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Infertility in Women

Maternal age is the most significant factor related to a woman's ability to conceive. While many women today are waiting to become pregnant, the ovary's ability to produce normal, healthy eggs declines with age, increasing the risk of chromosomal abnormalities and unsuccessful implantation and pregnancy.

The likelihood for successful pregnancy begins to decrease in women in their early 30s. While this decline is initially quite minimal, as the years pass the rate of decline increases and begins to rapidly accelerate around age 37 to 38, with an acute fall beyond 42 years of age.

Other factors, such as endometriosis and uterine fibroids can also play a role in infertility, though many women with these conditions conceive healthy children without trouble.

Many doctors recommend that women past age 35 have a fertility evaluation after attempting pregnancy for six months. Couples under age 35 should consider evaluation if they don't conceive after trying for a year. A woman using donor insemination should ask her doctor about an infertility evaluation after six months.

A woman's age is probably the most significant factor related to her ability to conceive. In addition to age, there are a number of conditions that can interfere with a woman's fertility, including endometriosis, polycystic ovarian syndrome, pituitary tumors and pelvic inflammatory disease.

Endometriosis

Endometriosis occurs when tissue from the membrane lining the uterus, called the endometrium, grows outside the uterus. Between 25 and 50 percent of infertile women are estimated to have this condition.

This tissue acts just like the endometrium in accumulating blood in the monthly menses period, but it has no place to shed the blood at the end of the cycle. The accumulation of tissue and blood can lead to inflammation, scarring and other problems. Symptoms include pain and cramping before and during periods, pain during intercourse, fatigue, diarrhea, constipation, nausea and infertility. Keep in mind, however, that all of these symptoms can occur with other conditions.

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The basic infertility evaluation for women includes a medical history and a physical examination. Additional testing to further refine the diagnosis is often completed as well.

Medical History

The evaluation typically starts with a careful history of each woman's symptoms and previous experiences. This can include:

  • A review of the pattern of menstrual cycle bleeding to help determine if ovulation is occurring and if other problems — such as aging of the ovary, or uterine defects like fibroids or polyps — are present.
  • Collecting information that might suggest an anatomic problem with the tubes, such as questions about past history of sexually transmitted infections, painful periods or intercourse, and/or a previous abdominal surgery.
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Treating specific illnesses such as endometriosis may or may not treat the fertility problem. At least 10 percent of infertility problems are due to unknown causes and another 30 percent are due to problems in both the male and female partners.

In addition to medication and surgical infertility treatments to treat specific health conditions in men and women, a new class of treatments — called assisted reproductive technologies, or ART — has been developed. The most common ART is in vitro fertilization, or IVF, but new procedures can enhance the IVF process or address other infertility conditions. These procedures include:

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Reviewed by health care specialists at UCSF Medical Center.

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UCSF Clinics & Centers

Reproductive Health

Center for Reproductive Health
2356 Sutter St., Seventh Floor
San Francisco, CA 94115
Phone: (415) 353-7475
Fax: (415) 353-7744
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