Common Reasons

Female

The hormonal control of the menstrual cycle can be extremely complex. Below is a short list of conditions that can cause fertility problems. The good news? Treatments are available for many of these conditions.

Ovulatory problems

Approximately 25% of all infertile women have problems with ovulation1. The normal ovarian cycle is so complex that even small changes may disrupt the cycle and prevent ovulation.

In most cases, hormonal imbalances, like not having enough of a certain hormone or not releasing a hormone at the right time, are the cause of the problem. Extremely low body weight, being overweight, or any significant change in weight (loss or gain) can also cause imbalances.2

If you have an ovulation problem, your healthcare provider may choose to treat you with clomiphene citrate.

Age

A woman's fertility naturally declines as she gets older. If you're over 35 and have been unable to conceive after six months of regular, unprotected intercourse, you should talk to a healthcare provider.

Anatomical problems

A variety of anatomical issues can cause infertility.

Blocked fallopian tubes

Sometimes a woman's fallopian tubes become blocked because of past infections (pelvic inflammatory disease, for example), or by abdominal surgery. Sexually transmitted diseases can also scar or damage the fallopian tubes, causing blockages. 3

Blockage can interfere with the sperm and egg uniting. If they do unite, blockages can prevent the embryo from implanting itself in the uterus. Often women with blocked fallopian tubes don't experience any symptoms. Treatment of tubal problems or pelvic scarring may require specialized surgery, depending upon a woman's situation. 4

Cervical disorders

When a woman isn't ovulating, cervical mucus helps prevent infections entering the uterus. During ovulation, the thickness and quality of the mucus alters to allow sperm to pass through. Sometimes cervical problems can prevent the sperm from entering. 2

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is one of the leading causes of infertility, affecting an estimated 5% to 10% of women of childbearing age. PCOS is a condition in which cysts develop in the ovaries due to abnormal hormone levels. The ovaries can then enlarge. Symptoms may include irregular or absent periods, high blood pressure, acne, elevated insulin levels, excess hair on the face and body, and weight problems. 5

Cancer treatments

Depending upon the location of treatment and the drug and dosage used, chemotherapy and radiation can contribute to difficulty conceiving.6 If you're undergoing treatment for cancer, you can find fertility information and support at Fertile Hope.

When to see a healthcare provider

You should see a healthcare provider any time you have concerns about your fertility. Don't wait! By definition, you are considered infertile if you're younger than 35 and have been unable to conceive after a year of regular, unprotected intercourse; or if you’re over 35 and have been unable to conceive after six months of regular, unprotected intercourse.

You should also see a healthcare provider if any of the following apply to you:

  • Over age 35
  • Irregular or absent periods
  • Two or more miscarriages
  • Prior use of an intrauterine device (IUD)
  • Endometriosis/painful menstruation
  • Breast discharge
  • Excessive acne or hirsutism (body hair)
  • Prior use of contraceptive and no subsequent menstruation
  • History of sexually transmitted disease
  • History or pelvic/genital infection
  • Previous abdominal surgery
  • Reversal of surgical sterilization
  • Chronic medical condition (e.g., diabetes, high blood pressure)
  • History of chemotherapy or radiation therapy

Important Considerations
As with all prescription medications, side effects may occasionally occur with use of fertility drugs. Doctors specializing in fertility or reproductive health should only prescribe these products. Patients prescribed gonadotropins and GnRH analogs should be monitored carefully by a trained fertility specialist. Risks include the following events which can be serious: hypersensitivity reactions; ovarian hyperstimulation syndrome (OHSS); pulmonary and vascular complications, and multiple births. For complete product details about a specific fertility drug, please refer to the Full Prescribing Information.

  • 1. American Society for Reproductive Medicine. Ovulation drugs: a guide for patients. Birmingham, Alabama: American Society for Reproductive Medicine; 2000.
  • 2. IBID p-8, line 10
  • 3. American Society for Reproductive Medicine. Infertility: an overview: a guide for patients. Birmingham, Alabama: American Society for Reproductive Medicine; 2003.
  • 4. IBID Tubal factor p-7, lines 1&2
  • 5. American Society for Reproductive Medicine. Medications for inducing ovulation: a guide for patients. Birmingham, Alabama: American Society for Reproductive Medicine; 2006.
  • 6. Fertility and Cancer Treatment page. Cancer.Net Web site. Available at: http://www.cancer.net/patient/Diagnosis+and+Treatment/Treating+Cancer/Sexual+and+ Reproductive+Health/Fertility+and+Cancer+Treatment. February 6, 2009.

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Important Considerations:
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program. Gonal-f® RFF Pen (follitropin alfa injection) should only be prescribed by physicians specializing in fertility or reproductive health. Gonal-f® is a potent gonadotropic substance capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications, and multiple births. Gonal-f® is contraindicated in women who exhibit prior hypersensitivity to FSH preparations, primary gonadal failure, uncontrolled thyroid or adrenal dysfunction and pregnancy. Nursing women should not use Gonal-f®. Common side effects include headache, abdominal pain, enlarged abdomen, and injection site disorders. For complete product details, see full prescribing information.

Important Considerations:
Women: Gonal-f® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Men: Gonal-f® (follitropin alfa for injection) is indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. Gonal-f® (follitropin alfa for injection) should only be prescribed by physicians who are thoroughly familiar with infertility problems and their management. Gonal-f® is a potent gonadotropic substance capable of causing Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications. Gonal-f® is contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor; and in women who exhibit abnormal uterine bleeding of undetermined origin, ovarian cyst or enlargement of undetermined origin and pregnancy. Women who are pregnant or nursing should not use Gonal-f®. The most common side effects in patients using Gonal-f® include headache, ovarian cysts, nausea and upper respiratory infections in women and in men, acne, breast pain and growth, and fatigue. Injection site reactions were also reported. Reports of multiple births have been associated with Gonal-f® treatment. For complete product details, see the full prescribing information.

For complete product details, please read the Prescribing Information offered below.


© EMD Serono, Inc. CIM Last Update 2008-09-16
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