WOMEN INFERTILITY, CAUSES, AND POSSIBLE SOLUTIONS

WOMEN INFERTILITY, CAUSES, AND POSSIBLE SOLUTIONS

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Getting pregnant, sustaining a pregnancy and achieving a live birth proves to be difficult for some couples. Here's what you need to know about infertility. 

The average woman has a 15 to 25 percent chance of conceiving a baby each cycle and about 85 percent of fertile couples will be successful within 12 months of having regular unprotected sex. However, some couples face challenges when it comes to conceiving.





Infertility is the inability to become pregnant after more than one year of regular, unprotected sexual intercourse. It is estimated that just over 10 percent of women of reproductive age have problems conceiving. In one third of cases, the problem lies with the woman’s reproductive system and in another third the problem lies with the man’s reproductive system. In the remaining third the problem lies with both partners or is not known. After a specialist’s investigation of both partners and treatment, 30-40 percent of couples achieve a pregnancy within two years.

What triggers infertility?

Why some people are infertile is not yet fully understood, but some causes have been identified. In women, it may be because ovaries are not producing eggs (anovulation). Endometriosis and pelvic inflammatory disease can damage or block fallopian tubes. In some women, mucus in the cervix may be hostile to the partner’s sperm. In men, a common cause is defective sperm. In couples, the genetic makeup of one partner may prevent the couple from achieving a pregnancy naturally, or in some cases occupational hazards (such as chemicals and working practices) are involved.

What’s causing the problem?

To determine the cause of any infertility, your doctor may see you and your partner, both separately and together.

You will have a physical examination and a detailed personal history will be taken. Obesity, acne and menstrual irregularities will be noted, and you may be asked about eating disorders, stress, occupational hazards (working with toxins, for example), exercise methods, sexual pattern, previous contraception and lifestyle habits such as alcohol, smoking and prescribed or illegal drugs. Blood tests may be carried out to seek known reasons for infertility’an excess of prolactin (a hormone regulating menstruation), excess or deficiency of thyroid hormone or an excess of androgens such as testosterone.

If you have endometriosis, uterine fibroids, polyps or ovarian cysts, the doctor may refer you to a gynecologist or endocrinologist for assessment.

For your partner, the doctor may suggest a sperm analysis. Finding out early on that he has too few sperm, no sperm at all or slow-moving or misshapen sperm may lessen the chance of you having to undergo invasive tests (though if you have other physical symptoms you may still need investigation as well).

Other causes are:

1) Advancing maternal age: Historically before the latter 20th century, women were conceiving in their teens and twenties, when age-related abnormalities with the egg were not evident. However, in our modern era, women are delaying child birth until their thirties and forties, which has lead to the discovery of the adverse effect of advanced maternal age on egg function. In fact, female age-related infertility is the most common cause of infertility today. For unknown reasons, as women age, egg numbers decrease at a rapid rate. And as aging occurs, egg quality, or the likelihood of an egg being genetically normal, decreases as well. Hence the ability to conceive a normal pregnancy decreases from when a woman is in her early 30s into her 40s. A woman is rarely fertile beyond the age of 45. This applies to the ability to conceive with her eggs, but not with donor eggs.

2) Ovulation disorders: Normal and regular ovulation, or release of a mature egg, is essential for women to conceive naturally. Ovulation often can be detected by keeping a menstrual calendar or using an ovulation predictor kit. There are many disorders that may impact the ability for a woman to ovulate normally. The most common disorders impacting ovulation include polycystic ovary syndrome (PCOS), hypogonadotropic hypogonadism (from signaling problems in the brain), and ovarian insufficiency (from problems of the ovary). If your cycles are infrequent or irregular, your doctor will examine you and perform the appropriate testing to discover which problem you may have and present the appropriate treatment options.

3) Tubal occlusion (blockage): As discussed previously, a history of sexually transmitted infections including chlamydia, gonorrhea, or pelvic inflammatory disease can predispose a woman to having blocked fallopian tubes. Tubal occlusion is a cause of infertility because an ovulated egg is unable to be fertilized by sperm or to reach the endometrial cavity. If both tubes are blocked, then in vitro fertilization (IVF) is required. If a tube is blocked and filled with fluid (called a hydrosalpinx), then minimally invasive surgery (laparoscopy or hysteroscopy) to either remove the tube or block/separate it from the uterus prior to any fertility treatments is recommended.

4) Uterine fibroids: Fibroids are very common (approximately 40% of women may have them) and the mere presence alone does not necessarily cause infertility. There are three types of fibroids: 1) subserosal, or fibroids that extend more than 50% outside of the uterus; 2) intramural, where the majority of the fibroid is within the muscle of the uterus without any indentation of the uterine cavity; and 3) submucosal, or fibroids the project into the uterine cavity. Submucosal fibroids are the type if fibroid that has clearly been demonstrated to reduce pregnancy rate, roughly by 50%, and removal of which will double pregnancy rate. In some cases, simply removing the submucosal fibroid solves infertility. Often, but not always, submucosal fibroids can cause heavy periods, or bleeding between periods. There is more controversy regarding intramural fibroids, where larger ones may have an impact and may necessitate removal. Subserosal fibroids do not affect pregnancy. Your physician will examine you carefully to determine if you have fibroids and if removal is necessary.

5) Endometrial polyps: Endometrial polyps are finger-like growths in the uterine cavity arising from the lining of the uterus, called the endometrium, These abnormalities are rarely associated with cancer (<1% in a woman before menopause), but polyps are can decrease fertility by up to 50% according to some studies. Removal of polyps by the minimally invasive procedure hysteroscopy is associated with a doubling of pregnancy rate. In some cases, simply removing the polyp solves infertility.

The solution

Medications to induce egg development and ovulation: 

The medications that help stimulate the ovary to develop mature eggs for ovulation come in two forms: pills taken by mouth and injections. The most commonly prescribed pill to stimulate ovulation (generally of one mature egg) is clomiphene citrate. This pill generally is taken from menstrual cycle days 3 – 7. It works in the following way: Clomiphene is an anti-estrogen. It binds in a part of the brain called the hypothalamus, which is essential in stimulating the ovary to grow and release an egg. When clomiphene binds to estrogen receptors in the hypothalamus, it leads to an increase release of an important signaling hormone called GnRH (gonadotropin releasing hormone). This hormone then binds to another area of the brain called the pituitary gland and leads to the release of FSH (follicle stimulating hormone), a hormone that directly binds to cells in the ovary, leading to egg growth and maturation.

The most commonly prescribed injections that stimulate the ovary are called gonadotropins. The gonadotropins in these formulations are FSH, and in some cases, a combination of FSH and LH (luteinizing hormone). These injections are taken nightly, typically for 5 – 10 days, and act directly on the cells of the ovary to stimulate egg development. Once a follicle containing an egg reaches a mature size, another hormone injection called HCG is often given to mimic the natural LH surge that occurs at the time of ovulation. This leads to the final maturation and release of the egg.

Intrauterine insemination with your partner’s or donor sperm is a treatment option in cases of infertility where sperm are too few or are insufficiently motile.

Optimize your chances

It is vital to understand your monthly menstrual cycle so you know when you ovulate and which days are optimal for sexual intercourse. You can identify these by observing changes in vaginal mucus, by making a temperature chart and by calculating over several months the cycle’s length.

Fertilization occurs within 48 hours of ovulation and implantation occurs some seven days after fertilization. Ovulation takes place 14 days before the expected next period. This is not the same as saying it takes place 14 days after the last period as menstrual cycles vary in length from 24 to 35 days’hence the need to identify the usual length of your own cycle. In a 28 day cycle, the optimal time for conception is on days 11 to 17 of the cycle where day 1 is the first day of the menstrual period. Daily intercourse during this time is generally advised. ‘

You should become familiar with the changes in your vaginal mucus. Just before ovulation the mucus increases in quantity and becomes thinner and more elastic, like raw egg white, and transparent’a drop can be stretched into a long strand without breaking. After ovulation, it becomes thicker and whiter.

When do you ovulate?

To find out whether you are ovulating, you may be asked to keep a basal body temperature chart (BBT) on which you record your morning temperature on waking, along with the day of the menstrual cycle. You mark the days when bleeding with a cross, and the days when intercourse occurs with a circle. During the menstrual cycle, the BBT is higher once ovulation occurs’confirmed by a 32F (0.4C) rise in temperature for three consecutive days. ‘

Over-the-counter ovulation kits can be used to detect luteinizing hormone, which surges immediately before ovulation occurs.’ A blood test to measure progesterone levels can also confirm ovulation‘the hormone is secreted around day 22 of a 28 day cycle, about a week after the egg is released, to stimulate the thickening of the uterus lining. The doctor may do an endometrial biopsy toward the end of the menstrual cycle but before bleeding begins, to check that thickening of the uterus lining has occurred. The simple procedure is usually carried out at a doctor’s office and requires no anesthetic.

Maximizing Fertility

Taking these steps before trying to conceive will maximize your chances of pregnancy:

‘ Completely stop all intake of alcohol.
‘ Stop smoking and avoid smoky rooms.
‘ Practice good hygiene to avoid infections.
‘ Maintain a healthy weight for your height.
‘ Get rid of excess stressors in your life.
‘ Practice anti-anxiety techniques’deep breathing, prayer, meditation or yoga.
‘ Give your body a chance to re-establish natural periods before you try to conceive, especially if you have recently taken hormonal contraception.
'  Avoid the use of unprescribed medicine 
'   Visit your doctor for medical check up and diagnosis. 

Complied by Clinicgists 

Credit to Women Health Encyclopedia and UCLA health 

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