Treatment of Female Infertility
by Beth G. Hodges, MD

In general, a couple should attempt conception on their own for one year prior to seeking evaluation for infertility, unless the woman is over age 35, at which the acceptable time is reduced to six months, since infertility is more likely above this age. If a woman is over 40 and desires pregnancy, she should seek medical evaluation prior to conception to maximize her chances of a healthy pregnancy. All women should initiate folic acid supplementation (found in the vitamin section of pharmacies) six months to one year prior to conception to reduce the risk of certain types of birth defects.

Once female infertility is suspected, testing to confirm that ovulation is occurring should be done through a physician's office or through the use of home ovulation testing kits. If ovulation is indeed occurring, the next step in the evaluation is to make sure the fallopian tubes are clear for passage of the egg to the uterus. This is done through a procedure called hysterosalpingography. The gynecologist squirts some dye from the uterus up the fallopian tubes to the ovaries. In the event of a minor blockage, this test procedure alone has been known to restore fertility. The next step, if necessary, would be laparoscopy, or exploratory surgery of the pelvic cavity itself to look for problems.

Ovarian reserve testing, to assess the ability of the ovaries to respond to ovary-stimulating drugs, would be next, followed by hormone testing.

Treatment of female infertility should address any problems found on the initial infertility workup. Metformin, a drug developed to treat diabetes, is often used to decrease insulin resistance in someone with confirmed or suspected polycystic ovarian syndrome (PCOS.) Decreasing the insulin resistance can restore ovulation by itself. Ovulation stimulating drugs, the most well-known of which is clomiphene (Clomid), are used frequently.

These drugs increase the risk of multiple births, especially in women over age 35. If medication fails, some couples choose to proceed to in vitro fertilization, where eggs are removed from the ovary, fertilized by the male sperm, and then implanted into the uterus. The woman is given injections of progesterone to encourage implantation. This procedure also increases the risk of multiple births, due to the fact that several eggs are usually implanted at one time to increase the risk of at least one being successful.

Prevention of female infertility focuses on a generally healthy lifestyle. It is important to maintain a normal weight, consume a healthy diet, limit caffeine and stress, and avoid things that would be harmful to a fetus anyway, such as alcohol, tobacco, and drugs.

Published - April, 2010

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