The problem of infertility cannot be undermined, especially in our community where great emphasis is placed on the issue. A wide range of problems cause infertility in women, but I will focus on the structural for today;
About 10 per cent of all cases of female infertility are caused by an abnormal uterus. Conditions, such as fibroid, polyps, and adenomyosis(over enlargement of the endometrium) cause obstruction in the uterus and fallopian tubes.
Fibroid is the most common benign tumour of the uterus (womb).
The word ‘tumour’ evokes fear mainly because it is commonly associated with cancer, however, fibroids are non-cancerous growths that arise from the smooth muscle cells of the uterus, sometimes known as myomas or leiomyomas.
It is different from uterine cancer, but this is not to say they are harmless, as they can cause symptoms that can lead to loss of life.
The cause of fibroid is still not clearly known, but it is believed that certain factors, such as family history, hormones, infertility, age, descent and body weight may influence their formation.
Typically, most women do not know that they have fibroids as it usually does not have symptoms. However, some women may have symptoms like heavy menstrual bleeding, bleeding between periods, painful periods, abdominal swelling, pain or discomfort during sex, constipation, lower back pain, and frequent need to urinate.
The treatment of fibroid depends on whether the patient is having symptoms or not, the desires of the patient involved (for instance, if it is for conception), the size, its location and age of the patient.
Most fibroids stop growing or even shrink as the woman approaches menopause, as a consequence it can be managed by ‘watchful waiting`. In women whose fibroids are large or causing them significant pain, active treatment may be necessary.
Generally, treatment options can be achieved with medications or surgery depending on the extent of the tumour. Anti-hormonal agents that oppose actions of oestrogen and progesterone are sometimes used. Surgical removal of the fibroid also known as myomectomy, involves the removal of the fibroid but leaving the uterus intact to enable future pregnancy.
In some cases where the affected woman has completed her family size, a procedure known as hysterectomy can be done, which involves the removal of the entire uterus.
A newer technique known as uterine artery embolisation involves the blocking off the blood supply to the uterus thereby shrinking them. This is done without a large abdominal incision.
Also, congenital abnormalities, such as septate uterus(a double cavity uterus) may lead to recurrent miscarriages or the inability to conceive.
Some females with abnormal cervical mucus face infertility. The mucus needs to be of a certain consistency and available in adequate amounts for the sperm to swim easily within it. Abnormal cervical mucus is majorly caused by hormonal imbalance, due to too little oestrogen or too much progesterone.
Statistics shows that about 10 per cent of infertile couples have endometriosis. Endometriosis is a medical condition characterised by excessive growth of the lining of the uterus called the endometrium. This growth may occur in the uterus or the abdomen, such as the fallopian tubes, ovaries and the pelvic peritoneum.
Women who delay having children till late or mid 30s or early 40s may have issues of infertility. Most women with endometriosis have their monthly fecundity (chance of getting pregnant) reduced by 12 to 36 per cent.
Symptoms like: heavy bleeding, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting are all associated with this disorder.
However, in some cases there are no symptoms at all, due to the fact that there is no correlation between the extent of the diseases and the severity of the symptoms.
Causes of poorly functioning fallopian tubes
About 25 per cent of infertile couples are affected by tubal diseases and blockage. Treatment for tubal disease is most commonly surgery, advancement in technology has brought about increase in pregnancy rate as high as 30 per cent overall after surgery. The development in IVF has now made it a suitable alternative to tubal surgery. Tubal damage can be caused by:
Sexually transmitted diseases (syphilis, chlamydia and gonorrhoea) caused by bacteria and viruses lead to inflammation of the fallopian tube and result in scarring and damage. For instance, Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube. A patient with hydrosalpnix going through IVF may find it difficult conceiving because the fluid produced can cause damage to the embryo.
They usually cause inflammation of the abdominal cavity, thereby affecting the fallopian tubes and lead to scarring and blockage.
This is an important cause of tubal disease and damage. Pelvic or abdominal surgery, such as appendectomy for someone with appendicitis, can result in adhesions that alter the tubes and hinder the eggs from travelling through them.
Most ectopic pregnancy occurs in the tube, and may cause tubal damage. It is also a potentially life-threatening condition.
In rare cases, women may be born with tubal abnormalities which are usually associated with uterus irregularities.