Patient education: Female infertility (The Basics)

Why might I have trouble getting pregnant? — For some people, pregnancy happens easily, while others have a harder time.

There are several things that need to happen for a person to get pregnant through sex (figure 1). There are different reasons why this process might not work. For example, there could be a problem with 1 or both partners. When the problem is with the person who is trying to get pregnant, this is called "female infertility." Doctors also sometimes use the term "female factor infertility."

You might have trouble getting pregnant because of:

●Problems with ovulation – Ovulation is the time in your monthly cycle when your ovary releases an egg into your fallopian tube (figure 2). Hormones control ovulation. Pregnancy happens if a sperm fertilizes the egg as it travels to the uterus after ovulation. In general, your chances of getting pregnant are highest if you have sex 1 to 2 days before ovulation or on the day of ovulation. But in some people, ovulation does not happen on a regular basis or at all, making it difficult to get pregnant.

●Problems with your uterus or fallopian tubes – For example, if you have scar tissue in your fallopian tubes from past infections or surgery, this can cause the fallopian tubes to be blocked. If the tubes are blocked, sperm might not be able to get through to the egg. Or you could have scar tissue or a fibroid in your uterus that prevents pregnancy.

●Endometriosis – Endometriosis is a condition that can cause pain in the lower part of the belly. This can also lead to trouble getting pregnant.

●Older age – If you are in your mid- to late-30s or older, it can be harder to get pregnant.

Luckily, there are treatments that can help with many of these problems.

When should I see a doctor? — See your doctor or nurse if you do not get pregnant after having unprotected sex for 1 year. If you are older than 35 or if you do not get your period every month, see your doctor or nurse if you can't get pregnant after 6 months of trying. But if you get worried before then, you can talk with your doctor or nurse sooner.

Your doctor or nurse will talk with you and do an exam. They will often do tests to try to figure out the cause of the problem. Depending on what they find, they might also suggest that your partner be tested. But sometimes, tests do not find an obvious problem to explain why you are having trouble getting pregnant.

Is there anything I can do on my own? — Maybe. If you are overweight, losing weight might help you get pregnant. Losing weight can also help you have a healthier pregnancy if you do get pregnant. Avoiding smoking and alcohol might also increase your chances of getting pregnant.

Your doctor or nurse can talk to you about other things you can try. For example, it might help to keep track of your periods to get a better idea of when you ovulate and when you are most likely to get pregnant each month.

If you have a physical problem making it hard to get pregnant, specific treatment can often help.

What treatments are available? — You might be able to try 1 or more of the following treatments. You and your doctor should discuss which treatment to try first.

Treatments can include:

●A medicine called clomiphene (brand names: Clomid, Serophene) – Many times, this treatment is tried first. If you do not ovulate regularly or at all, this medicine improves the chances that you will ovulate. Your doctor will tell you how and when to take this medicine. They will also tell you when to have sex so the treatment has the best chance of working. If this medicine does not work after a few months, your doctor might recommend trying other medicines to help with ovulation.

●Hormone shots – Hormone shots are often recommended if you are not able to get pregnant while taking clomiphene. Hormones improve the chances that you will ovulate. Your doctor will tell you how and when to get the shots.

●Intrauterine insemination – For this treatment, a doctor uses a tube to place sperm directly inside your uterus. This is done right before ovulation. In some cases, this treatment is combined with clomiphene or hormone shots to increase the chance of pregnancy.

●In vitro fertilization, or "IVF" – This is a procedure that is usually done if other treatments have not worked. It involves the following:

•You will get hormone shots for a few weeks. These hormones get your ovaries ready to ovulate.

•Just before ovulation, a doctor uses a thin needle to remove some eggs from your ovaries. They do this through the vagina.

•The eggs are put into a laboratory dish with sperm so the sperm can fertilize 1 or more eggs.

•After 2 to 5 days, the fertilized egg or eggs are put into your uterus. Hopefully, 1 of the fertilized eggs will attach to your uterus and grow into a pregnancy.

•IVF is usually done if:

-Your fallopian tubes are missing or blocked.

-Tests show that your partner has too few sperm.

-You have not gotten pregnant using other treatments.

How will I know if a treatment is working? — Your doctor will do tests at different times during treatment to check if it is working. These tests can include blood tests and ultrasounds. An ultrasound is an imaging test that creates pictures of the inside of the body.

Do treatments always work? — No. Treatments do not always help a person get pregnant. The same treatment can work for 1 person, but not another.

How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you, you might want to think about:

●How well your doctor thinks that the treatment will work

●The cost of the treatment – Some treatments cost a lot of money. Health insurance does not pay for all of them.

●How long the treatment will take – Treatments might need to be done more than once to work. Getting pregnant can take months to years.

●Side effects and downsides of the treatment

You should also talk with your doctor about other options for having children, such as adoption.

These decisions can be difficult. You might find it helpful to talk to a counselor or go to a support group for people who are having trouble getting pregnant.

More on this topic

Patient education: Infertility in couples (The Basics)
Patient education: Male infertility (The Basics)
Patient education: Oophorectomy (The Basics)
Patient education: What you should know about oophorectomy (The Basics)
Patient education: Pelvic ultrasound (The Basics)

Patient education: Ovulation induction with clomiphene or letrozole (Beyond the Basics)
Patient education: Infertility treatment with gonadotropins (Beyond the Basics)
Patient education: In vitro fertilization (IVF) (Beyond the Basics)
Patient education: Evaluation of infertility in couples (Beyond the Basics)
Patient education: Treatment of male infertility (Beyond the Basics)
Patient education: Endometriosis (Beyond the Basics)