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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Infertility in Women

Dr-Sascha-Edelstein_smallInfertility is becoming a common medical issue for most modern women. This article takes an expert medical look at the problems associated with infertility and the solutions available. 

According to Dr Sascha Edelstein, a Cape Town-based specialist Obstetrician and Gynaecologist, with a subspecialist certificate in Reproductive Medicine, infertility is defined as “the inability to conceive after one year of regular unprotected intercourse”.

Dr Saleema Nosarka, a Reproductive Medicine Specialist at the Cape Fertility Clinic says that the reason female fertility is such a hot topic lately is because “women are delaying child bearing due to their careers as well as financial constraints and thus as you get older your egg quality decreases and your chance of conceiving is much less.

“Also women are more aware of fertility issues these days and thus younger women seek help sooner.”

Dr Edelstein says that there has been a noticeable increase in fertility issues recently, for a number of reasons ranging from general health issues, such as obesity and the rise in sexually transmitted diseases.

There are six issues which can affect female fertility; we spoke to the experts to find out what they are and what solutions are available to deal with them:

Advanced maternal age

One primary influence over a woman’s fertility is her age. This is because the older a woman gets, the more her ovaries deteriorate, which is why the best age to fall pregnant, when your ovaries are at their ‘healthiest’, is between 23 and 31 years of age. Although this varies from woman to woman, most experts agree that after the age of 35 fertility decreases and it will become increasingly difficult to fall pregnant.

Women are also born with only a finite number of eggs, known as oocytes, which decline in quantity and quality over time. According to research, the decrease in the number of eggs in the ovaries gets rapidly worse after the age of 37, which not only presents issues with conception, but also increases the risk of miscarriage and chromosomal abnormalities should conception occur.

Dr Nosarka says that while this is a problem which cannot really change, and the fact that egg quality declines from the age of 35, the best option is to try for a baby when you’re younger and your ovaries and eggs are in prime condition.

Anovulation

This basically means that the body does not produce an egg every month, explains Dr Nosarka. So while a woman may continue to have her monthly period, anovulation means that she did not ovulate during that menstrual cycle and is thus infertile for that particular month.

Dr Edelstein adds that “for ovulation to occur, a complex interplay is required between the hypothalamus and pituitary gland within the brain and the ovary. Under the influence of the hypothalamus, the pituitary gland releases hormones that act on the ovary.

“This hormonal orchestra can be disrupted by both metabolic and psychogenic stressors, including sufficient weight loss and strenuous exercise. This picture of anovulation is frequently seen in athletes, dancers and eating disorders.”

When anovulation occurs, the ovary does not allow a follicle to rupture and then release an egg cell into the fallopian tube. The symptoms of anovulation are usually irregular menstrual cycles.

With anovulation it is still possible that you can have what may appear to be a period despite the fact you’re not ovulating, but the bleeding is different and can be markedly heavier or lighter than usual. This bleeding might be what’s known as oestrogen withdrawal bleeding, or could occur when the lining of the uterus builds to an unsustainable level and then begins to disintegrate.

It can occur for a number of different reasons including natural life phases such as during pregnancy or menopause or while breastfeeding, it could be down to temporary influences such as stress, travelling or coming off the contraceptive pill or it could be down to a medical condition.

Anovulation is fairly easily treated and if diagnosed in time can have a positive impact on fertility. From basic lifestyle changes such as a healthy, balanced diet with exercise and reduced stress to medications to induce ovulation, and in extreme cases, surgery to remove part of the ovaries, anovulation can be alleviated.

Endometriosis

Dr Edelstein describes endometriosis as, “a chronic disease that results in lesions of the reproductive tract” resulting in pain and often infertility.

“It is a common condition, which affects between 10 and 15% of women of reproductive age. Although the causes of endometriosis aren’t fully understood, it’s associated with a dysfunction of the immune system,” he says, adding that, “both stress and mood disorders are known to affect the immune system, increasing susceptibility to inflammatory diseases. Several studies have found that women with endometriosis suffer from anxiety related disorders more than women with other causes of infertility.”

Although the cause of endometriosis is still unknown and as yet there is no cure, doctors believe that the reasons it might contribute towards fertility problems stem from abnormal hormonal function, irregular intercourse (due to pain), abnormal ovulation, affected sperm transportation, anatomical distortion with tubal blockage, impaired immunological function, and ovarian damage following surgical treatment.  

Treatment includes laparoscopic surgery to remove any abnormal tissue or to unblock tubes as well as assisted conception treatments. Ironically, women with endometriosis are often advised to try fall pregnant as soon as possible as the more the disease progresses, the more likely it is to cause infertility and pregnancy may also lead to a remission of endometriosis.

Tubal disease

Dr Edelstein says that tubal disease is also a common cause of female fertility problems. “It frequently occurs as a result of pelvic inflammatory disease, particularly with Chlamydia or Gonorrhoea.”

The prevalence of sexually transmitted infections has increased with the reduction in age at first intercourse.

“Unfortunately, sexually transmitted infections are frequently asymptomatic and many women only become aware of the existence of tubal disease when they try to conceive,” he says.

Tubal disease is also one of the most common reasons for female infertility worldwide and most often occurs as a result of pelvic inflammatory disease (PID), which is an infection of the upper genital tract and can affect the uterus, fallopian tubes and ovaries. It most often occurs when sexually transmitted bacteria move up from the vagina through the cervix into the upper genital tract.

Conventional methods used to treat tubal disease include tubal ligation reversal, surgery of damaged fallopian tubes, or by In Vitro Fertilization (IVF).  However they’re all quite expensive and there is no guarantee they will work.

Polycystic ovarian syndrome

Dr Edelstein describes polycystic ovarian syndrome (PCOS) as the most common endocrinopathy in women of reproductive age, effecting between seven to 10% of women.

“Obesity is also on the rise and an increase in body mass has a negative impact on women with PCOS. In addition to the metabolic complications, obesity leads to anovulation in women with PCOS,” he adds

PCOS is a hormonal disorder which includes symptoms such as irregular or no periods, acne, obesity and male-pattern hair growth.

Another sign of PCOS is that women with the condition do not ovulate, meaning they do not release an egg on a monthly basis which contributes to their irregular periods and thus affects fertility. It can also put them at risk for endometrial cancer.

The good news, however, is that this condition can be managed through either birth control medication and/or a healthy diet and exercise, most of the symptoms can be controlled too.

Fertility can be achieved with ovulation inducing agents, laparoscopic ovarian drilling (surgery) or IVF treatment.

Uterine fibroids

According to Dr Nosarka, uterine fibroids are also a common cause for female fertility problems.

Uterine fibroids are nodules of muscle cells and fibrous connective tissue that develop within the wall of the uterus which grow as a single nodule or in clusters. Experts estimate that roughly to 20 to 30% of women of reproductive age have fibroids, but not all have been diagnosed.

While the exact cause of uterine fibroid tumors is unknown, fibroid growth may depend on the hormone oestrogen. Which is why when the oestrogen and progesterone levels begin to decrease at menopause, the symptoms of uterine fibroids also begin to disappear.

The bad news is that fibroids may cause infertility in a many different ways from interfering with the ovulation process to blocking the tubes and preventing fertilisation of the egg to causing a miscarriage.

Dr Nosarka says the best solution for uterine fibroids is usually surgery to have them removed if they are threatening fertility.

Lifestyle choices that affect fertility

Both Dr Nosarka and Dr Edelstein agree that lifestyle plays a big part in female fertility and advocate adopting a healthier way of life if you’re planning on starting a family or having trouble with fertility.

“Patients who are overweight or underweight generally don’t ovulate regularly and this can lead to infertility. Stress is also a contributing factor as can delay having children,” says Dr Nosarka.

She advises eating healthy and maintaining a healthy weight and body mass index (BMI), as well as avoiding too much caffeine, smoking and alcohol.

Dr Edelstein adds that one cannot underestimate the impact that stress plays on fertility as well, which is why a healthy lifestyle with a balanced diet and exercise will help counter this too.

Support groups

Dr Sascha Edelstein, Fertility Specialist: Phone 021 -424-0670 or visit www.fertilityspecialist.co.za/

Cape Fertility Clinic: Phone 021-674-2088 or visit www.capefertilityclinic.co.za

Fertilicare (online fertility support forum): Visit http://www.fertilicare.org/

Get Pregnant (online fertility shop): Visit http://www.getpregnant.co.za/

Fertility Care SA: Phone 021-403-6592 or visit http://www.fertilitycaresa.com/

MedFem Clinic: Phone 011 463 2244 or visit http://www.medfem.co.za/