03/09/2018
INFERTILITY
Infertility simply means inability to get pregnant (conceive).
There are 2 types of infertility Primary and Secondary infertility . The former refers to couples who have not become pregnant after at least 1 year of having s*x without using birth control methods while the latter refers to couples who have been able to get pregnant at least once, but now are unable. There are many causes of infertility which include many physical and emotional factors that may be due to problems in the woman, man, or both.
Female causes
Female infertility may occur when a fertilized egg or embryo does not survive once it attaches to the lining of the womb (uterus);The fertilized egg does not attach to the lining of the uterus;The eggs cannot move from the ovaries to the womb;The ovaries have problems producing eggs. Female infertility may be caused by birth defects that affect the reproductive tract, cancer / tumor, blood disorders[clotting dxs], Diabetes, Alcohol abuse, too much exercise, eating disorders, Malnutrition, Growths (such as fibroids or polyps) in the uterus and cervix, Medicines such as chemotherapy drugs, hormone imbalances, obesity, older age, Ovarian cysts, polycystic o***y syndrome (PCOS), Pelvic infection resulting in scarring or swelling of fallopian tubes (hydrosalpinx) /pelvic inflammatory disease (PID), Scarring from s*xually transmitted infection, abdominal surgery or endometriosis, smoking, Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal (reanastomosis), Thyroid disease.
Major causes
a) Advancing maternal age: Female age-related infertility is the most common cause of infertility today. Especially in our modern era where women are delaying child birth until their thirties and forties, which has lead to the discovery of the adverse effect of advanced maternal age on egg function. Historically before the latter 20th century, women were conceiving in their teens and twenties, when age-related abnormalities with the egg were not evident. For unknown reasons, as women age, egg numbers decrease at a rapid rate. And as aging occurs, egg quality, or the likelihood of an egg being genetically normal, decreases as well. Hence the ability to conceive a normal pregnancy decreases from when a woman is in her early 30s into her 40s. A woman is rarely fertile beyond the age of 45. This applies to the ability to conceive with her eggs, but not with donor eggs.
b) Tubal occlusion (blockage): A history of s*xually transmitted infections including chlamydia, gonorrhea, or pelvic inflammatory disease can predispose a woman to having blocked fallopian tubes. Tubal occlusion is a cause of infertility because an ovulated egg is unable to be fertilized by s***m or to reach the endometrial cavity. If both tubes are blocked, then in vitro fertilization (IVF) is required. If a tube is blocked and filled with fluid (called a hydrosalpinx), then minimally invasive surgery (laparoscopy or hysteroscopy) to either remove the tube or block/separate it from the uterus prior to any fertility treatments is recommended.
c) Ovulation disorders: Normal and regular ovulation, or release of a mature egg, is essential for women to conceive naturally. Ovulation often can be detected by keeping a menstrual calendar or using an ovulation predictor kit. There are many disorders that may impact the ability for a woman to ovulate normally. The most common disorders impacting ovulation include polycystic o***y syndrome (PCOS), hypogonadotropic hypogonadism (from signaling problems in the brain), and ovarian insufficiency (from problems of the o***y).
d) Uterine fibroids: Fibroids are very common (approximately 40% of women may have them) and the mere presence alone does not necessarily cause infertility. There are three types of fibroids: 1) subserosal, or fibroids that extend more than 50% outside of the uterus; 2) intramural, where the majority of the fibroid is within the muscle of the uterus without any indentation of the uterine cavity; and 3) submucosal, or fibroids the project into the uterine cavity. Submucosal fibroids are the type of fibroid that has clearly been demonstrated to reduce pregnancy rate, roughly by 50%, and removal of which will double pregnancy rate. In some cases, simply removing the submucosal fibroid solves infertility. Often, but not always, submucosal fibroids can cause heavy periods, or bleeding between periods. There is more controversy regarding intramural fibroids, where larger ones may have an impact and may necessitate removal. Subserosal fibroids do not affect pregnancy.
e] Endometrial polyps: Endometrial polyps are finger-like growths in the uterine cavity arising from the lining of the uterus, called the endometrium, These abnormalities are rarely associated with cancer (
