You've missed your period again, and you've purchased another at-home pregnancy test. Something tells you that you're finally pregnant (fingers crossed). But after enduring a wait that feels like forever, you check the stick, only to find disappointing results once again. You're learning what many other women already know -- getting pregnant isn't always as easy as having unprotected sex.
A medical reason could be to blame for your struggle to conceive. With the help of infertility psychologist and Parents advisor Alice Domar, Ph.D.; Jane L. Frederick, M.D., a reproductive endocrinologist with HRC Fertility in Laguna Hills, Ca.; and Corey Whelan, program director for the American Fertility Association, we pinpoint the most common infertility issues, how they're caused, and how they're treated.
Premature menopause is when a woman's period stops before she turns 40. The cause is usually genetic, and it doesn't necessarily mean you can't get pregnant if you're in this situation. "Some women can still get pregnant with their own eggs," Dr. Domar says. "But for many, their only option for pregnancy is with egg donation." (This condition is not to be confused with Premature Ovarian Failure (POF), in which ovaries stop functioning normally in a woman who is younger than age 40.) Symptoms include having no or irregular periods, as well as menopausal symptoms such as vaginal dryness, hot flashes, and irritability. "A woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible," Dr. Domar says. In either case, Dr. Domar suggests seeing a reproductive endocrinologist.
Anovulation means there is no egg released from the ovary and, according to Dr. Frederick, this can be the cause of infertility in up to 40 percent of infertile women. Ovulation induction medications like Clomid can successfully treat this condition.
Endometriosis occurs when the tissue that lines the inside of the uterus enters other organs of the body, such as the abdomen and fallopian tubes. "When this happens, the misplaced tissue develops into lesions that respond to the woman's menstrual cycle," Whelan explains. "Outside of the uterus, the tissue has nowhere to go and backs up, causing internal bleeding, inflammation, adhesions, pain, and eventually, for many, infertility." Women suffering from this condition are advised to see a reproductive endocrinologist who may recommend surgery or another form of treatment.
Polycystic Ovary Syndrome (PCOS) is a hormone disorder that reduces the ovaries' ability to mature and release eggs into the fallopian tubes. According to Dr. Domar, there is a lot of controversy surrounding possible treatments. "The standard treatment is medication, but there is recent research that shows that lifestyle changes, like weight loss, exercise, and a low-carbohydrate diet, are beneficial," she says. Because women suffering from PCOS tend to be hungry more often, Dr. Domar suggests seeing a nutritionist to develop an appropriate eating plan.
Male infertility can sometimes be the culprit when a woman is not able to conceive. "Although infertility has historically been considered mostly a female problem, recent studies show that male infertility results in problems conceiving in almost half of couples struggling with reproduction," Dr. Frederick says. Before women seek any type of fertility treatments, experts advise getting a semen analysis to determine whether the sperm is capable of moving through the cervix, uterus, and fallopian tubes. Both artificial insemination and IVF are viable options for women with this condition.
Uterine fibroids are benign tumors inside or outside the uterus that can result in abnormal bleeding and infertility. The placement and size of the fibroid determines whether or not the fibroids should be surgically removed. Fibroids that grow inside the uterine cavity can often be removed during an outpatient surgical procedure, which can ultimately lead to a healthy pregnancy.
Fallopian tube damage is defined as complete or partial blocking and/or scarring of the fallopian tubes. According to a report from the Advanced Fertility Center of Chicago, roughly 20 to 25 percent of all diagnosed infertility cases in the U.S. stems from a tubal factor. A dye test called a hysterosalpingogram (HSG) takes an X-ray of the uterus and the fallopian tubes to determine if they are open or closed. Tubal reconstructive surgery can repair minimally damaged fallopian tubes, but if your case is more severe, IVF can bypass the tube and help you achieve a normal pregnancy.
Low ovarian reserve is associated with a reduced number and quality of eggs, resulting in fewer embryos and lower pregnancy rates with IVF. Hormone level detection tests can determine whether infertility treatments are necessary. "However," Dr. Frederick cautions, "these tests should be utilized to discuss prognoses with patients before infertility treatment is begun."