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Female Infertility

  • The inability to get pregnant after a year of trying, which can result from a variety of factors
  • Female-factor infertility involves ovulation issues, blocked tubes, fibroids, or endometriosis
  • Treatment includes medication, procedures, and surgery
  • Involves Yale Fertility Center, Ob/Gyn and Gynecologic Surgery

Female Infertility


At Yale Fertility Center, we abide by a closely held philosophy: our patient’s dream is our dream, too. We are physicians, specialized staff and scientists who have dedicated our life's work to improving our patients’ chances at conceiving.

“We offer the breadth and depth of fertility services comparable to that any state of the art private practice offers, and more," says Yale Medicine's Lubna Pal, MBBS, director of Yale Medicine Polycystic Ovary Syndrome (PCOS) Program. “Our physicians, are not only experts in the art of medicine, but also in reproductive biology sciences. Our breadth and depth of experience ranges from successfully helping thousands of patients and couples with common fertility problems to managing the most complicated patients, such as a woman with a heart defect or who has had a kidney transplant or someone with a bleeding disorder, conditions where both fertility related medical treatment as well as procedure of egg collection can be challenging."

Using the latest research and fertility science, our goal is to maximize our patient’s chances of successful pregnancy in the shortest possible time and with utmost attention to the wellbeing of our patients and their future generation. 

We offer a comprehensive range of services for both female-factor and male-factor infertility, for women and men seeking fertility preservation in the setting of an illness that could potentially harm their ability to conceive in the future, for single women and men, same gender couples interested in family building to transgender individuals seeking fertility preservation. 

What is female infertility?

"Fertility is a team sport. There are two players and there is a playing field. If the team (couple) has not succeeding in the achieving the goal (i.e., pregnancy) despite trying over a one year, the couple/patient meets criteria for infertility. Underlying mechanism/s contributing to a couple’s infertility can lie with the woman (female factor) or the man (male factor); it is not uncommon that both partners may have factors that are contributing to their infertility.

Infertility is a common problem, affecting approximately 10% of women in the United States. In most cases, the cause of infertility may be with the female partner (such as ovulation problems, blocked tubes, common conditions such as uterine fibroids, endometriosis), whereas in about one-third of the cases, male factors (few sperm, slow sperm, abnormal sperm or no sperm) may contribute in addition to female factors, Dr. Pal estimates.

"I really believe that primary health care providers (pediatricians, primary care, obstetrician-gynecologists) must utilize every opportunity to engage reproductive age women in discussing and counseling on aspects of reproductive wellbeing" Dr. Pal says. "By the time patients get to a specialist, it can be too late. We want women to know that aging is a part of healthy existence, and not a disease." 

However, medical professionals must do a better job in conveying the relevance of reproductive aging for pregnancy success, Dr. Pal says. "Women in their mid-30s should preemptively be asking their providers about this topic. Give them a timeline," she says. "There is no need to wait six months before seeking input from a fertility specialist for those with concerns such as irregular menstrual cycles, a history of sexually transmitted infection, uterine fibroids or endometriosis, or those who have had trouble conceiving in a prior relationship." 

For women 35 or older, fertility evaluation is warranted after six months of trying to conceive as timing is of the essence in situations of advancing age of the female partner, Dr. Pal says.

What are risk factors for female infertility?

In addition to advancing age (mid 30s and beyond), other factors that can affect fertility include sexually acquired infections, smoking, stress and obesity.

"A woman’s family history can be relevant to her own reproductive wellbeing. For example, history that her mother had a hysterectomy in her 30s or 40s could be very relevant to a young woman’s reproductive wellbeing, regardless of whether she has been attempting to conceive or plans to do so in the future," Dr. Pal says. "Maternal history may be very relevant to a woman’s reproductive health and we all (providers as well as women) should be paying attention to these aspects."

Although sometimes cast as a female issue, male-factor infertility may be the sole cause of problems with conception in about 20 to 25 percent of infertile couples. Similar to women, a man's medical and reproductive history should be taken into account.

"Knowing that a man fathered a pregnancy in the past is reassuring in that while it is possible for him to have abnormalities in his semen, but the chance of finding no sperm in this patient is quite unlikely," Dr. Pal says. "Obesity, alcoholism, smoking, substance use, other medical conditions including diabetes, sexually transmitted infections, as well as lifestyle (profession, exercise), all of these can contribute to male-factor infertility."

Our team of experts at the sperm physiology laboratory offers state of the art investigations to help our fertility specialist clinicians identify male contributions to couple’s infertility.

How is female infertility treated?

There is no one-size-fits-all solution, Dr. Pal says, adding, "Fertility is burdensome. Infertility is burdensome."

Clarifying simple concepts that are critical to successful pregnancy is often all that is needed for some young couples to achieve success. It is not uncommon to find that couples attempting to conceive simply aren't timing intercourse at the most opportune period in a woman’s menstrual cycle, she says. 

"Obesity is also a huge problem, for men and women, and if you have time on your side, the single best approach that really works is, 'Let's help you achieve some weight loss,'" she says. "Morbid obesity is not just a recognized cause of infertility, but even more importantly, it dramatically adds to pregnancy related risks, and sets the stage for a lifetime of obesity in the next generation." 

Children of obese women are much more likely to be obese and to suffer from obesity related health problems such as diabetes, elevated cholesterol and metabolic syndrome. You don't need to go from a BMI of 44 to 24. It could be as simple as just losing 5 to 10 percent of excess weight, Dr. Pal says.

If the causes of infertility are due to physical issues—blocked fallopian tubes is one example, uterine fibroids, endometriosis are others—our physicians will develop an individualized treatment plan for each patient, tailored to her age, physical health and other factors.

Some of the common fertility treatments offered in our practice include:

  • Ovulation Induction & Intrauterine Insemination (IUI)Ovulation induction is the most common form of treatment for women who do not ovulate or who ovulate infrequently. Fertility medications, oral and/or injected, are given to stimulate the release of one or more eggs from the ovaries. Sperm can be introduced to the vagina by intercourse or intrauterine insemination, in which semen is prepared to isolate motile sperm and then placed within the uterus using a small catheter. The IUI procedure is particularly useful for patients with mild male factor (low sperm counts and or motility). IUI takes just a few minutes, is entirely painless, and adds to the overall likelihood of treatment success, even for couples with normal sperm results. 
  • In Vitro Fertilization (IVF): One of the most well-known fertility treatments, IVF is the process of combining sperm and egg in a lab to create a viable embryo that can then be transferred to the woman’s uterus. Yale Medicine was among the first institutions in the Northeast to have an IVF program and has become a recognized leader in the field.
  • In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI): This represents a modification of IVF wherein an extra step is undertaken to facilitate fertilization (union of egg and sperm); a single sperm is injected into a single egg (ICSI) using specialized instruments by our highly trained embryology team.  This type of IVF is of particular benefit for couples with known male factor.
  • In Vitro Fertilization (IVF) with Preimplantation Genetic Screening (PGS) or Preimplantation Genetic Diagnosis (PGD): Both PGS and PGD represent advanced assisted reproductive techniques that represent advancements in IVF technology. For patients/couples with known genetic disorders (such as cystic fibrosis, sickle cell disease, Thalassemia’s), PGD allows an opportunity to eliminate the risk of genetic transmission of their particular disease to their next generation. PGS is commonly utilized by couples undergoing IVF to improve the chances of successful pregnancy and reduce the risk of common genetic abnormalities such as Down syndrome, as well as reduce risk of miscarriage resulting from genetically abnormal embryos. PGS can be particularly helpful for patients with a history of recurrent pregnancy loss and for women of advancing age.
  • Third Party Reproduction (Egg Donation & Gestational Surrogacy): Since 1989, the Yale Medicine Fertility Center has achieved successful results for infertile couples interested in using an egg donor or gestational surrogates. The first baby born in the U.S. through egg donation was born here. “Under direct supervision of Dr. Emre Seli who is the Director of the Yale Fertility 3rd Party Reproduction Program, our practice continues to have some of the highest success rates in the region”, says Dr. Pal.
  • Fertility Preservation: Advanced fertility preservation procedures at the Yale Medicine Fertility Center allow cancer patients (women and men), those who suffer from autoimmune diseases and those wishing to delay childbearing the opportunity to conceive in the future. Fertility preservation options provided by Yale Fertility include elective as well as emergent freezing of eggs and sperm, freezing of embryos as well as of ovarian and testicular tissue for future use. 

What other conditions does the Yale Medicine Fertility Center treat?

The Yale Medicine Fertility Center offers the diagnosis and treatment of many different conditions besides female and male infertility. The most common ones include:

  • Polycystic Ovary Syndrome (PCOS): PCOS is the most common hormonal reproductive problem in women of childbearing age. It can affect a woman's menstrual cycle, fertility, appearance as well as future health.
  • Endometriosis: A common condition that sometimes causes pelvic pain or infertility. Despite being common, it is often misdiagnosed or overlooked. It’s very common in younger patients.
  • Recurrent Pregnancy Loss: The loss of multiple pregnancies, either through stillbirth or miscarriage. 
  • Issues of Adolescent Gynecology: Disorders of puberty (too early or too late), of menstruation (absent, too frequent, too much, too infrequent, totally erratic) and issues related to development of the female genital tract (vagina and uterus) offer unique challenges for the adolescent population, and require particular management expertise.
  • Menopause: Symptoms of perimenopause and menopause can be particularly bothersome for some women, and menopause management can be particularly challenging in those with complex medical history (such as those with known heart disease, diabetes). 

Are infertility services covered by insurance?

The State of Connecticut passed a bill in 2005 that requires insurance companies to cover most infertility related services. At Yale Medicine Fertility Center, we will work with your insurance carrier to help you understand your benefits.

What makes Yale Medicine's approach to treating infertility unique?

At Yale Fertility Center, we understand that when a couple is having trouble conceiving they often want to face the issue together. Typically, male infertility is treated by a urologist, while a woman will see a reproductive endocrinologist. 

Unlike other practices where each partner may need to be evaluated separately, we evaluate and treat both partners simultaneously. Our couple-focused approach is deeply appreciated by patients who say it helps deal with the emotional ups and downs of treatment. We believe that when any treatment is made simpler for patients, they are empowered to spend more energy on their medical goals—and in this case, one another.

Our patient centered approach, our experienced team of physicians and highly trained staff, our pioneering research and our leading advances in the field, set us apart from other reproductive health care providers in the region and the country.

"When it comes to fertility, technology is cookie cutter. Our true strength and what differentiates us from others in the field, lies in the depth of knowledge and the expertise of our clinicians, who have experience with complicated cases," Dr. Pal says. "We have built a collaborative network of subspecialists (including hematologists, oncologists, immunologists and many other specialists) here at Yale to ensure the most optimal treatment that is individualized for each and every patient."  

All treatments we offer are vetted by solid data. "We prioritize patient safety and maximize patient success," she says. 

We prioritize psychological support and counseling to individuals and couples who are navigating treatment options or simply struggling with the complex emotions that accompany infertility. 

And we recognize that those seeking fertility treatments come from all walks of life, and with individual life choices and preferences. We offer assisted reproductive services to address fertility needs of a diverse patient population, from infertile couples, to same gender couples, to single men and women and transgender individuals. 

Lastly, we have several locations. 

Our Fertility Center in New Haven is our full-service facility that functions seven days a week. 

Our Westport office is a fully staffed facility that allows patients to receive specialist care in all aspects related to reproductive endocrinology and infertility including all basic infertility services and daily fertility treatment monitoring for patients closer to home, while allowing infertility patients undergoing IVF treatment the benefit of our state of the art IVF lab and our expert embryology team at the Yale Medicine Fertility Center in New Haven. 

Our Guilford and Stamford offices similarly allow patients seeking specialist care in all aspects related to reproductive endocrinology and infertility closer to home.