There is nowhere in the world where
people do not have some ideas about why a woman may become infertile.
Advancing age is among the most important reasons that ordinary people
know about. It is a known fact that conception becomes increasingly
difficult after the age of 35 years. And even during her most fertile
period, many external factors and changes in her life style would play
various roles in determining whether she can have normal and healthy
babies. This worsens as the periods become less regular and the egg
count reduces. It gets even worse as the menopause approaches and while
this important landmark varies very much among women, it is nevertheless
sometime between 45 and 55 years. Some women have become menopausal as
early as 40 while others continue to menstruate into their late 40s or
early 50s. As a result of these facts, advancing age is one of the most
recognised causes of female infertility.
Continue reading after the cut.....
Another common factor is obesity. A woman
who is grossly overweight with a body mass index of 25 to 29.9, or is
frankly obese with a body mass index greater than 30, is at significant
risk of having challenges with her fertility. Such a woman is carrying
extra kilogrammes above what is healthy, and this extra load is known to
adversely affect hormone function. As an extension, this affects the
normal activity of the ovaries with a reduction of the normal cyclical
changes in the ovaries that determine whether they are ready for the
important function of achieving a pregnancy. Women who are obese at the
age of 18 years are more likely to develop polycystic ovary syndrome and
have problems with fertility. This disorder of the ovaries is the most
common hormonal disorder in women of reproductive age. It is thus the
leading cause of infertility among women in that age group.
As women who are obese tend to have
challenges with fertility, so do those who are too thin. Women, whose
body mass index is too low, at 18.5 or less, tend to also have
challenges with getting pregnant. This is because they are lacking in
the hormone that is responsible for controlling hunger and the feeling
of satisfaction. That hormone, called Leptin, contributes to having
absent periods when it is deficient. Therefore, achieving a healthy
weight, something a woman can attain through a combination of smart
feeding and a regular dose of moderate exercise, are two factors a woman
must aim for to increase her chances of getting pregnant.
Certain
chemicals in use at our various homes also play a role in determining
the level of fertility in many women. The presence of these substances
in the home and a woman’s exposure to them are other factors that have
been known to be associated with the onset of premature menopause for
some 40years. They have accordingly been banned in some advanced
countries of the world. In developing countries, however, some of those
chemicals found in plastics and other organic compounds that include
nail polish and perfumes have been implicated. So have pesticides and a
bye-product of industrial combustion called furan. Some of these
compounds have been estimated to decrease fertility levels by nearly 30
per cent in some parts of the world. Some of the countries most commonly
affected by this combination of events are the newly emerging markets
where safeguards are not yet stringent enough to deal with the problem
and where industrial pollution is seen as a major issue. The Bhopal
chemical plants disaster in 1984 in India comes readily to mind, but
then, so does the Fujian chemicals plant explosion in China just last
month. Both incidents left many dead, but the long-term effects will
result in some of the issues being discussed now on this page.
Smoking is another factor that causes
infertility. While that act is not a widespread practice among women in
our part of the world, it is nevertheless important for people to be
aware of the hidden dangers as we continue to westernise in our habits.
Cigarette smoking can damage a developing foetus in a variety of ways,
including causing low birth weight. But among those who are expecting to
get pregnant, that desire is much reduced by the act of smoking. Even
those exposed to secondary smoke are equally at risk. Similarly, the
consumption of alcohol in large amounts is known to predispose a woman
to premature delivery. While there is no evidence that alcohol intake a
few times a week or month would affect a pregnancy, it is nevertheless a
wise thing to be cautious in the first few months of pregnancy. What is
known for sure though is that the heaviest female consumers of alcohol
are more than likely to seek fertility treatment than most other women.
More than one drink a day has been linked to the onset of ovulation
disorders.
A woman is born with a fixed set of
follicles and these are used up over time. The speed with which they are
used up differs widely among different women. As many of the problems
which plague successive generations are found in their parents, it is
often the case that the patient’s mother is quizzed about when she began
and ended her menstruation. The daughters are likely to be very similar
to her in that regard. Because of this, it is important to remember
that the detail missing in the mix may be in the genes.
Certain drugs are known to interfere with
the normal pattern of ovulation. Many such drugs are hormone-based
drugs which are often used for the purpose of birth control, or
sometimes to achieve an abortion. Some of these drugs retain their
function in the system beyond the period stipulated for their
effectiveness. As a result, medications such as the injectable Depot
Provera which is taken every three months, may act in such a profound
manner that even six months after its administration or one year,
fertility remains a distant dream. Some women are able to get pregnant
the month following the effectiveness of the injection. Others are not
able to do so for up to one year afterwards.
Breastfeeding is another activity that
could interfere with fertility. It is a myth that a woman is unable to
get pregnant while she is breastfeeding. The likelihood of a woman being
able to get pregnant while breast-feeding is certainly reduced. In our
traditional setting, women were often sent away from the home when they
were breastfeeding to stay with their mothers so they could be properly
cared for. That model is not easy to extrapolate in relation to what
would happen in a normal setting. At any rate, women who live with their
husbands all through the breastfeeding period tend to have some
protection for the period in which they are breastfeeding their babies
on demand. This pattern subsists for the first three months or
thereabouts. After this time frame, women who do not desire to have a
fresh pregnancy are advised to take some precautions because absolute
safety is not guaranteed any longer.
Extreme physical exercise, especially
among those persons who have suddenly discovered a need to lose weight
or keep fit, can equally impact negatively on fertility. It is good to
exercise in order to keep fit and strong, but exercises that are
prolonged for five hours or more are not ideal in relation to fertility
because such extreme sport is known to adversely affect it. However,
Evelyn Ashford was already three months pregnant when she broke the
women’s 100 metres Olympic record at the 1984 Los Angeles Games and must
have trained very hard for at least an entire year in physically
demanding conditions before then. So, like in everything else, there are
exceptions to the conventional rule. She accordingly, got pregnant even
in the midst of such training.
Thyroid disease is another common cause
of a woman being unable to get pregnant. This is especially true of
women tending towards the end of their reproductive career and those who
are otherwise being investigated for infertility. It is often the case
that under-performance of the thyroid gland is to blame for the woman’s
fertility challenge. In other cases, the cause is thyroid over-activity
as seen in thyrotoxicosis. Sometimes, the associated hormonal changes
are so profound that the menstrual cycle would have no pattern that can
be easily related to. It thus becomes imperative to first treat the
thyroid disease before tackling the fertility problem associated with
it. People with significant thyroid dysfunction will know they have a
problem and seek medical help. For millions of other women, the changes
are very subtle and they will have to see an expert on fertility before
the challenge may be unmasked.
Finally, previous operations performed on
any of the reproductive organs which include the fallopian tubes, the
uterus or the ovaries are likely also to affect fertility. Of course,
the more highly equipped a hospital is, the more likely it will be to
minimise such problems. Besides, if the persons performing the operation
have the requisite training and experience, the adverse effect on
fertility of conducting such operations will be lessened. These
assumptions are made without prejudice to the adverse complications that
can arise, even from the best well-planned operations, where unforeseen
problems like infection and similar cases, may be an additional problem
weighing heavily on the eventual long-term outcome.
Culled - Dr. Sylvester Ikhisemojie/Punch
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