Trouble Getting Pregnant? Understanding Infertility in Women

This article is for women who are concerned about or have experienced infertility (trouble getting pregnant) and their partners, or anyone who wants to learn more about infertility in women. The goal of this patient education activity is to educate patients about treatments for infertility, including alternatives before in vitro fertilization (IVF).

You will learn about:

• What can cause infertility in women

• Diagnosing and testing for infertility

• Treatment options for infertility

• Making a plan with your doctor

• Questions to ask your doctor

Infertility means you’ve been trying to get pregnant for at least a year and haven’t, despite having frequent sex without birth control. If you're a woman older than 35, infertility is when you haven’t gotten pregnant after 6 months of trying.

Infertility can happen in both men and women. If you’ve been trying to get pregnant and haven’t, you’re not alone. Infertility in women, men, or a combination of both affects millions of adults in the US.

Infertility doesn't mean you're "sterile," or unable to ever to have a baby. Many people can eventually have a child, either on their own or with medical help.

Causes of infertility in women can include:

• Ovulation disorders where the ovaries aren’t making or releasing eggs

• Damaged or blocked fallopian tubes that stop sperm from reaching an egg, or block an egg from reaching the uterus

• Endometriosis, where tissue lining the uterus -- the endometrium -- moves and grows in other parts of the body

• Changes in the uterus or cervix, such as an unusual shape, fibroids (growths in the uterus), scarring or inflammation, or the mucus the cervix makes

• Hormone problems that stop an egg from releasing or the endometrium from thickening

Often, infertility doesn’t have any symptoms. So many women won’t know about it until they try to get pregnant. But sometimes symptoms may appear, depending on what’s causing infertility.

Symptoms of infertility may include:

• Abnormal, irregular, painful, or no periods

• Changes in sex drive and desire (libido)

• Skin changes, such as more acne

• Extra hair growth on the lips, chest, and chin

• Hair loss or thinning

• Weight gain

• A milky white liquid from the nipples that’s not from breastfeeding

• Pain during sex

To help diagnose infertility, your doctor will do a physical examination and ask about your medical, sexual, and social history. This includes if you’ve ever been pregnant and had any sexually transmitted infections (STIs) or conditions such as diabetes, lupus, arthritis, high blood pressure, or asthma. They’ll also ask if you drink or smoke and what medicines you take -- including those you can get without a prescription -- as well supplements and herbals.

Your doctor will also ask about your period. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular, or doesn’t happen can mean you're not ovulating properly.

It’s important to be honest with your doctor when talking about your medical, sexual, and social history. Open communication can be key, and knowing the full picture will help your doctor find the right tests and potential treatment for you.

Tests or procedures your doctor may recommend to check your infertility can include blood or urine tests, ovarian reserve testing, imaging tests, or procedures such as an endometrial biopsy or laparoscopy.

There are several options to treat infertility, and sometimes more than one type of treatment may be used. Treatment may include medicine, non-surgical procedures, surgery, and technological methods.

Which treatment you and your doctor choose will depend on the cause of infertility, your age, how long you've been trying to get pregnant, and your preferences. 

Medicines to help with infertility include clomiphene citrate oral tablets or gonadotropin -- a type of hormone -- injections. Your doctor may also recommend additional medicines to help with the conditions that may be causing your infertility.

Other treatments can include:

• Tubal cannulation, a non-surgical X-ray procedure using a contrast agent (an oil- or water-based liquid) to help unblock fallopian tubes. This is sometimes called "tubal flushing" and may be done after a hysterosalpingogram

• Surgery to correct problems causing infertility in your uterus or endometrium

• Technological methods such as:

  Intrauterine insemination (IUI) where sperm are placed inside your uterus near ovulation

  Assisted reproductive technology, such as in vitro fertilization (IVF) where eggs are fertilized by sperm in a laboratory

Depending on your results, your doctor may recommend treatment or may refer you to a fertility specialist.

Your doctor may also recommend you make certain lifestyle changes, such as quitting smoking, maintaining a healthy weight, limiting alcohol to no more than 1 drink a day, and managing your stress levels.

Keeping a menstrual diary of when you have your period and for how long can help track ovulation. Your doctor may suggest you record your basal body temperature -- your temperature at rest -- to also help track ovulation. This temperature can increase during ovulation, so you’re likely to be most fertile during the 2 to 3 days before it rises.

Questions you can ask your doctor about infertility can include:

• Why am I having trouble getting pregnant?

• Are there symptoms of infertility I should look for?

• What tests or procedures should I have to check for infertility?

• Should my partner be tested?

• What types of treatment would be best for me?

• What side effects can I expect from treatment?

• Are there lifestyle changes I should make?

• What should I do if I feel stressed?

Congratulations!

You have successfully completed the program Trouble Getting Pregnant? Understanding Infertility in Women

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