Reasons for Infertility

There are many different reasons for infertility in a woman, most of which can be treated successfully to allow for conception. Some of the causes of infertility are described below:

• Ovulation Problems: Ovulation problems are responsible for more than 30% of the infertility cases in women. Without ovulation there is no egg to fertilize. There are multiple reasons for ovulation problems including:
• Irregular menstrual cycles in which no egg is produced or the eggs that are produced are immature and unable to be fertilized.
• Ovarian cysts (polycystic ovarian syndrome, caused by a hormonal imbalance)
• Primary ovarian insufficiency or POI, this is a cessation of proper ovary function that is not caused by menopause.
• Dysfunctioning ovaries caused by the pituitary and hypothalamus glands not releasing hormones properly.
• Injury or trauma to the ovaries at some point in the past that is not obvious until conception is attempted.
• Tumors
• Excessive exercise and extreme dieting: These can alter the hormonal balance and cause problems with ovulation.
• Medications: Certain medications can interfere with ovulation.

Treating problems with ovulation can typically be a simple matter of medication and possibly surgery to remove cysts or tumors. If medications are interfering with ovulation then alternate treatments can be explored:

• Blocked fallopian tubes. This can also be caused by many different medical conditions and or birth defects such as:
• Congenital deformities that cause the fallopian tubes to be too small and thus not allow the egg to pass through;
• Pelvic inflammatory disease (PID): PID is a sexually transmitted disease that can cause many problems in the reproductive organs, including infection in the fallopian tubes;
• Endometriosis: A condition in which tissue that should be growing inside the uterus is instead growing outside the uterus. When this tissue sheds, it has nowhere to go and so it becomes scar tissue which can block the fallopian tubes.
• Ectopic Pregnancy: This is a pregnancy in the fallopian tubes which would of course block the eggs from travelling through the tubes.
• Chlamydia: Another sexually transmitted disease that is a primary cause of fallopian tube damage. Fallopian tube damage may or may not be correctable, depending on the extent of the damage and or defect. A fertility specialist will be able to better diagnose the outcome after seeing the tubes and determining what caused the damage.
• Elevated levels of prolactin. Prolactin is the hormone responsible for stimulating the production of breast milk. Women who are nursing or who have high levels for unknown reasons may not ovulate.
• Scar tissue in the pelvic area. This scar tissue, commonly referred to as pelvic adhesions, is typically the result of infection, pelvic surgery or even appendicitis. Surgery can be successful at removing this tissue.
• Medications: Many medications can cause infertility. This should be discussed with the doctor. There may be alternate medications that can be used without affecting fertility.
• Thyroid problems: Both hyperthyroidism and hypothyroidism can cause irregularities in the menstrual cycle with leads to problems conceiving. Treating the thyroid problem typically regulates the menstrual cycle and increases fertility.

These are just a few of the causes of infertility. There can be many other causes and only a doctor can truly determine what the ultimate problem is and how to correct it.

Treatment Options

Once the cause of the infertility is determined, the doctor will be in a better position to present options for revisiting the infertility. Typically, surgery, medication or a change in lifestyle to reverse the condition will result in conception. It may take time for some conditions to be eliminated and there may be multiple steps that need to be taken; however, with diligence and a good fertility doctor, most conditions that cause infertility can be treated. Those conditions that cannot be treated will have to be handled through other means, such as invitro fertilization if the fallopian tubes are simply too damaged to be repaired.

The good news is that treatment options today have dramatically improved and women who once would not have had much success with becoming pregnant are now able to thanks to fertility specialists that have opened the door to conception in many new ways.

Understanding Ovulation

Young girls who are just starting menstruation probably pay little, if any attention, to exactly what is happening in their body during this time. However, later in life they may want to understand so that they can plan their pregnancy and possibly identify any mysterious cramps or pains they may be experiencing. This understanding of ovulation is simply one more step in being in tune with her body.

Every reproductively healthy woman produces eggs in the ovary that are released during their monthly cycle. The release period is known as ovulation. During ovulation, the body releases the largest, healthiest eggs. These eggs go into the fallopian tubes and hopefully reach the cervix where they are either fertilized by sperm after intercourse or eventually disintegrate and are expelled from the body during menstruation.

Menstrual bleeding typically starts approximately two weeks after ovulation. Since the egg can live up to 24 hours before disintegrating, the body has about that much time to become pregnant and then 12 or 13 days for the pregnancy hormones to kick in and stop the menstrual cycle, thus indicating the possibility of pregnancy and the need for a pregnancy test.

Cramps During Ovulation

Most women are accustomed to having some cramping and other pains during their menstrual cycle and many mistakenly think that all cramps during the month are a result of menstruation. However, approximately twenty percent of all women will experience some cramps during ovulation and even during the implantation if the egg is fertilized.

There are some symptoms and time frames that can be clues as to whether or not the cramping is due to an impending menstrual cycle or if ovulation is causing the cramping. Some of these include:

• Cramping that starts approximately two weeks prior to the onset of menstrual bleeding. This is typically when ovulation occurs.
• Pains and cramps occurring in the lower abdominal area, typically toward the side in the area the ovaries would be found.
• Cramping or pains that are only on one side of the lower abdomen. This is due to the egg being released on that side of the reproductive system.
• The pain lasts less than 48 hours, typically anywhere from a few minutes to about 24 hours.

Doctors and scientists have not determined exactly why ovulation causes cramping but they do have some theories and there are some medical conditions that can be the cause. Follicles are one cause that many doctors suspect are behind the cramping that occurs during ovulation. Follicles are the sacs or containers that the eggs are in prior to becoming mature. Two of the main theories involving cramping and follicles are:

• Emergence of the Follicle: Every month the hormones in a woman’s body cause it to create as many as twenty follicles which could ultimately be twenty mature eggs. However, there is usually only one follicle that reaches maturity and passes through the fallopian tubes. It is thought that the growth of this one follicle causes the ovary to stretch and thus produce cramps.
• Follicles Rupturing: Once an egg is mature and ready to be released, the follicle carrying it has to literally erupt to allow the egg freedom. When this occurs, there may be some cramping and possibly even light bleeding.

These two theories may or may not be the reason for cramping and pain during ovulation. However, there are medical reasons that can cause this pain, including those listed here:

• Swollen, irritated, or inflamed fallopian tubes. This condition is known as salpingitis and usually is the result of an infection.
• Endometriosis: This condition is caused when the lining that covers the womb unexpectedly grows somewhere else, such as the abdominal cavity or even the bowels.
• PID or chronic pelvic inflammatory disease: PID can cause severe inflammation and thus pain during ovulation.
• Ectopic Pregnancy: If an egg becomes fertilized while it is still in the fallopian tube, the resulting embryo will cause cramping, pain and bleeding. This condition must be treated by a doctor.
• Cysts: Ovarian cysts can cause ovulation to be painful due to the egg expanding and stretching in an area that is already being stretched by the cyst.

There are other medical conditions that may mimic the painful cramps caused by ovulation that are not related to ovulating. Women should pay attention to their body and be able to alert their doctor when they feel that something other than ovulation is causing pain.