#HEALTHTALK 19: Infertility in women

Infertility is the inability of a sexually active couple that is not using any birth control, to get pregnant after about one year of trying.

Infertility can also mean not being able to get pregnant after 6 months of trying, if the woman who is sexually active is over age 35. When a woman keeps having miscarriages, it is also called infertility.

In this part of the world, infertility is blamed on the woman. However, in reality, the men have a higher probability of being the cause of Infertility. This is because, unlike women who are very concerned about their body and easily notice changes, men often aren't so concerned, or are often oblivious about the state of their reproductive health. Plus the fact that the signs can be readily detected earlier in women than in men.

About a third of the time (35%-40%), infertility is because of a problem with the woman. But, a little over one-third of the time (40%), it is a problem with the man.Therefore, before you take a lot of tests and treatment, your partner should have a semen analysis done to make sure his sperm is normal. In some cases (about 20%), no cause is found.

For pregnancy to occur, several things have to happen:

An egg must develop in the woman’s ovary.

The ovary must release an egg each month (ovulation). The egg must then be picked up by one of the fallopian tubes.

A man’s sperm must travel through the uterus to the fallopian tube to meet and fertilize the egg.

The fertilized egg must travel through the fallopian tube and attach (implant) in the lining of the uterus.

If any of these events does not happen, or is disrupted, infertility will result. About 35% to 40% of infertility cases are due to female infertility, but male infertility is a factor in 40%. Therefore, before you have a lot of testing and treatment, your partner should have a semen analysis done to make sure his sperm is normal.

What causes female infertility?

Female infertility can result from age, physical problems, hormonal problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs.

About 25% of women with infertility have infrequent or absent ovulation. These women usually have irregular periods or no periods at all. Ovulation can be disrupted by changes in the way certain hormones are released from the hypothalamus (a part of your brain that releases gonadotropin-releasing hormone [GnRH]) and the pituitary gland (a gland near the base of your brain, releasing luteinizing hormone [LH]). LH and follicle-stimulating hormone (FSH) signal an egg to develop and be released from the ovary.

Hormonal conditions that affect fertility

1.   Problems that interfere with normal LH and FSH release include:

• Injuries to the hypothalamus (a part of the brain that works with the pituitary gland)
• Pituitary tumors
• Weight
• Extreme exercise
• Stress

2.   Polycystic ovary syndrome (PCOS): Here, the ovaries may not release an egg regularly or they may not release a healthy egg.

3.   An overactive or underactive thyroid. 

4.   Diabetes. 

5.   Early menopause/primary ovarian insufficiency: The ovaries stop functioning before natural menopause.

6.   Cushing’s syndrome (a disorder that causes very high levels of cortisol, sometimes called “the stress hormone”). 

Other factors that affect fertility are:

Age: The quality and number of eggs start decreasing from age 35. 

Problems with the reproductive tract:

Blocked fallopian tube. 

Scarring of the uterine lining: Uterine scarring might include a lighter period, “hypomenorrhea” or no period, “amenorrhea”. Scar tissue can cause cyclic pelvic pain from menstrual blood getting trapped in the uterus (Endometritis), leading to recurrent pregnancy loss or an inability to conceive.

Polyps or fibroids in the uterus (Uterine polyps occur when too many cells grow in the endometrium, the lining of the uterus. Fibroids grow in the wall of the uterus),

Endometriosis: Happens when the endometrium (the tissue that usually lines the inside of a woman’s uterus), grows outside it; which could also cause scarring of tissue.

Sexually transmitted diseases such as chlamydia and gonorrhea, that can cause tubal blockages. 

Excessive caffeine, any smoking or alcohol, or recreational drugs like cocaine and marijuana. 

Certain medications like antidepressants, tranquilizers, calcium channel blockers, narcotics, and anti-cancer drugs. 

Chronic medical conditions like kidney disease, liver disease, sickle cell disease, HIV/AIDS, and hepatitis B or C. 

Early Signs of Infertility

Irregular Periods: This means you are not ovulating every month. Statistics show that the primary cause of infertility in women is irregular periods. Regular ovulation is important for pregnancy. Seek help early if you notice this.

Period suddenly stopped when you are not up to the age of menopause. Be very concerned if this is your case because no period means no ovulation, and no ovulation means no pregnancy.

Heavy flow indicates no ovulation: So, if your periods are heavy, you should get yourself checked. 

Blood in the urine or terrible rectal pain

Growth of thick unwanted hair in odd places like your face. This could be an indicator of PCOS (Polycystic Ovarian Syndrome) which means that there are some hormonal imbalances which have led to the formation of cysts, though benign, in the ovaries.

Excessive hair loss: You suddenly begin to lose your hair in chunks, or you've always battled with hair loss. Seek medical attention and get yourself checked.

Poor Sex drive: This maybe due to stress, depression or medical conditions.

Effects of infertility

On the economy, it negatively impacts individual productivity and growth, because the persons involved might be distracted with thoughts of how to reproduce. China's strength and productivity as a nation is linked to this reality. 

Infertility causes emotional trauma for the couple, especially the woman. And in some cases, it brings about divorce in marriages. 

Infertility also stops natural succession, as there won't be further generations, since no new offprings are born.

However, it shouldn't be a source of distress, since the individuals involved can make use of alternative means of having children, including adoption and IVF.

Chisom Deborah Ogbonna is a Biologist in Lagos, Nigeria, and a lead content developer for the #HealthTalk series.

Lilian Uchechi Eze is a Nutritionist-Dietitian and teacher in Lagos, Nigeria. She is also a Lead Content Creator at The Paul Anunaso Blog, and can be reached at lilian.thepaulanunasoblog@gmail.com

Note: The #HealthTalk series is aimed at informing the public in a general sense that is not necessarily professional. Hence, the information provided herein is not meant to replace the appropriate medical guidance of a trained and licensed physician. Doctor's counsels are to be taken in preference.

~  The Paul Anunaso Blog Team