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Female Infertility – Female Sexual Health – Birmingham, AL

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At the America Institute of Reproductive Medicine – Alabama (AIRM), we understand that when you are experiencing infertility or secondary infertility, it can be an overwhelming situation. A woman with a hormonal imbalance, an ovulation disorder, or an unknown structural issue within the uterus may find it difficult to become pregnant. Our board-certified reproductive endocrinologist, Dr. Cecil A. Long, can consult with you about treatments and medical strategies to hopefully lead you to a positive pregnancy test. 

While there are common symptoms of female infertility, finding the reason you cannot become pregnant may require blood tests, diagnostic imaging, and some minimally invasive testing. Our highly qualified and practiced medical team at AIRM is here to find the right diagnosis. If you choose to go through treatment with Dr. Long, he will be there with you at every appointment and every step of the way. If you have been referred by your primary care physician or OBGYN, please call and schedule a consultation.


While some women show no symptoms, some possible indicators of infertility in women can include:

  • Menstruating irregularly or not at all
  • Menstrual cycles that are longer than 35 days or shorter than 21 days
  • A history of pelvic inflammatory disease, endometriosis, or painful periods
  • Obesity
  • Multiple miscarriages
  • Previous treatment for cancer, including radiation or chemotherapy

We can start the process today by helping you find answers to why you are experiencing infertility.

Causes of Female Infertility

Infertility in women may be caused by one or more factors, including the following conditions below.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes a woman’s eggs to remain immature, among other symptoms related to the imbalance of hormones. About 10% of women of reproductive age in the United States have PCOS.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the woman’s reproductive organs that is often the result of sexually transmitted diseases like chlamydia or gonorrhea. It can cause scarring, adhesions, or other damage to the fallopian tubes, ovaries, or uterus. 

Fibroids or Polyps

Fibroids or polyps, which are noncancerous tumors that develop in the woman’s uterus, may change the shape of the womb or alter the receptivity of the endometrium for an embryo trying to implant. Polyps, which can form in the uterus, cervix, or vagina, are small overgrowths of endometrial tissue. While usually benign, a small percentage of polyps are precancerous or malignant. Uterine polyps can affect the lining of the uterus, which can lead to infertility or miscarriage.

Hormone imbalance

If the body produces too much or too little of one or more hormones essential for reproduction, this can affect ovulation and/or the success of embryo implantation.

Female Aging

As women increase in age, the quantity and quality of eggs begin to decline. Beginning at age 35, a woman’s fertility declines steeply, lowering the chance of a healthy pregnancy. This can make conception much more difficult.

Ovulatory dysfunction

Ovulatory dysfunction is a female condition where the ovaries do not produce or release an egg regularly during a menstrual cycle. With diagnostic testing, we can determine if an egg is not released during ovulation to be fertilized.


Menopause, the cessation of a woman’s menstrual periods, indicates that a woman’s egg supply is depleted. The average age of menopause is 51, although some women may experience premature menopause.

Recurrent Miscarriages

If you have had more than one miscarriage (experiencing 2 or more consecutive pregnancy losses), we may recommend a thorough female infertility examination and testing. Recurrent miscarriage can indicate an underlying fertility condition.


Endometriosis results when the endometrium, the tissue that lines the inside of the womb (uterus), grows abnormally outside it. This tissue continues to act as if it were still inside the uterus, responding to the menstrual cycle by thickening, breaking down, and bleeding. Since it is outside the uterus, this endometrial tissue is not shed from the body as it normally would be from the uterus during menstruation. The tissue becomes trapped in the woman’s abdomen, typically affecting her ovaries, her bowels, fallopian tubes, the lining of her pelvis, or her bladder. The endometrial tissue can cause pain, particularly during a woman’s period, and scar in these areas. This can become a cause of some women's infertility. This condition is mainly reported by women of reproductive age, 15 – 45 years old. 

Unexplained Infertility

Unexplained infertility is a diagnosis made when the cause of infertility is unknown despite thorough testing of both the female and male partners. Unexplained infertility affects up to 10% of infertile couples.

Diagnostic Testing Available 

Age is one of the most significant factors in deciding when a woman should pursue fertility testing. In general, if a woman in her early 30s or younger does not become pregnant after a year of frequent intercourse without a contraceptive, most doctors recommend infertility testing. If a woman is age 35 or older, testing is recommended after just 6 months of trying to become pregnant. For women over 40 years old, fertility testing should be done right away. Common fertility tests for women include:

  • Ovulation testing
    There are specific ovulation tests we can perform to determine if and when a woman is releasing an egg based on a surge in luteinizing hormone (LH). The patient often does this test at home using an over-the-counter kit. Other ovulation tests may include blood tests to check a woman’s hormone levels.
  • Ovarian reserve testing
    We can measure the quantity and quality of a woman’s egg supply. A woman’s ovarian reserve is evaluated by blood tests that examine hormone levels on specific days of her menstrual cycle. In addition, an antral follicle count may be performed via transvaginal ultrasound to examine the ovaries and make an estimate of how many immature eggs are available.
  • Hysterosalpingogram (HSG) 
    HSG is an outpatient imaging test that evaluates the shape of the woman’s uterus and checks whether her fallopian tubes are open or not.
  • Transvaginal ultrasonography
    A transvaginal ultrasonography test is performed by inserting an ultrasound probe into the woman’s vagina. This allows the fertility specialist to view the uterus and ovaries to examine for cysts, fibroids, or other abnormalities.
  • Saline infusion sonohysterography
    Saline infusion sonohysterography is used to detect uterine abnormalities like polyps or fibroids, which involves filling the uterus with saline (a salt solution) prior to performing a transvaginal ultrasound.

More advanced fertility tests may be performed if necessary. Hysteroscopy can be used to look for signs of disease or damage to the uterus or fallopian tubes. Laparoscopy, a minimally invasive surgery, can evaluate a woman’s uterus, ovaries, and fallopian tubes for blockages, endometriosis, scar tissue, or other problems with the reproductive organs.

Treatments Available

The American Society for Reproductive Medicine (ASRM) reports that 85% – 90% of infertility cases are treated with either medication or surgery. The recommended course of treatment will vary for each woman based on her individual circumstances, including age, duration of infertility, and overall health. Some treatments for women include:

Lifestyle changes
It is very important for women having trouble conceiving to manage chronic conditions like diabetes, maintaining a healthy weight, having decreased stress levels, and not smoking.

Ovulation induction medications
We have ovulation induction medications, which are hormones to stimulate the ovaries to release mature eggs, available to women who qualify.

Intrauterine insemination (IUI)
By inserting a partner's sperm or donor's sperm directly into the uterus, we can increase the likelihood of a successful conception.

Minimally invasive surgery
We can repair structural issues or damage to a woman’s reproductive organs, or remove cysts or fibroids with minimally invasive surgery.

In vitro fertilization (IVF)
IVF is an advanced assisted reproductive therapy in which a woman’s eggs are fertilized in a laboratory and healthy embryo(s) are returned to her uterus.

Intracytoplasmic sperm injection (ICSI) 
To obtain a pregnancy, an intracytoplasmic sperm injection can be used to insert a single sperm directly into the egg retrieved during IVF.

Preimplantation genetic diagnosis (PGD)
PGD evaluates embryos for the presence of a specific genetic condition prior to implantation in the uterus during IVF.

Assisted hatching
Assisted hatching is a procedure that thins or punctures the outer shell of an embryo prior to transfer back into the uterus during IVF, making successful implantation more likely.

Use of donor eggs or embryos 
For women who cannot conceive with their own eggs (oocytes), we may recommend the use of a donor egg or embryo.

Gestational carriers or surrogates 
If you are experiencing problems getting or staying pregnant, or have health risks associated with pregnancy, there are options with gestational carriers or surrogates. A surrogate will carry your embryo to term.

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How can we help?

We are fortunate to have an exceptional team of experienced doctors and scientists with access to a world-class, state-of-the-ART (assisted reproductive technologies) laboratory where collaborative efforts have helped build many families. If you suspect you or your loved one is having an infertility issue, our doctors would like to help you find answers. Call and schedule your initial appointment today.

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