Infertility

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Quick GuideInfertility: Types, Treatments, and Costs

Infertility: Types, Treatments, and Costs

What causes infertility in women?

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Ovarian function (presence or absence of ovulation and effects of ovarian "age")

  • Ovulation. Regular predictable periods that occur every 24–32 days likely reflect ovulation. Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to see the woman's progesterone level. A woman's menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of "full flow."
  • A woman with irregular periods is likely not ovulating. This may be because of several conditions and warrants an evaluation by a doctor. Potential causes of anovulation include the following:
    • Polycystic ovary syndrome (PCOS). PCOS is a hormone imbalance problem that can interfere with normal ovulation. PCOS is the most common cause of female infertility.
    • Functional hypothalamic amenorrhea (FHA). FHA relates to excessive physical or emotional stress that results in amenorrhea (absent periods).
    • Diminished ovarian reserve (DOR). This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
    • Premature ovarian insufficiency (POI). POI occurs when a woman's ovaries fail before she is 40 years of age. It is similar to premature (early) menopause.
    • Menopause. Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. It is often associated with hot-flashes and irregular periods.
  • Ovarian function. Several tests exist to evaluate a woman's ovarian function.
  • No single test is a perfect predictor of fertility.
  • The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3–5 of the menstrual cycle, anti-mullerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

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