Female Infertility 女性不孕症

不孕症：夫妻結婚後，每週維持2~3次的頻率性行為，且沒有採取任何避孕的措施，超過一年以上，仍然沒有懷孕稱之為不孕症，若想懷孕生子則必須接受不孕症治療，讓不孕症專科醫師做療程規劃。

Non-genetic Causes of Female Infertility

Pelvic Issues：Fallopian tube blockage or adhesions, Pelvic adhesions

Uterine Issues：Uterine fibroids, Uterine polyps, Uterine malformations, Intrauterine adhesions (Asherman's syndrome), Cervical stenosis or atresia, Endometriosis

Ovarian Issues：Ovulation disorders, Polycystic ovary syndrome (PCOS), Ovarian tumors, Premature ovarian insufficiency (POI)

Endocrine Disorders：Hyperprolactinemia, Hyperandrogenism, Luteal phase deficiency

Other or Multifactorial Causes：Environmental factors, Stress and psychological factors

Female Infertility Evaluation

Hormonal Blood Tests

• Anti-Müllerian Hormone (AMH)

• Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)

• Prolactin (PRL)

• Thyroid-Stimulating Hormone (TSH)

• Testosterone (Androgens)

Hysterosalpingography (HSG)

The fallopian tubes play a critical role in natural conception. Blockages, hydrosalpinx (fluid in the fallopian tubes), or adhesions can significantly reduce the chances of natural or assisted pregnancy and may also negatively affect IVF outcomes.

This exam is typically performed after menstruation but before ovulation. A contrast dye is injected through the cervix, and X-ray imaging is used to assess whether the fallopian tubes are open. It also helps evaluate adhesions around the fimbrial end, identify abnormalities such as tubal disease, hydrosalpinx, and uterine malformations.

Hysteroscopy (TCR)

A hysteroscope is used to visualize the inside of the uterine cavity, allowing diagnosis of conditions such as:

• Endometrial polyps

• Intrauterine adhesions (Asherman's syndrome)

• Uterine septum

• Uterine fibroids

• Endometrial inflammation

Transvaginal Ultrasound (TVS)

Ultrasound imaging is used to evaluate uterine structure, monitor ovarian follicle development, and detect abnormalities like:

• Endometrial thickness and pattern

• Uterine fibroids

• Ovarian endometriomas (chocolate cysts)

• Endometriosis

2D Ultrasound：Evaluates follicle count and shape, Determines uterine position (anteverted or retroverted), Measures endometrial thickness, Recommended for routine gynecological checkups or women planning pregnancy

4D Ultrasound：Offers detailed follicle tracking, with each follicle color-coded, Assesses uterine cavity shape and surrounding tissues, Recommended for women with known ovulation disorders or suspected uterine abnormalities

Female Infertility Treatments and Reproductive Procedures

A. Intrauterine Insemination (IUI)

Artificial insemination (IUI) is a reproductive technique where sperm, after being processed and selected for quality in the laboratory, is directly inserted into the woman's uterine cavity on the day of ovulation. The sperm must swim on its own to the end of the fallopian tube to fertilize the egg.

Suitable candidates for artificial insemination include:

• Women over 35 years old or with decreased ovarian reserve

• Mild endometriosis

• Irregular menstrual cycles

• Mild fallopian tube adhesions or mild blockage

• Unexplained infertility with normal test results

B. In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a reproductive technique where eggs and sperm are retrieved and fertilized outside the body in a laboratory. The resulting embryos are cultured and then implanted into the uterus.

Suitable candidates for IVF include:

• Women over 35 years with age-related decline in reproductive function

• Women with bilateral fallopian tube blockage or adhesions, or moderate to severe endometriosis

• Women with anovulation, polycystic ovary syndrome (PCOS), or poor ovarian response

• Women who have experienced multiple failed IUI attempts (3 or more)

• Unexplained infertility despite normal anatomical and reproductive function tests

• Other factors such as habitual miscarriage or known chromosomal abnormalities in the couple