Infertility treatments - female

Approximately one in five couples has trouble conceiving a child. If a couple is unable to conceive after one year of unprotected intercourse, they are said to be sub-fertile. Around 40 per cent of fertility problems originate in the woman, with causes including failure to ovulate and abnormalities of the fallopian tubes or uterus. In most cases, the couple can be helped with assisted reproductive technologies. For around one in 10 couples investigated for infertility, no cause is found. This is known as 'idiopathic infertility'.

Diagnosis methods for infertility

Investigating suspected infertility requires a range of tests for both the woman and her partner. Some of the tests the woman may undergo include:

• Physical examination – including medical history
• Blood tests – to check for the presence of ovulation hormones
• Ultrasound scans – to check the health of reproductive organs
• Laparoscopy – the reproductive organs are examined via a slender telescopic instrument (a laparoscope) inserted through a small incision in the abdomen.

A range of reproductive technologies

Some of the reproductive technologies available to infertile women include:

• Surgery
• Ovulation induction
• In vitro fertilisation (IVF).

Surgery

Usually, an egg released during ovulation travels down the fallopian tube. If it meets with a sperm on its journey, conception may occur. Female infertility can be caused by obstructions within the reproductive organs.

Some of the problems that can be addressed by surgery include:

• Fibroids – non-malignant tumours growing inside the uterus
• Polyps – overgrowths of the uterine lining (endometrium)
• Endometriosis – the growth of endometrial tissue outside of the uterus, which can block the fallopian tubes
• Salpingitis – the fallopian tube becomes inflamed and scarred by bacterial infection
• Abnormalities of the uterus – such as uterine septums
• Ovarian cysts – can be drained or removed.

These days most reproductive surgery is performed by ‘keyhole surgery’ using an operative laparoscope (through the abdomen) or an operative hysteroscope (through the cervix and into the uterus).

Occasionally, this may not be possible for a variety of reasons and ‘open surgery’ (a surgical incision on the abdomen) may be necessary.

Ovulation induction

Irregular or absent periods may indicate that ovulation is also irregular or absent. However, even women with regular periods may skip ovulation every now and then. Ovulation can be induced with a range of drugs in tablet or injectable forms.

Oral drugs such as clomiphene citrate (Clomid, Serophene) can dull the response of receptors in the brain to naturally occurring oestrogens in the body. This leads to an increase in the release of hormones from the brain, which then stimulates ovulation.

Injectable forms of synthetic gonadotrophins, the hormones released by the pituitary gland in the brain that prompt the ovaries to release an egg, can also be used to stimulate ovulation. The response to these drugs can be unpredictable and close monitoring of the women is necessary while on these medications.

Sometimes, the response to synthesised gonadotrophins may be excessive, leading to a condition known as ovarian hyperstimulation syndrome (OHSS). The symptoms include oedema (fluid retention), abdominal pain and bloating. Regular blood tests are used to help fine-tune the dosage and minimise the risk of ovarian hyperstimulation syndrome and multiple pregnancy from occurring.

In vitro fertilisation (IVF)

In vitro fertilisation (IVF) is conception outside of the human body. The woman undergoes ovarian stimulation using one of a number of hormonal agents and at the right time the eggs are collected. This is done through the vagina under light sedation and ultrasound control.

The collected eggs are then mixed with sperm previously collected from the woman's partner, or injected with a single sperm (ICSI). They are then placed in special incubators and allowed to develop into embryos. These embryos are then transferred to the woman’s uterus using a thin tube that is inserted through the cervix under ultrasound guidance.

Pregnancy isn't always possible

Despite the sophistication of assisted reproductive technologies, pregnancy doesn't always happen. It depends on a range of factors, including the reasons for the woman's infertility, her age and the type of technology used.

Potential health risks

Some of the problems associated with the use of assisted reproductive technologies include:

• Ovarian hyperstimulation syndrome (OHSS)
• An increased incidence of multiple pregnancies
• An increased risk of premature labour and low birth weight
• An increased risk of caesarean delivery.

Where to get help

• Your local doctor
• Obstetrician or gynaecologist
• Family Planning Victoria Tel. (03) 9257 0100
• Monash IVF Tel. (03) 9429 9188 or 1800 628 533

Things to remember

• Around 40 per cent of fertility problems originate in the woman, with causes including failure to ovulate and abnormalities of the fallopian tubes or uterus.
• Some of the reproductive technologies available to infertile women include surgery, ovulation induction and in vitro fertilisation (IVF).

You might also be interested in:

• Conceiving a baby - tips.
  
• In vitro fertilisation (IVF).
  
• Infertility - female.
  
• Infertility - male.
  
• Infertility treatments - male.
  
• Reproductive system.
  

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Last reviewed: July 2011

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Treatments for infertility and to help conceive a baby include surgery to clear blockages or scar tissue, ovulation induction and in vitro fertilisation (IVF). Pregnancy can be achieved using assisted reproductive techniques (ART), but is not always possible.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

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