This is the second article of a three-part series on infertility. Last week we looked at male infertility. Today’s issue will focus on female infertility.
To recap, infertility is when a couple fails to conceive after frequent unprotected intercourse for more than a year (or 6 months if the woman is over age 35). About a third of fertility problems are female-related, another third are male-related, and the remaining cases are due to a combination of factors from both partners.
In approximately 20% of couples, the cause cannot be determined. According to the World Health Organisation (WHO), infertility can be described as ‘the inability to become pregnant, maintain a pregnancy, or carry a pregnancy to live birth.’
A woman is born with a finite number of eggs and as the reproductive years progress the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30. This reduction in fertility worsens after a woman reaches 40 years of age. Alcohol, smoking and sexually transmitted infections (STIs) are other risk factors.
For pregnancy to occur successfully, a woman has to ovulate, in other words has to release an egg from her ovaries into the fallopian tube.
Sperm swim up the cervix through the uterus and into the fallopian tube to reach the egg for fertilisation. The fertilised egg travels down the fallopian tube and gets implanted into a thickened uterus. Any disturbance to that delicate process will cause infertility.
Causes of infertility in women
The most common causes of infertility in Namibia are:
Damage to fallopian tubes (tubal infertility) is the most common cause of infertility, mainly due to latent STIs. A woman can be infected with an STI and not feel any symptoms, especially in the case of chlamydia! (Condoms, when used correctly and consistently, can reduce the risk of transmission of STIs.)
Hormonal causes (ovulation disorders). Discuss with your doctor the possibility of high prolactin levels and polycystic ovary syndrome (PCOS).
Cervical causes: structural abnormality of the opening to the uterus.
Uterine and ovary causes. Abnormal anatomy of the uterus, the presence of polyps and fibroids - which are common in black patients and women who fall pregnant late. Ovarian cysts reduce fertility.
Endometriosis. This is a condition resulting from the appearance of endometrial tissue outside the womb and causing pelvic pain, especially associated with menstruation.
Unexplained infertility. The cause of infertility in approximately 20% of couples cannot be determined using currently available methods of investigation.
Some potential questions your doctor or other healthcare provider might ask include:
How long have you been trying to become pregnant?
How often do you have intercourse?
Have you ever been pregnant? If so, what was the outcome of that pregnancy? Miscarriages are significant.
Have you had any pelvic or abdominal surgeries?
Have you been treated for any gynaecological conditions?
At what age did you first start having periods?
On average, how many days pass between the beginning of one menstrual cycle and the beginning of your next menstrual cycle?
Do you experience premenstrual symptoms, such as breast tenderness, abdominal bloating or cramping?
Your menstruation history for least in the last 6 months. Free apps are available on Google store and iTunes to keep a record of menstruation history.
A number of tests can help your doctor to try to diagnose the cause of the infertility. These include:
Ovulation test home-kits are available from most pharmacies. The test is best done on day 14 of 28-day regular period.
Blood test to check your hormone levels. Prolactin and thyroid tests included.
Urine test to check for infections.
Hysterosalpingography (HSG), preferably done on day 7 and diagnoses blockages in the fallopian tubes.
Laparoscopy. A type of surgical procedure that allows a surgeon to access the inside of the pelvis without having to make large incisions in the skin can visualise endometriosis and remove ovarian cysts
Possible Treatment for Infertility
How your infertility is treated depends on the cause, your age, and how long you’ve been infertile. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.
Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before you’re able to conceive. Treatments can either attempt to restore fertility by means of medication or surgery or assist in reproduction with sophisticated techniques.
Dealing with female infertility can be physically and emotionally exhausting, and can put pressure on a couple’s relationship as well. To cope with the ups and downs of infertility testing and treatment, know the journey can be long with many false starts and many disappointments, but be ready to consider other options, such as adoption as early as possible in the infertility treatment process.
This can reduce anxiety during treatments and disappointment if conception doesn’t occur.
* Dr B Chaka is a general practitioner and can be contacted at 065-251373 or email@example.com New Era Reporter
2015-09-21 09:57:17 | 5 years ago