| ICD-9-CM: |
| 628 - | Female Infertility |
| 628.0 - | Infertility, Female, Associated with Anovulation |
| 628.2 - | Infertility, Female, of Tubal Origin |
| 628.3 - | Infertility, Female, of Uterine Origin |
| 628.4 - | Infertility, Female, of Cervical of Vaginal Origin |
| 628.8 - | Infertility, Female, of Other Specified Origin |
| 628.9 - | Infertility, Female, Unspecified |
| Infertility is generally considered to be the failure to conceive a child after 1 year of unprotected sexual activity.
Major causes of infertility in women include anatomic abnormalities of the reproductive tract; disorders of the cervix such as infection, laceration, tearing from previous childbirth, or narrowing of the cervical opening for any reason; abnormal ovulation or irregular release of an egg (ovum) from the ovary, chemical changes in the cervical mucus, severe vaginitis, pelvic inflammatory disease (PID), ovarian cysts, endometriosis, and tumors. Hormone dysfunction secondary to diabetes, thyroid disorders, low levels of sex hormones, or elevated prolactin may also cause infertility. The lack of menstrual periods (amenorrhea), compulsive exercise, psychiatric disorders such as bulimia or anorexia nervosa, chronic emotional stress, and weight gain or weight loss cycles can also cause infertility.Risk: The effects of cigarette or marijuana smoking, environmental and occupational factors (e.g., excessive exposure to radiation), and the side effects of certain medications, including contraceptives, may increase a woman's risk of infertility. Incidence and Prevalence: Exclusively female causes account for approximately 32% of infertility cases (Garcia). |
Source: Medical Disability Advisor
| History: The individual will report failure to conceive. Women may have a history of past PID or sexually transmitted diseases. Some may report abnormal menstrual patterns, painful menstrual cycles, a history of endometriosis or other chronic illnesses. Physical exam: The physical exam may be normal. Evidence of vaginal infections, fibroid tumors, or ovarian cysts may be found. Tests: Tests include complete blood count (CBC), HIV testing, urinalysis, cervical cultures, blood tests for syphilis, rubella antibody, thyroid function, and sickle cell disease (in blacks), luteinizing hormone tests, serum progesterone level, follicle-stimulating-hormone level, prolactin level, histocompatibility antigen testing, ultrasound of the pelvis, hysterosalpingography, endometrial biopsy, laparoscopy, and genetic testing to rule out possible genetic causes of infertility. Cervical mucus will be tested. The semen of the male partner should be tested early on. |
Source: Medical Disability Advisor
| Treatment depends on the underlying cause and may include hormone supplementation, antibiotics, fertility drugs, artificial insemination, surgery to correct blocked fallopian tubes, endometriosis, fibroids, genetic defects, or ovarian cysts. These problems are often evaluated and treated via laparoscopy.
Assisted reproductive technologies (ART) can also be used. In these cases, fertility drugs and other conventional treatment options are combined with high-tech procedures. ART procedures include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), and donor egg or embryo IVF. The use of a surrogate mother is another ART method. The use of donor egg and/or sperm is also an option.
IVF is the most common type of ART and is often used when fallopian tubes are absent or blocked. In IVF, eggs are retrieved from the ovary and mixed with sperm outside the body. If fertilization occurs, the eggs are placed in the uterus. |
Source: Medical Disability Advisor
| A woman's chance of having a baby depends on many factors, including age and the underlying cause for infertility. If the underlying cause can be found and treated, the chances of conceiving are good. According to the Centers for Disease Control, in 2001 there were approximately 108,000 ART procedures started, which resulted in 41,000 live births ("Assisted"). |
Source: Medical Disability Advisor
| The presence of infertility in both partners may complicate treatment. Multiple births and birth defects can create complications. Various ethical and moral decisions may need to be made throughout the diagnostic and treatment phase. Infertility that is severe or prolonged over 3 years is more difficult to treat. Advancing age may introduce a sense of urgency about treatment and further complicate treatment.
Psychological complications such as grief and depression may also occur. The inability to conceive a child can be emotionally disturbing to both partners. |
Source: Medical Disability Advisor
| Work restrictions depend on the treatment method. There may be activity restrictions if surgery is done, and frequent trips to the doctor may be necessary for follow-up care. Infertility tests and treatments are numerous and often time-sensitive. Therefore, the employer should be considerate and provide flexibility with scheduling. Heavy lifting or long periods of standing may need to be limited, depending on the surgical procedures performed. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual consulted the appropriate medical fertility specialists?
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Has individual had a thorough infertility workup?
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Was the diagnosis of infertility confirmed?
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Does individual struggle with grief, depression, anorexia nervosa, or bulimia?
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Is the condition or its treatment complicated by factors such as advancing age, endometriosis, and ovarian or uterine tumors?
Regarding treatment:
- Were underlying physical conditions effectively resolved?
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Would individual and/or partner benefit from psychological counseling?
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Were all appropriate options considered? Which ones have been tried so far?
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What further options are individual and partner willing to try?
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Were other pertinent factors addressed, such as exercise and weight gain, nutritional assessment, and psychotherapy or counseling if stress or other psychological factors are present?
Regarding prognosis:
- Is individual prepared to spend the time and finances to attempt fertility?
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Do individual and partner have a realistic grasp of the situation?
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Have they seriously considered adoption as a viable option?
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Source: Medical Disability Advisor
| "Assisted Reproductive Technology Success Rates." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 12 Dec. 2004 <http://www.cdc.gov/reproductivehealth/ART01/nation.htm>.Garcia, Jairo E., Lawrence M. Nelson, and Edward E. Wallach. "Infertility." eMedicine. Eds. Robert K. Zurawin, et al. 5 Oct. 2004. Medscape. 12 Dec. 2004 <http://emedicine.com/med/topic3535.htm>. |
Source: Medical Disability Advisor
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