What is infertility?
Infertility is defined as not having become pregnant after 1 year of having regular sexual intercourse without the use of birth control. Infertility can be caused by a number of factors. Both male and female factors can contribute to infertility.
Bleeding in any of the following situations is abnormal:
- Bleeding between periods
- Bleeding after sex
- Spotting anytime in the menstrual cycle
- Bleeding heavier or for more days than normal
- Bleeding after menopause
Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3 – 6 months (amenorrhea) also is abnormal.
Abnormal uterine bleeding can have many causes. They include the following:
- Ectopic pregnancy
- Use of some birth control methods, such as an intrauterine device (IUD) or birth control pills
- Infection of the uterus or cervix
- Problems with blood clotting
- Endometrial hyperplasia
- Certain types of cancer, such as cancer of the uterus, cervix, or vagina
- Polycystic ovary syndrome
Based on your symptoms, other tests may be needed. Some of these tests can be done in your health care provider’s office. Others may be done at a hospital or surgical center:
- Sonohysterography: Fluid is placed in the uterus through a thin tube, while ultrasound images are made of the uterus.
- Ultrasound: Sound waves are used to make a picture of the pelvic organs.
- Magnetic resonance imaging: In this imaging test, powerful magnets are used to create images of internal organs.
- Hysteroscopy: A thin device is inserted through the vagina and the opening of the cervix. It lets the health care provider view the inside of the uterus.
- Endometrial biopsy: Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). It is looked at under a microscope.
The most important risk factor for cervical cancer is infection with the types of HPV linked to cancer. The following factors increase your risk of becoming infected with HPV:
- Multiple sexual partners
- Having a male sexual partner who has had multiple sexual partners
- Early age at which you first had sex (younger than 18 years)
- A personal history of dysplasia of the cervix, vagina, or vulva
- A family history of cervical cancer
- Certain sexually transmitted diseases, such as chlamydia
- Problems with the immune system
- Having a mother who took a drug called diethylstilbestrol (DES) during pregnancy
If your health care provider suspects that you have cancer of the cervix, a biopsy may be done. For certain abnormal Pap test results that require treatment, the abnormal cervical tissue may be removed and sent to a lab to be studied. If cervical cancer is diagnosed, your health care provider will assess the size of the cancer and the extent (if any) to which the disease has spread. This process may include the following tests:
- A pelvic exam (which may include a rectal exam): An examination in which your health care provider checks the uterus, ovaries, and other organs near the cervix
- Cystoscopy: A test in which the inside of the urethra and bladder are studied with a lighted device
- Colonoscopy: A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope
You should contact your health care provider if you have any of the following:
- Heavy bleeding from the vagina
- Pain in the abdomen
- Foul-smelling discharge from the vagina
After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time. It may be early or late. Until your cervix returns to its normal size, bacteria from the vagina can enter the uterus and cause infection. It is important not to put anything into your vagina after the procedure. Ask your health care provider when you can have sex or use tampons again.
Factors that increase the risk of preterm birth include the following:
- Having a previous preterm birth
- Having a short cervix
- Short interval between pregnancies
- History of certain types of surgery on the uterus or cervix
- Certain pregnancy complications, such as multiple pregnancy and vaginal bleeding
- Lifestyle factors such as low pregnancy weight, smoking during pregnancy, and substance abuse during pregnancy
Call your health care provider right away if you notice any of these signs or symptoms:
- Change in type of vaginal discharge (watery, mucus, or bloody)
- Increase in amount of discharge
- Pelvic or lower abdominal pressure
- Constant low, dull backache
- Mild abdominal cramps, with or without diarrhea
- Regular or frequent contractions or uterine tightening, often painless
- Ruptured membrane (your water breaks with a gush or trickle of fluid)
Art includes all fertility treatments in which both eggs and sperm are handled. ART usually involves In Vitro Fertilization (IVF). In IVF, sperm is combined with the egg in a lab, and the embryo is transferred to the uterus. IVF is done for the following causes of infertility:
- Damaged or blocked fallopian tubes that cannot be treated with surgery
- Some male infertility factors
- Severe endometriosis
- Premature ovarian failure
- Unexplained infertility