CAUSES OF INFERTILITY IN WOMEN

Adhesions and scarring: Can be caused by sexually transmitted diseases left untreated, Chlamydia being the most common. Scarring can lead to blockage of the fallopian tubes, or damage to the delicate membranes within the tubes. It can also be formed by endometriosis and prior surgeries in the abdominal area.

Age: A woman's fertility begins falling off after the age of 25, though pregnancy can be achieved and maintained for most women into their early 40s. The rate of miscarriage and birth defects increases after 35.

Asherman's Syndrome: This is a condition where the walls of the uterus adhered to each other. Usually caused by uterine inflammation.

Cancer treatment: Chemotherapy and radiation can cause early menopause. Information on how cancer treatment affects fertility is posted at http://oncolink.upenn.edu/specialty/med_onc/bmt/bmt_11.html

DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s and 60s to prevent miscarriage. Can cause abnormalities in the reproductive organs such as shortened cervix, deformities of the vagina or cervix, T-shaped uterus, abnormal fallopian tubes, ovulation problems, increased risks of ectopic pregnancy, repeated miscarriage, and premature delivery.

Endometriosis: Growth of endometrial tissue outside the uterus. Can cause blockage of the fallopian tubes and adhesions. May not cause any symptoms beyond infertility, but could cause crampy periods and painful intercourse.

Environmental hazards: Pesticides may damage a woman's eggs leading to early menopause. Some materials are linked to early miscarriage. Ethylene oxide, used in chemical sterilization of surgical instruments. Exposure by healthcare professionals (including veterinary) to nitrous oxide. Vinyl chloride, used in plastics, and metallic compounds including manganese, arsenic, and nickel.

Hyperprolactinemia (elevated levels of the hormone prolactin): Can be caused by pituitary tumors, and breast milk production after giving birth. May lead to weak or skipped ovulation. Lowering prolactin levels can be achieved with Bromocriptine (Parlodel).

Hypothyroid: Underactivity of the thyroid gland. Symptoms include low basal body temperature and unexplained weight gain. Can throw off the endocrine system leading to ovulation problems and to miscarriage.

Immunological problems: The most common immune problems, testing positive for anti-phospholipid antibodies or the lupus anticoagulant, can lead to blood clots in the placenta that prevent nourishment from reaching a fetus. There are other more controversial causes of immunological fertility problems

Luteal phase defect (LPD): There are two types of luteal phase problems that fall under the category of LPD. One is a short luteal phase -- 10 days or less. The second is when the length of the phase is not necessarily shorter than the standard 12-16 days, but it is out of phase and progesterone production is low. Typical treatment is to enhance ovulation and/or to use hCG or progesterone support after ovulation.

Luteinized unruptured follicle syndrome (LUFS): Failure of the follicle to release an egg even though it has reached maturity. Commonly seen when an LH surge is not followed by ovulation. Can be confirmed with ultrasound. May account for 5-30% of women with unexplained infertility.

Medication: Non-steroidal anti-inflammatory drugs (NSAIDs ), radiation and chemotherapy for cancer treatment, antihistamine and decongestants may lead to fertility problems. Vitamin C in large doses is also considered an antihistamine - which can lead to cervical mucus drying out.

Menopause: When a woman stops having regular ovulation and menses. Pregnancy may still be achieved through drug therapy and perhaps IVF with donor egg.

Obesity: Excess weight can lead to elevated estrogen levels which act as birth control and prevent a woman from ovulating. Drugs to induce ovulation can bypass this problem.

Polycystic ovaries (PCO): This condition often leads to ovulation problems. It can be diagnosed through ultrasound to show cysts in the ovaries or through blood tests of hormone levels. PCO patients often have elevated LH (LH:FSH greater than 3:1) and excess androgens. Insulin resistance is also common.

Polycystic Ovary Syndrome (PCOS): Symptoms include infertility, irregular cycles, obesity, acne, excess facial and body hair, obesity, skin tags, dark skin patches (back of neck, under arms, under breasts, groin), cystic ovaries, excess male hormones, insulin resistance, and dyslipidemia. It should be diagnosed through a combination of a physcial exam, ultrasound evaluation to look for possible cysts in the ovaries or ovarian enlargment, and blood tests to check LH and FSH (check ratio as well as levels on these two as LH higher than FSH is indicative of PCOS, especially when 2:1 or 3:1), testosterone, DHEAS, SHBG, androstenedione, prolactin, TSH, fasting glucose and insulin testing.

Premature ovarian failure (POF): Characterized by high FSH in a younger woman (usually in her 30s). Cancer treatment and environmental hazards may play a role in the development of POF.

Recurrent miscarriage/pregnancy loss (RPL): When a woman miscarries more than one pregnancy. Testing can be done to try to determine the cause of such losses. If an underlying condition is found, the woman may need to be treated for the problem before a pregnancy can be carried to term.

Smoking: Associated with an approximately 5% increase in miscarriage rate. Smoking also doubles the chances of an ectopic pregnancy by damaging the cilia in the tubes. Studies have shown a marked decrease in effectiveness of IVF and GIFT.

Tubal ligation (and failed surgery to reverse): Surgical sterilization of a woman by obstructing or tying of the fallopian tubes. May be reversed surgically with varying degrees of success.

Turner's Syndrome: Women should have cells that are 46XX, but Turner's women are missing an X -- hence a karyotype of 45XO or a mosaicism of 46XX and 45XO. Turner's women with a 45XO karyotype are sterile while those with a mosaicism may be able to get pregnant and carry to term. Women tend to be ultra-feminine and small in stature. Uterine abnormalities: Include problems from DES exposure, septums, T-and heart-shaped uterus.

Vegetarian lifestyle: Vegetarians may experience irregular ovulation that reduces the chances of conception.