Understanding Causes of Infertility

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Kunle Emmanuel
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Understanding Causes of Infertility

Unread post by Kunle Emmanuel »

Infertility is the inability to conceive after one year of regular, unprotected intimate activity or the inability to carry a pregnancy to term. Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature. If a woman keeps having miscarriages, it is also called infertility. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

A woman’s body must release an egg from one of her ovaries (ovulation).
The egg must go through a fallopian tube toward the uterus (womb).
A man's sperm must join with (fertilize) the egg along the way.
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.

There are strict definitions of infertility used by many doctors. However, there are also similar terms, e.g. subfertility for a more benign condition and fecundity for the natural improbability to conceive. Infertility in a couple can be due to either the woman or the man, not necessarily both.

Infertlity
A couple is considered to be infertile if:
the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34
the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for the age-based discrepancy as when to seek medical intervention)
the female is incapable of carrying a pregnancy to term.

Subfertility
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple's fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome.

Primary vs. secondary infertility
Couples with primary infertility have never been able to conceive, while, on the other hand, secondary infertility is difficulty conceiving after already having conceived (and either carried the pregnancy to term, or had a miscarriage). Technically, secondary infertility is not present if there has been a change of partners.

CAUSES
What causes infertility?Infertility may be due to problems in the female, the male or a combination of both. In some cases, the cause is not known.Some common female factors that may cause or contribute to infertility include:
Damage to the fallopian tubes following infection or surgery;
  • Uterine fibroids;
    High levels of the hormone prolactin;
    Ovulation problems;
    Endometriosis;
    Pelvic inflammatory disease;
    Galactorhoea (milk leaking from the bosoms).
    Amennorhoea (absence of periods).
Hostile cervical mucus. This is a condition in which the cervical mucus creates a thick barrier that sperm cannot penetrate.
Sexually transmitted diseases such as chlamydia;
The production of sperm antibodies (when a woman develops antibodies to her partner’s sperm).

Others are
Male associated infertility
Age-related factors
Uterine problems
Previous tubal ligation
Previous vasectomy
Unexplained infertility
Tuberculosis (TB)

Recent research suggests that psychological issues, such as anxiety resulting from a lack of emotional support, can lead to hormonal problems that affect a woman’s fertility.

Male infertility is often caused by a low sperm count or an anatomical abnormality, such as a palpable dilation of veins in the scrotal area known as varicocoele. Other contributing factors can be attributed to how the sperm move (motility), or an abnormal sperm type. A few reasons for low sperm count include prolonged fever or a recent severe illness, excessive alcohol consumption, endocrine disorders, testicular injury and exposure to toxins, radiation or high heat.
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Re: Understanding Causes of Infertility

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Infertility Caused By Abortion
There is a risk of becoming infertile after an abortion, arising from various complications. If you have had a first trimester abortion (in the first 13 weeks) this is done by vacuum suction which can cause perforation of the womb. This is when the womb ruptures and causes internal bleeding. It is life threatening and the surgeon would be required to do additional surgery to repair the damage. Sometimes after this has occurred, the damage to the womb prevents another embryo from attaching. Rupture happens in about 1% of cases, so if 100 women had an abortion, one of them would have this problem.

The main abortion complications that could cause infertility:
90% of abortions are done in the first trimester. However, a late abortion frequently requires a material called laminaria to dilate the cervix. This makes the passage large enough to allow a suction tube to be inserted. The laminaria could weaken the cervix and conceivably cause infertility.

If the physician scrapes too hard, the lower lining of the uterus can be removed. This is extremely rare.
An untreated infection can scar the uterus and cause later fertility problems. The infection rate for first trimester abortions is less than 1%. Most women monitor their body temperature after an abortion to detect if an infection has occurred. Early detection should prevent any problems.

A woman who already have gonorrhea or chlamydia are very likely to suffer pelvic inflammatory disease which causes infertility. They are particularly susceptible to damage from PID after an abortion. This can be avoided by obtaining a STD test before the abortion.

The suction tube can perforate both the uterus and a large blood vessel or intestine. If the latter happens, then surgery may be required. The surgery can cause infertility. Perforation of the uterus is also quite rare. 2

It would seem that if the physician is competent, and the woman monitors her body temperature after the procedure, that the chances of an abortion causing later infertility is quite remote.
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Re: Understanding Causes of Infertility

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Ultrasound scan is a simple and easy outpatient procedure to examine the internal reproductive organs. It can clearly show the position and size of uterus, endometrial lining and the ovaries. Certain abnormal conditions such as fibroid, double uterus and ovarian cyst can be diagnosed through ultrasound scan alone. In addition, ultrasound scan can be used for the diagnosis of ovulation.

Ultrasound scan appears as a routine practice in the management of infertility, from the initial stages of diagnosis of the cause of infertility, to the eventual confirmation of pregnancy, including routine monitoring of early pregnancy. Ultrasound scan is probably the most important test in investigation of infertility. A well-preformed and detailed ultrasound scan of the female pelvis will give more information than any other single test.
[a] Transvaginal Scan for Uterine and Ovarian function
Folliculometry [Follicular tracking]
[c] Sonohysterography [SonoHSG]

[2] HSG [X-Ray] Study to evaluate the uterine cavity and fallopian tubes
[3] Fluid analysis
[4] Post-coital cervix test
[5] Sperm migration tests
[6] Ovulation tests
[7] Cervical mucus tests
[8] Hormone blood tests
[9] Uterus examination tests
[9] Fallopian tube examination tests
[10] Laparoscopy
[11] Laparotomy

Typically, couples are seen together when diagnosing infertility. The doctor will take a note of the couples' full medical histories and this will be followed by an examination. They will also be asked about the use of prescribed or illegal drugs, alcohol and tobacco, and whether there is a family history of infertility or genetic disorders.
Women can expect questions about their menstrual history, including the age of onset and any difficulties with menstruation. They also will be asked whether they have noticed milk leaking from their bosoms.

Women may have to undergo a genital examination, as well as a cervical smear. Blood tests are taken to measure prolactin levels and thyroid function and sometimes to test for certain hormone levels, such as progesterone and oestradiol. A post-coital test, which is similar to a cervical smear, may be required to see if the sperm can penetrate the cervical mucus. Sometimes an ultrasound scan of the pelvis is taken to check for fibroids in the uterine cavity. A laparoscopy also may be performed, in which a lighted camera is passed through a hole in the abdomen to look at the pelvic structures. Occasionally, a hysteroscopy is required, in which a thin, lighted tube is passed into the uterus to directly examine it.

Men will be required to provide a Fluid analysis. They must abstain from intimate intercourse for three days before providing the sample. If the initial sample is abnormal, another will be required. The volume of Fluid, the sperm count, how the sperm move (motility), as well as the presence of immature sperm are checked. If the second sample is abnormal, your doctor may advise the man to have a genetic blood test is performed to make sure that there are no chromosomal abnormalities or defective genes that could be passed on to potential offspring. Blood tests also may be taken to determine levels of testosterone.
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Re: Understanding Causes of Infertility

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Increasing your chances naturallyIf you have been having trouble conceiving do not give up hope, as spontaneous pregnancy may occur on its own. In many cases, couples are simply not having enough sex at the right time to conceive. To increase the chance of getting pregnant, intercourse should take place around the time of ovulation.

For women with a regular 28-day cycle, ovulation occurs around day 13-15. Women with irregular periods will find it more difficult to pinpoint their most fertile time. Some over-the-counter tests can help you determine the best time to conceive, although no products are guaranteed to be 100% accurate. Indications for ovulation include a rise in body temperature and a thinning of the cervical mucus. A female egg lives only twelve hours, however sperm can survive in the female genitals for close to 72 hours. Sperm that are waiting in the female genitals can immediately fertilise the eggs once ovulation begins so you will increase your chances by having regular sex for a few days before ovulation.

Lubricants that contain spermicides, such as K-Y Jelly, should be avoided.

In situations where a woman develops antibodies to her partner’s sperm, the use of a condom for thirty days may allow time for the antibodies to decrease and intercourse should then take place during ovulation.
Infertility drugs. If timing intercourse around ovulation does not work, a general physician may then prescribe various courses of treatment, such as stimulating ovulation with a drug called Clomiphene. Side effects include hot flushes, womanly dryness and ovarian cyst formation. The number of eggs that you release cannot be controlled precisely so there is a chance that several eggs could be released at once thereby increasing your risk of multiple pregnancy. Other drug treatments include the use of either Bromocriptine or Cabergoline, which act to reduce the levels of prolactin. Check with your general physician about possible side effects of any drug prescribed.

What about assisted reproduction techniques?
There are several ways of bringing sperm and egg together to achieve fertilisation.
The most commonly performed procedures are IUI (Intrauterine Insemination), IVF (In vitro fertilisation) and ICSI (Intra cytoplasmic sperm injection).

Hope this information help someone. Share your experience here on this forum so others may learn from you.
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Re: Understanding Causes of Infertility

Unread post by Christy »

Some patients presenting for infertility diagnosis due to unexplained reasons often are discovered to have fibroids during the associated pelvic examination. These patients show little or no symptoms or signs. Other patients however show signs ranging from increased uterine bleeding at menses to signs associated with pelvic pain pressure and pain. The severity of the symptoms is related to the number, size, and location of the fibroids. These signs and symptoms will be explored in a latter blog. Of major concern is how fibroids may cause infertility. Fibroids may cause infertility in a number of different ways.
1) A fibroid may cause compression on the fallopian tubes (blockage of these tubes due to fibroids and other causes is a major cause of infertility and associative IVF treatment) resulting in a blockage of the passage of sperm or eggs. A large fibroid (some large fibroids can be as big as a basketball or football) may distort the pelvic anatomy sufficiently to make it difficult for the fallopian tube to capture an egg at the time of ovulation.
2) If a fibroid protrudes into the uterine cavity or causes distortion of the uterine cavity, it may present a mechanical barrier to implantation.
3) Some studies have suggested that fibroids in the muscle portion of the womb may cause an alteration or reduction of blood flow to the lining of the making it more difficult for an implanted embryo to grow and develop.
4) Another theory suggests that even small fibroids that grow inside of the cavity of the womb may act as a foreign body and result in an inflammatory reaction that makes the environment of the womb hostile for an embryo to implant.
Some of these same possibilities may also increase the risk of an embryo to miscarry. Since fibroids especially the large ones are space occupying, miscarriage can also occur due to “running out of space” as the fetus grows. Furthermore, some studies have suggested a slightly increased risk of certain problems during pregnancy in women with very large fibroids, including difficulties with labor, breech presentation of the fetus, premature rupture of the “bag of waters”, and abruptio placenta (a condition in which the placenta separates from the uterine wall during the pregnancy). These problems are more likely if the placenta is implanted over the area of the large fibroid. However, many women with fibroids have completely normal pregnancies and deliver healthy babies with no complications. Next on our blog: Fibroid treatment.
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Re: Understanding Causes of Infertility

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Natural ways to address root causes of infertility

Have an STD check
Most people believe both they and their partner are free from sexually transmitted diseases. However, there are some STDs which can be asymptomatic, meaning that you may not be aware you have them, as there are no obvious symptoms. One such STD is a Chlamydia infection.

In men, a Chlamydia infection can lead to sperm abnormalities, including sperm antibodies. In women, it can lead to scarring, blocked tubes and miscarriage.

A study found 60 per cent of asymptomatic male partners of infected females attending a fertility clinic were found to be infected with Chlamydia. Most STDs are easy to treat, so it pays for both partners to have an STD check. There is no point in only one partner going for a test, as the other partner can re-infect.

Allow for 120 days before trying to conceive

There is a common misconception that egg and sperm quality cannot be improved. In fact, it is possible to improve the quality of your egg and sperm. However, it takes 120 days. This is because it takes approximately 120 days for eggs to mature and sperm to develop. During the generation and maturation of gamete cells (sperm and ovum) that form an embryo, everything that you and your partner ingest, inhale or are exposed to will influence the health of your eggs and sperm — for better or for worse — and the ultimate quality of the genetic building blocks you pass onto your child.

This is why it’s crucial to follow a good preconception plan for a minimum of four months before conception. A baby is a 50-50 product of his or her parents; therefore, optimising the quality of eggs and sperm is of paramount importance.

Sperm disorders contribute to 40 per cent of infertility cases. Women who suffer from recurrent miscarriages often have partners with low sperm count and visually abnormal sperm. Therefore, both partners should detox, follow a fertility diet, take preconception supplements and avoid reproductive toxins discussed in this article for a minimum of four months before conception.

Avoid coffee, smoking and alcohol
You may not want to hear this, but drinking coffee decreases fertility. A large study from Connecticut, United States of America, found as little as one cup of coffee per day increases the risk of not conceiving by 55 percent. And if you have two or three cups per day, that risk rises to 100 percent and continues to increase with an additional cup up to 176 percent.

And did you know that women who drank coffee before and during pregnancy had twice the risk of miscarriage?

Alcohol is harmful to women’s eggs and men’s sperm and as little as one glass can reduce fertility by 50 percent! This can further lead to damage of the developing embryo and may result in miscarriage. And although it’s been known for a long time that drinking while pregnant is a no-no, drinking before pregnancy has been largely ignored. This doesn’t stop with coffee and alcohol.

Smoking and recreational drugs can also reduce your odds of conception. A study tested the effects of cigarette smoking on semen quality in men and found that sperm motility (ability to propel forward) decreased in light smokers, while heavy smoking produced abnormal sperm shape.

Scientists have discovered that quitting smoking may increase sperm count in men who quit smoking for between five and15 months by 50 percent to 800 percent respectively.

Use good preconception/pregnancy supplement
Regardless of whether you are eating organic produce and a healthy diet, you are unlikely to be getting all the nutrients your body needs for optimal fertility from your diet. This is why supplementation is important.

Getting pregnant and growing a new human being with your own reserves require a surplus of nutrients and energy. In your body’s accounting terms, pregnancy is a luxury, a splurge of energy and nutrients. Some of the key nutrients for fertility are zinc, selenium, magnesium, calcium, B12, B6, Folic acid, Vitamin C, and Omega-3 fats.

IVF vs. root cause of infertility
Conventional IVF and other assisted reproductive technology treatments don’t address root causes of infertility. These root causes include nutritional deficiencies, toxin exposure, stress, food intolerances, allergies and immune deficiencies. These subtle but critical factors interact synergistically to impact the quality of your eggs and sperm, affecting your ability to conceive and the health of your embryo.

Financial cost of IVF
Recent media reports of grandparents funding their children’s IVF treatments in the hope of a grandchild illustrate the financial strain these treatments can pose to couples. While celebrities and wealthy couples can afford it, many struggle with treatments costing thousands of dollars ($5,000-$150,000 per live birth is typical).

IVF, the last option

IVF should be the last option after all natural treatment options have been exhausted. It should never be the first option. The rate of success of IVF is, on the average, 25 percent per single attempt. Studies show that by following a natural preconception programme prior to attempting IVF, the success rate increases to 47.1 percent per single attempt.

I always advise couples to undertake a preconception programme as a first step and reserve IVF as a final option. Most infertility can be treated without IVF. However, if IVF is needed, the success rate of each attempt is nearly doubled by combining it with a natural preconception programme.
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Re: Understanding Causes of Infertility

Unread post by Aunty Nurse »

DID YOU KNOW? Only 50% of couples trying for conception get pregnant in less than 6 months. The remaining half get pregnant from 6 months of trying without having any fertility problems. So ladies, do not panic....just keep trying and remember to have fun while trying!
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