Structural, behavioural and environmental causes of female infertility by Prof. Oladapo Ashiru
This article discusses some common factors that cause female infertility. They are structural, behavioural and environmental factors.
Causes of poorly functioning Fallopian tubes
The tubal disease affects approximately 25 per cent of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for the tubal disease is most commonly surgery and, owing to the advances in micro-surgery and lasers, success rates (defined as the number of women who become pregnant within one year of operation) are as high as 30 per cent, with specific procedures increasing success rates by 65 per cent. The development in IVF has now made it a suitable alternative to tubal surgery. The leading causes of tubal damage include:
Infection is caused by both bacteria and viruses and usually transmitted sexually (STI-sexually transmitted infection) such as syphilis, chlamydia and gonorrhea. These infections commonly cause inflammation resulting in scarring and damage. A specific example is Hydrosalpinx, a condition in which the Fallopian Tube (a long structure that carries the egg and where the sperm fertilises the egg) is occluded at both ends and fluid collects in the tube. A patient with Hydrosalpinx, who is going through IVF, will find it difficult to conceive because of the fluid that is produced can damage the embryo.
The most common of these are appendicitis and colitis (inflammation of the colon) causing inflammation of the abdominal cavity, which can affect the fallopian tubes and lead to scarring and blockage.
It is a significant 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 in such a way that the eggs cannot travel through them.
This is a type of pregnancy that occurs in the Fallopian tube itself. Even if carefully and successfully overcome, it may cause tubal damage. It is also a potentially life-threatening condition.
In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.
Approximately 10 per cent of infertile couples are affected by endometriosis. Endometriosis affects about 5 million women in the USA, between six and seven per cent of all females, and it is linked to late marriage due to prior occupation with the busy schedule of work in these women, who delay having children till the late mid-30s or early 40s.
About 30 or 40 per cent of patients with endometriosis are infertile. It is two to three times the rate of infertility in the general population. For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36 per cent.
This condition is characterised by excessive growth of the lining of the uterus called the Endometrium. Growth occurs not only in the womb, but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum. The symptoms often associated with endometriosis include heavy, painful and prolonged menstrual periods, urinary urgency, rectal bleeding, and premenstrual spotting. Sometimes, however, there are no symptoms at all, since there is no correlation between the extent of the disease and the severity of the symptoms.
The long term cumulative pregnancy rates are typical in patients with minimal endometriosis and normal anatomy. Current studies demonstrate that pregnancy rates are not improved by treating minimal endometriosis.
Abnormalities of the female reproductive organ
An abnormal uterus causes at least 10 per cent of all cases of female infertility. Conditions such as fibroid, polyps and adenomyosis (over enlargement of the endometrium) may lead to obstruction of the uterus and Fallopian tubes. Congenital abnormalities, such as the septate uterus (a double cavity uterus), may lead to recurrent miscarriages or the inability to conceive.
…to be continued.