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 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.
Endometriosis is diagnosed by looking into the pelvic cavity with a viewing instrument called a laparoscope. It can be treated with drugs or surgery to remove the cysts. Women who are not planning to have children or are nearing menopause may consider hysterectomy, the surgical removal of the uterus.
Pelvic inflammatory disease (PID) in the female reproductive organs often occurs after a sexually transmitted disease such as gonorrhea or a chlamydia infection, or after miscarriage, abortion or childbirth. Symptoms include abdominal pain and tenderness, fever and an unpleasant-smelling vaginal discharge. Repeated attacks may occur with or without reinfection. About 20 percent of infertility is attributed to scarring from PID.
PID usually is diagnosed during a pelvic examination, although samples of discharge may be analyzed. Antibiotics are the usual treatment. Surgery or in vitro fertilization (IVF) is used to treat infertility resulting from PID.
Pituitary tumors, although usually benign, can lead to destruction of some of the hormone-secreting cells in the pituitary gland, causing cessation of menstrual periods in women and reduced sperm production in men. Because of their location, these tumors also can cause visual field defects.
Pituitary tumors are diagnosed by measuring hormone levels in the blood and urine, from MRI or CT scans of the brain and by visual field tests. Treatments include surgical removal of the tumor, radiation therapy, hormone replacement therapy or a combination.
In polycystic ovarian syndrome (PCOS), there is a long-term inability to release eggs to the uterus, where they can be fertilized — a process called ovulation. Elevated insulin levels stimulate excess production of the hormone androgen, which cause some of the unfertilized eggs to disintegrate, leading to inconsistent or no ovulation. Most women with PCOS have multiple benign cysts in their ovaries.
Symptoms include irregular ovulation and menstrual periods, obesity, insulin resistance, acne and excessive hair growth. PCOS, the number one cause of infertility, occurs in about 10 percent of all women, with about 30 percent of all women having some characteristics of PCOS.
PCOS is diagnosed by blood tests and ultrasound. Treatments include weight loss, medications including hormones, medications to treat the insulin resistance associated with PCOS, or surgery to remove a portion of the ovary or to drill holes in the ovary with a laser to reduce androgen production.
Reviewed by health care specialists at UCSF Medical Center.