Female infertility
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2008-07-08T08:38:24Z
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{{Infobox_Disease
| Name = Female infertility
| Image =
| Caption =
| DiseasesDB = 4786
| ICD10 = {{ICD10|N|97|0|n|80}}
| ICD9 = {{ICD9|628}}
| ICDO =
| OMIM =
| MedlinePlus = 001191
| eMedicineSubj = med
| eMedicineTopic = 3535
| MeshID = D007247
}}
'''Female infertility''' is a term that refers to [[infertility]] in female humans.
==Causes==
Factors relating only to female infertility are:
===General factors===
*Significant [[liver]] or [[kidney]] disease
*[[Thrombophilia]]<ref name="pmid17433901">{{cite journal |author=Middeldorp S |title=Pregnancy failure and heritable thrombophilia |journal=Semin. Hematol. |volume=44 |issue=2 |pages=93–7 |year=2007 |pmid=17433901 |doi=10.1053/j.seminhematol.2007.01.005}}</ref><ref name="pmid16835215">{{cite journal |author=Qublan HS, Eid SS, Ababneh HA, ''et al'' |title=Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure |journal=Hum. Reprod. |volume=21 |issue=10 |pages=2694–8 |year=2006 |pmid=16835215 |doi=10.1093/humrep/del203}}</ref>
===Hypothalamic-pituitary factors===
*[[Hypothalamic dysfunction]]
===Ovarian factors===
*[[Polycystic ovarian syndrome]]
*[[Anovulation]]
*Diminished [[ovarian reserve]], also see [[poor ovarian reserve|Poor Ovarian Reserve]]
*[[Premature menopause]]
*[[Menopause]]
*[[Luteal dysfunction]]<ref name="titleeMedicine - Luteal Phase Dysfunction : Article by Thomas L Alderson, DO">{{cite web |url=http://www.emedicine.com/med/topic1340.htm |title=eMedicine - Luteal Phase Dysfunction : Article by Thomas L Alderson, DO |accessdate=2007-11-21 |format= |work=}}</ref>
*Gonadal dysgenesis ([[Turner syndrome]])
*[[Ovarian cancer]]
===Tubal (ectopic)/peritoneal factors===
*[[Endometriosis]]<ref name="pmid16820110">{{cite journal |author=Tomassetti C, Meuleman C, Pexsters A, ''et al'' |title=Endometriosis, recurrent miscarriage and implantation failure: is there an immunological link? |journal=Reprod. Biomed. Online |volume=13 |issue=1 |pages=58–64 |year=2006 |pmid=16820110 |doi=}}</ref>
*Pelvic [[Adhesion (medicine)|adhesions]]
*[[Pelvic inflammatory disease]] (PID, usually due to [[Chlamydia infection|chlamydia]])<ref name="pmid17160569">{{cite journal |author=Guven MA, Dilek U, Pata O, Dilek S, Ciragil P |title=Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women |journal=Arch. Gynecol. Obstet. |volume=276 |issue=3 |pages=219–23 |year=2007 |pmid=17160569 |doi=10.1007/s00404-006-0279-z}}</ref>
*[[Tubal occlusion]]<ref name="pmid16005574">{{cite journal |author=García-Ulloa AC, Arrieta O |title=Tubal occlusion causing infertility due to an excessive inflammatory response in patients with predisposition for keloid formation |journal=Med. Hypotheses |volume=65 |issue=5 |pages=908–14 |year=2005 |pmid=16005574 |doi=10.1016/j.mehy.2005.03.031}}</ref>
*Tubal dysfunction
===Uterine factors===
*[[Uterine malformation]]s<ref name="pmid9402295">{{cite journal |author=Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, Pellicer A |title=Reproductive impact of congenital Müllerian anomalies |journal=Hum. Reprod. |volume=12 |issue=10 |pages=2277–81 |year=1997 |pmid=9402295 |doi=}}</ref>
*Uterine fibroids ([[leiomyoma]])
*[[Asherman's Syndrome]]<ref name="pmid12470565">{{cite journal |author=Magos A |title=Hysteroscopic treatment of Asherman's syndrome |journal=Reprod. Biomed. Online |volume=4 Suppl 3 |issue= |pages=46–51 |year=2002 |pmid=12470565 |doi=}}</ref>
===Cervical factors===
*[[Cervical stenosis]]<ref name="pmid17877600">{{cite journal |author=Tan Y, Bennett MJ |title=Urinary catheter stent placement for treatment of cervical stenosis |journal=The Australian & New Zealand journal of obstetrics & gynaecology |volume=47 |issue=5 |pages=406–9 |year=2007 |pmid=17877600 |doi=10.1111/j.1479-828X.2007.00766.x |doi_brokendate=2008-06-24}}</ref>
*[[Antisperm antibodies]]<ref name="pmid17485267">{{cite journal |author=Francavilla F, Santucci R, Barbonetti A, Francavilla S |title=Naturally-occurring antisperm antibodies in men: interference with fertility and clinical implications. An update |journal=Front. Biosci. |volume=12 |issue= |pages=2890–911 |year=2007 |pmid=17485267 |doi=}}</ref>
*Non-receptive cervical [[mucus]]<ref name="pmid7745077">{{cite journal |author=Farhi J, Valentine A, Bahadur G, Shenfield F, Steele SJ, Jacobs HS |title=In-vitro cervical mucus-sperm penetration tests and outcome of infertility treatments in couples with repeatedly negative post-coital tests |journal=Hum. Reprod. |volume=10 |issue=1 |pages=85–90 |year=1995 |pmid=7745077 |doi=}}</ref>
===Vaginal factors===
*[[Vaginismus]]
*Vaginal obstruction
===Genetic factors===
*Various [[intersexuality|intersexed conditions]], such as [[androgen insensitivity syndrome]]
==Diagnosis==
Diagnosis of infertility begins with a [[medical history]] and [[physical exam]]. The healthcare provider may order tests, including the following:
* an [[endometrial]] [[biopsy]], to verify ovulation and inspect the lining of the uterus
* hormone testing, to measure levels of female hormones at certain times during a [[menstrual cycle]]
* day 2 or 3 measure of [[Follicle-stimulating hormone|FSH]] and [[estrogen]], to assess [[ovarian reserve]]
* measurements of thyroid function<ref name="pmid16842634">{{cite journal |author=Wartofsky L, Van Nostrand D, Burman KD |title=Overt and 'subclinical' hypothyroidism in women |journal=Obstetrical & gynecological survey |volume=61 |issue=8 |pages=535–42 |year=2006 |pmid=16842634 |doi=10.1097/01.ogx.0000228778.95752.66}}</ref> (a [[thyroid stimulating hormone]] (TSH) level of between 1 and 2 is considered optimal for conception)
* [[laparoscopy]], which allows the provider to inspect the pelvic organs
* [[fertiloscopy]], a relatively new surgical technique used for early diagnosis (and immediate treatment)
* measurement of [[progesterone]] in the second half of the cycle to help confirm ovulation
* [[Pap smear]], to check for signs of infection
* [[pelvic exam]], to look for abnormalities or [[infection]]
* a postcoital test, which is done soon after [[intercourse]] to check for problems with sperm surviving in cervical mucous (not commonly used now because of test unreliability)
* special [[X-ray]] tests
Diagnosis and treatment of infertility should be made by physicians who are [[Fellowship (medicine)|fellowship]] trained as [[reproductive endocrinologist]]s. Reproductive Endocrinologists are usually Obstetrician-Gynecologists with advanced training in Reproductive Endocrinology & Infertility (in North America). These highly educated professionals and qualified physicians treat Reproductive Disorders affecting not only women but also men, children, and teens.
Prospective patients should note that reproductive endocrinology & infertility medical practices do not see women for general [[maternity care]]. The practice is primarily focused on helping their patients to conceive and to correct any issues related to recurring pregnancy loss.
==Prevention==
{{howto | date = May 2008}}
Some cases of female infertility may be prevented by taking the following steps:
* Avoid excessive [[exercise]].
* Avoid [[smoking]].
* Control diseases such as [[diabetes]] and [[hypothyroidism]]
* Eat a well balanced nutritious diet with plenty of fresh [[fruit]]s and [[vegetable]]s (plenty of [[folate]]s).
* Follow good weight management guidelines.
* Practice safer sex to avoid [[sexually transmitted disease]]s.
* Get early treatment for [[sexually transmitted disease]]s.
* Have regular [[physical examination]]s (including [[pap smear]]s) to detect early signs of infections or abnormalities.
* Limit [[caffeine]] and [[alcohol]] intake.
* Ask your mother (biological) to share any unusual or abnormal issues she had related to conceiving. For example, [[premature menopause]] in your mother can be genetic and passed on to you, which limits the years in which you will have optimal egg quality.
* Fertility starts declining after age 27 and drops at a somewhat greater rate after age 35.<ref name="titleStudy speeds up biological clocks / Fertility rates dip after women hit 27">{{cite web |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/04/30/MN182697.DTL |title=Study speeds up biological clocks / Fertility rates dip after women hit 27 |accessdate=2007-11-21 |format= |work=}}</ref> It should be noted, however, that fertility does not ultimately cease before menopause.
==References==
{{reflist|2}}
{{Diseases of the pelvis, genitals and breasts}}
[[Category:Gynecology]]
[[Category:Fertility medicine]]