitor the effects of certain ongoing fertility treatments, such as those focused on the uterine lining.
In order to help your doctor diagnose certain medical conditions that may jeopardize your ongoing fertility, an endometrial biopsy involves removing a small tissue sample from the endometrium and searching it for signs of abnormal tissue or hormonal shifts causing cellular changes to the uterine lining.
Since genetic factors contribute to around 10 percent of diagnosed recurrent pregnancy loss or infertility, thorough testing can help couples who have struggled to become pregnant clarify their future options for starting a family.
How Is Female Infertility Treated?
Causes of female infertility can become excruciatingly frustrating for doctors and prospective parents to diagnose. The same symptoms may point to multiple possible conditions and further testing required to narrow that shortened list down. A thorough diagnosis can require months of trial-and-error examination before arriving at a definitive cause and an ideal course of action. No two cases are guaranteed to ever be alike.
A variety of pharmaceutical treatment options may rectify various culprits of female infertility. However, your doctor can only recommend a drug after careful consideration of your medical history, assessment of your current systems and a candid discussion of all possible side effects. Depending on your case, options may include:
Intrauterine Insemination (IUI)
As a means of making it possible for the greatest number of sperm to reach the fallopian tubes and fertilize an egg, IUI involves transferring sperm directly into the potential mother’s uterus.
In Vitro Fertilization (IVF)
This common procedure involves obtaining a sperm sample, retrieving an egg directly from the ovary and combining both partners’ cells in a dish so that sperm can “naturally” achieve fertilization independent of any further human intervention. The embryo is then implanted directly inside the uterus.
Intracytoplasmic Sperm Injection (ICSI)
Instead of mixing male and female gametes in the same setting and “letting nature take its course,” a doctor uses an extremely fine needle to directly inject a single sperm into a retrieved egg before inserting the viable embryo into the uterus.
Gamete Intrafallopian Tube Transfer (GIFT)
This assisted reproductive technique removes an egg from the ovary and places it directly inside one of the fallopian tubes with a male partner’s sperm.
Zygote Intrafallopian Transfer (ZIFT)
To circumvent fallopian blockage, laparoscopy can be used to place a zygote resulting from successful IVF into the fallopian tube where it can then travel unimpeded to the uterus.
Hysteroscopy / Laparoscopic Surgery
Both of these minimally invasive surgical procedures have proven themselves to be remarkably effective in diagnosing and treatment such female-factor infertility conditions as fibroids, polyps, pelvic infection and endometriosis.
Depending on the location and extent of the mass, several common surgical procedures can correct fallopian tube blockages that would prevent an egg from successfully pairing with sperm and traveling to the uterus. Most utilize microsurgical techniques using either laparoscopy through a tiny incision or open abdominal surgery. Options may include:
To reverse a tubal ligation or repair a disease-damaged portion of a fallopian tube, the distressed section is removed and replaced by two joined healthy ends of the tube. Although generally performed via abdominal incision, some specialists have successfully executed this procedure using laparoscopy.
This procedure significantly improves the likelihood of successfully IVF by removing part of a tube that has accrued a buildup of fluid preventing clear passage.
This procedure rebuilds the fringed end of a damaged fallopian tube closest to the ovary to address either a partial blockage or mass of scar tissue preventing normal egg pickup.
In slight contrast to controlled ovarian hyperstimulation, which stimulates development of multiple mature follicles and eggs using the same medications in order to increase various fertility treatments’ respective pregnancy rates, induced ovulation is geared toward utilizing similar processes to kickstart egg development in the ovaries of women suffering from infertility and anovulation without assistance from any additional therapies.
Prospective parents from heterosexual male and female partners diagnosed with infertility to single and coupled gay men have embraced the option to engage an egg donor in order to have a baby. A fertility specialist extracts several eggs from the ovaries of the donor and either fertilizes them immediately prior to implantation in the mother’s uterus or freezes them for future fertilization.
This alternative to traditional surrogacy uses IVF to fertilize an egg from the mother and sperm from either the father or a donor to create an embryo in a laboratory setting before implanting it inside the uterus of a surrogate “birth mother.” As with traditional surrogacy, she will then carry the pregnancy to term and deliver the baby to the biological parents.
This relatively newer, revolutionary horizon in conquering infertility involves separating molecules that trigger tissue and blood vessel growth from a sample of a woman’s blood and injecting them directly into the ovary. Ideally, it will take only a month or two before ovaries generate follicles and prepare the body to possibly conceive a child. The resulting eggs can then be immediately utilized in IVF or ICSI, frozen for use in fertility treatments at a later time or fertilized naturally through normal intercourse. Though experimental, early research has shown promise for patients from women who have experienced POF during their prime childbearing years to those who have already been through menopause.
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