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.
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.
Credit: Dr. Sylvester Ikhisemojie
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