[YOUR HEALTH] Causes of female infertility (1)

The next common reasons for female infertility after endocrine factors, as reported last week, are the following five categories:

Fallopian tubes factors (tubal disorders)

Tubal disease affects approximately 25 per cent of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30 per cent overall, with certain procedures having success rates up to 65 per cent.  The development in IVF has now made it a suitable alternative to tubal surgery.

The main causes of tubal damage include:

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a.       Infection: Caused by both bacteria and viruses and usually transmitted sexually through such diseases as syphilis, Chlamydia and gonorrhoea. These infections commonly cause inflammation resulting in scarring and damage.  A specific example is hydrosalpinx, a condition in which the fallopian tube is blocked at both ends and fluid collects in the tube. A patient with hydrosalpinx going through IVF will have difficulty in conceiving because the fluid can damage the embryo.

b. Abdominal diseases: The most common of these are appendicitis and colitis (inflammation of the colon), high fever as in malaria, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.

c. Previous surgeries: Prior surgery is an important cause of tubal disease and damage. Pelvic or abdominal surgery such as removal of infected appendix can result in adhesions (band of tissues) that alter the tubes in such a way that egg cannot travel through them.

d. Ectopic pregnancy: This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition.

e. Congenital defects: In rare cases, women may be born with abnormalities of the fallopian tubes, usually associated with abnormalities of the uterus (womb).

Endometriosis

Approximately 10 per cent of infertile couples are affected by endometriosis. Endometriosis affects five million American women, six to seven per cent of all females. It has been linked to late marriage due to prior occupation with the busy schedule of work in these women who delay having children till the late mid 30s or early 40s. In fact, 30-40 per cent of patients with endometriosis are infertile. This is two to three times the rate of infertility in the general population.

For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36 per cent. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting.  Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.

Abnormalities of the female reproductive organ

At least 10 per cent of all cases of female infertility are caused by an abnormal uterus.  Conditions such as fibroid, polyps, and adenomyosis (over-enlargement of the endometrium) may lead to obstruction of the uterus and fallopian tubes. Congenital abnormalities, such as septate uterus ( a double cavity uterus), may lead to recurrent miscarriages or the inability to conceive.

Approximately three per cent of couples face infertility due to problems with the female’s cervical mucus. The mucus needs to be of a certain consistency and available in adequate amounts for sperm to swim easily within it. Otherwise, it comes hostile to the sperm. The most common reason for abnormal cervical mucus is a hormone imbalance, namely too little estrogen or too much progesterone.

To be concluded

-Oladapo Ashiru/Punch

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