Did you know that infertility is the 5th highest serious global disability?
Approximately 34 million women, mostly from developing countries, have infertility resulting from maternal sepsis and unsafe abortions. Infertility is defined as the inability to become clinically pregnant after 12 months; with regular unprotected sex and without use of contraception.
Before we get into the details of infertility, an important fact is that infertility is not always a woman’s problem; both men and women can have problems that lead to infertility.
Infertility can either be:
- Primary: It refers to when a woman is unable to become pregnant or carry a pregnancy. Women who have spontaneous miscarriages or give birth to still born children are classified as having primary infertility.
- Secondary: This on the other hand, refers to a woman being unable to bear children due to the inability to become pregnant or to carry a pregnancy, either because of a previous pregnancy or a previous inability to carry a pregnancy to a live birth. Women who repeatedly spontaneously miscarry or who have still births are said to have secondary infertility.
What causes infertility in women?
- Ovulation problems: The major cause of infertility in women is having problems with ovulation, which is a natural process in women, during which an egg from the ovaries is released. Without ovulation, there is no egg to be fertilised and therefore, pregnancy is impossible. Ovulation problems can be brought about by ovulation disorders such as:
1. Polycystic ovary syndrome (POCS) which causes hormonal imbalance affecting the ovulation process.
2. Premature ovarian failure, also known as primary ovarian insufficiency, is caused by an autoimmune response or premature loss of eggs from the ovary.
3. Hypothalamic dysfunction which occurs when production of the two hormones that stimulate ovulation; the follicle stimulating hormone (FSH) and luteinizing hormone (LH), is disrupted thereby affecting ovulation.
4. Too much prolactin reduces production of oestrogen which can cause infertility.
- Damage or blockage of the fallopian tubes: It blocks the sperm from getting into the fallopian tube to fertilize an egg or the fertilized egg from moving to the uterus. This can be caused by:
1. Previous surgery in the abdomen or pelvic such as that done for ectopic pregnancy.
2. Sexually transmitted infections such as chlamydia and gonorrhoea which can cause pelvic inflammation.
3. Pelvic tuberculosis, which is a major cause of tubal infertility.
- Uterine or cervical causes which can interfere with implantation or increasing the likelihood of a miscarriage. Uterine and cervical causes include:
1. Endometriosis which causes scarring or inflammation in the uterus and can disrupt implantation
2. Cervical stenosis that is characterised by narrowing of the cervix brought about by inherited malformation or damage to the cervix.
3. Benign polyps or tumors such as fibroids or myomas which can block the fallopian tube affecting implantation and affecting fertility.
4. Uterine abnormalities such abnormally shaped uterus which can cause problems getting pregnant or remaining pregnant.
5. The cervix not producing mucus that enables the sperm to travel into the uterus.
Risk Factors for Infertility
Other factors that can increase the risk of infertility include:
- Smoking which can damage the fallopian tubes and increase the risk of miscarriage and ectopic pregnancy
- Being in the mid-30s when the quality of a woman’s eggs starts to decline
- Excessive alcohol intake
- Sexual history
- Being overweight or obese
For most people, having their own child is of great importance. Infertility makes this hard for others, however, depending on a number of factors such as age, the cause of the disability, the length of infertility and a person’s preference, this problem can be treated.
The treatment option available for women with infertility are as follows:
- Fertility restoration by stimulating ovulation: TOvulation can be stimulated using drugs which work like the natural hormones . In women who ovulate fertility drugs can be used to stimulate better or extra eggs. Examples of these drugs are metformin, letrozole and clomiphene citrate.
- Fertility restoration through surgery: Fertility problems can be corrected through surgeries leading to improved fertility for women. Some of the surgeries that can be used to correct fertility problems are:
1. Laparoscopic or hysteroscopic surgery: Used to remove adhesions, dilate a tube or create a new tubal opening. It can also be used to correct abnormal uterine shape, remove endometrial polyps or fibroids that misshape the uterine cavity and to remove pelvic or uterine adhesion.
- Reproductive assistance: The common methods are:
1. Assisted reproductive technology: Through In vitro fertilization (IVF), mature eggs are retrieved from a woman and then fertilized with a man’s sperm in a dish inside a lab after which the embryos are transferred into the woman’s uterus using an intrauterine insemination catheter. This treatment takes several weeks and requires frequent blood tests and daily hormone injections. The woman takes gonadotropins to trigger the development of more than one egg
2. Intrauterine insemination: When ovulation is near, sperms are placed in the uterus.
Before deciding on which infertility method to use, it is important to talk to a doctor or an infertility specialist so that you are able to choose the right option for you.
It also important to remember that you may need to try several options before you can find one that works for you so you.