Understanding Female Infertility of unspecified origin: Causes, Symptoms, and Management

What is it?

Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby. Infertility is defined as failure to conceive after a year with frequent intercourse. Infertility can be related to the male (one-third of the time), the female (one-third of the time or a combination of both(one-third of the time along with unknown cause). There are many causes for female infertility such as damage or blockage of the fallopian tubes, due to pelvic scars after surgeries, infections or endometriosis. Hormonal abnormalities that may prevent the woman from ovulating such as Polycystic ovary syndrome (PCOS), hypothalamic dysfunction, premature ovarian failure or hyperprolactinemia due to medication or a Prolactinoma, for example. Uterine or cervical causes such as benign polyps or tumors such as fibroids or myomas, endometriosis scarring or inflammation within the uterus, uterine abnormalities, and cervical stenosis. Risk factors for female infertility is advanced age, excessive alcohol consumption, smoking, high weight and a history of sexually transmitted diseases and recurrent pelvic inflammatory disease.

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Additional names

This group contains additional names:
- Secondary infertility
- Primary female infertility

Signs & symptoms

Being unable to conceive for one year after having frequent intercourse up to the age of 35 is a good reason to go see a doctor. Between ages 35-40, six months are enough to start an infertility diagnosis. For women older than 40 or for women with a known underlying condition, the doctor may want to begin testing right away.

Diagnosis

In order to trace the cause of infertility, the doctor will start by taking a complete medical history. The doctor will ask about the regularity of menstruation, whether the patient suffers from headaches, blurred vision, discharge from the breast, hot waves, vaginal dryness, diarrhea, constipation, dry skin, hair loss. It is important to ask whether she is engaging in extreme physical activity, has there been a significant weight loss or is the woman under a lot of stress. Has she suffered from recurrent pelvic infections in the past and are there any fertility issues in the family. On physical examination, the doctor will be impressed by the woman's weight, hirsutism, acne, enlarged thyroid gland, secretion of milk from the breasts. Doctor will perform an abdominal examination to feel lumps like large fibroids and will end with a an US to demonstrate the structure and appearance of the uterus and ovaries. Laboratory tests will include thyroid function, prolactin level, hormones levels (FSH, LH, estrogen, progesterone) in the blood and an ovarian reserve test (AMH). Additional tests will be performed according to the suspicion that arises such as hysteroscopy, a brain MRI and more. It is also always important that her partner performs a sperm analysis.

Treatment

Treatment depends on the underlying cause for infertility. To remove scar tissue, treat endometriosis, open blocked tubes, or remove ovarian cysts a Laparoscopy can be done. Hysteroscopy is being used to treat other anatomical abnormalities such as polyps and fibroid tumors. In the case of failure to ovulate, medications like clomiphene citrate or letrozole are prescribed to induce ovulation and gonadotropins such as gonal- F stimulate a follicle to develop and mature. Metformin is another type of medication that may help women with PCOS or insulin resistance ovulate normally.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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Source of Information - We analyze big data of more than 23 million patients de-identified medical records from the following sources:

National Institution of Health ∙ World Health Organization ∙ University of Illinois hospital