Infertility is when a woman is unable to conceive because of abnormalities of her uterus, fallopian tubes, or ovaries or if eggs are not being produced. Sometimes a woman with normal menstrual periods does not produce an ovum with each menstrual cycle. This can be determined by a basal body temperature chart, which a woman creates at home by taking her own temperature before getting up in the morning. If ovulation is taking place, her temperature rises slightly and remains higher in the second half of the menstrual cycle than in the first half. Her chart at the conclusion of a menstrual cycle demonstrates whether this rise takes place. Alternatively, a home ovulation kit test can determine if and when ovulation takes place.

Female infertility may also result from hormonal imbalance. Normally, many hormones contribute to the successful balance of the female reproductive process, and these substances are necessary for development of viable ova. Blood tests can detect and quantify the necessary hormones, which include progesterone, seven days after ovulation or before menstruation. On the other hand, the hormone prolactin, which is usually produced when a woman breast feeds, may be present and may be preventing both menstruation and ovulation.

Measurements of the hormone progesterone may determine whether her reproductive system is allowing insufficient time for fertilised egg implantation. This condition can be treated with hormones, a treatment that sometimes results in over stimulation of the ovaries, which may produce multiple births.

The Uterus
Several uterine conditions may make pregnancy difficult or impossible.

1. Fibroids
   These are benign tumours that can distort the shape of the uterus. Surgery may be required to remove them.
2. Tipped uterus
   Normal wombs lie with their closed end facing forward and pointing upward. A tipped uterus faces back and down. Surgery to correct the position has no place in improving fertility and is not recommended.
3. Endometriosis
   This condition usually affects women between ages 30 and 40. The endometrium, the same tissue that lines the uterus and is expelled each month during menstruation, may grow elsewhere in the pelvic cavity, (for example, in the pelvic ligaments or on the ovaries). The misplaced tissue responds to hormonal signals and may cause scarring and adhesions. In some cases, endometriosis may twist the reproductive organs out of their normal alignment, preventing the ova from reaching the fallopian tubes. Otherwise, it is not fully understood how endometriosis interferes with fertility.

Research indicates that the “wandering”  tissue may have some influence on the ovum after it is released from the ovary.

Treatment of endometriosis may include hormonal therapy and/or surgery.

The Fallopian Tube
Damage to the fallopian tubes makes it difficult or impossible for an ovum to be passed to the uterus every month, and may prevent conception.  Sometimes, if the tubes’ lining is damaged, conception may occur too high in the tube and pregnancy will begin there instead of in the uterus, (an “ectopic”, or “tubal pregnancy”). This requires surgical removal to prevent rupture of the tube and other serious complications. Some surgeons try to leave the tube intact, but often it is damaged beyond repair. A woman with only one functioning fallopian tube has her chances of pregnancy cut in half.

To determine fallopian tube function, fertility specialists use a variety of tests, including laparoscopy, hysterosalpingogram and ultrasound.

When the couple remains infertile
A large proportion of couples actually conceive while undergoing fertility tests. Another group will be helped by removal of blockages, treatment of endometriosis, or induction of ovulation with fertility drugs. For some couples, however, the tests reveal an absolute inability to have children. These couples often adopt children.

Another alternative is artificial insemination: The male partner’s semen is collected and placed in the cervix or uterus of the female partner around the time of ovulation. Reported pregnancy rates with this technique, however, are low.

Artificial insemination with sperm from a donor should take place only if both partners concur in taking this action. Donors are usually chosen for physical similarities to the couple, and a physical history of potential donors is used to rule out disease and poor semen count. Medical students and doctors are often donors. Insemination procedures are usually performed more than once, sometimes with a different donor each time. Often the partner’s sperm may be mixed with the donor sample. This method of artificial insemination often produces satisfactory results.

In vitro fertilisation
In vitro fertilisation has received widespread media attention since the first test-tube baby in 1978. It is still highly experimental and used only when no other alternative is acceptable. It requires a woman to be capable of producing ova and ovulating. During this procedure, the woman receives hormones to stimulate ovarian activity just after her menstrual period in order to produce as many ova as possible. Just before ovulation, the woman enters the hospital, where the ova are removed by laparoscopy, (or “key hole surgery”),  or more commonly by needle aspiration. (Needle aspiration is the means of sucking fluid from a patient’s body, through a needle.)  After a short incubation, a sperm sample is added, either from her partner or from a donor and, should fertilisation occur, the developing embryos are incubated (in a “test tube”), until the embryo reaches a two- to eight-cell state. The embryos are then transferred to the uterus or fallopian tubes, depending upon the technique being used. The woman may receive more hormones to decrease the possibility of miscarriage. Hormone levels continue to be measured until it is certain that the pregnancy is in progress.

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4. Specific disorders of ovulation
5. Erectile dysfunction – Impotence
6. Chlamydia — a sexually transmitted disease
7. Infertility
8. Lessons on HIV and AIDS – Oral thrush
9. Hormone replacement therapy (HRT) and the menopause

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