Fertility FAQ – Female Infertility

I have been trying to become pregnant for two years. Test results show my fallopian tubes are open and my husband has no issues. I don’t have a period very often but when I do, they’re heavy and painful. Is this normal?

The most common cause of irregular menstrual cycles is polycystic ovary syndrome or PCOS. This is the most common endocrine disorder affecting reproductive-age women and is often associated with irregular cycles, polycystic-appearing ovaries on ultrasound and frequent signs or symptoms of excessive male hormone, testosterone. This can include acne or excessive hair growth, although this does not have to be present to make the diagnosis.

We like to exclude other conditions that could cause irregular cycles, including thyroid disease, high levels of prolactin or disorders of the adrenal glands. PCOS has a genetic component and can lead to insulin resistance and diabetes if left untreated. There is also a risk for endometrial disease, including endometrial polyps or even hyperplasia or cancer if left untreated for many years.

The good news is that this is a recognized cause for infertility and can be adequately treated with diet and exercise, although medications are often helpful as well. It is surprising how many women have PCOS, perhaps reflecting changes in our society regarding weight, exercise and eating patterns.

We are unable to get pregnant and no one seems to know what’s wrong with us. My husband’s sperm is normal, and I have a normal uterus and tubes. I do notice spotting for several days before my period starts and periods are painful. What does this mean?

The approach to couples with infertility includes an assessment of the male (semen analysis), the fallopian tubes (HSG) and some assessment of ovulatory status. In women with painful periods, laparoscopy is also warranted, since up to 40% of couples we see are diagnosed with endometriosis. This is a condition that is common and often overlooked.

Spotting or bleeding at times other than your period is sometimes a sign of endometriosis. The presence of endometrium (lining of the womb) outside of the uterus is associated with painful menses but also infertility. Interestingly, even mild forms of this disease can cause profound infertility. The good news is that endometriosis is very treatable and most women conceive after it is diagnosed.

Years ago, I had an abnormal pap smear and was treated with cryotherapy. Since then, my Pap smears have been normal. Now that I’m trying to get pregnant, should I be concerned that my cervix was frozen?

Having cryosurgery, or “freezing” your cervix, rarely causes a complication preventing pregnancy. The cervix functions by making watery mucus around the time of ovulation that makes it easy for the sperm to swim to the egg. After surgery on their cervix, some women have a decrease in mucus production. When there is a decrease in mucus, sperm might have trouble getting to the egg for fertilization. This can easily be treated with intrauterine inseminations (IUI).

IUI is a common fertility procedure that improves fertility in most couples. There is no more discomfort with an IUI than a woman encounters with a Pap smear. A small catheter is placed through the cervix and the sperm are injected. This places the sperm beyond the damaged cervical glands.

There is one other thing to think about for women with a history of cryosurgery of the cervix. They are at a slightly increased risk of having tubal damage for a number of reasons. If pregnancy does not occur soon, even with IUI, a test of the fallopian tubes would also be helpful.

One other concern about more advanced treatments for cervical dysplasia, including removing some of the cervix, is that scarring might occur that could limit the outflow of menstrual blood. Women with this problem often notice an increase in pelvic discomfort during their menses. In addition to causing infertility, cervical stenosis could also increase the development of endometriosis.