Female Infertility (2)

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Dr. Francis Obinyan, Ph. D {N.D}

Senior Medical Consultant

Greenlife Medical Center

Email: greenlifemed2@yahoo.com

Tel: 080-5516-9702, 070-6395-8414, 090-2808-6032, 080-9668-3097

BB Ping No. 271A503C

Introduction

I am Pastor {Dr.} Francis Oseremeshan Okoria-Obinyan. I hold Ph. D in Naturopathic Medicine from Kingdom College of Natural Health, New York, USA. I am the senior Medical Consultant of Greenlife Medical Center, Lagos.

As a GP {General Practitioner}, I handle various cases of health or medical conditions prevalent in our times. This ranges from cases such as female and male Infertility, Cancer {Breasts, Lungs, Colon, Prostate Enlargement or Cancer} Uterine Fibroid, Diabetes, BP, Peptic Ulcer, Cardio-vascular Disease or Disorder, Kidney failure or its related conditions, Staphylococcus Aureus, Arthritis and Stroke and so on.

If you have any of these medical conditions or know anyone with any of these lamentable health challenges, you will be doing that person a great favour if you bring this knowledge to the awareness of such person.

You can reach out to us through any of the telephone numbers, WhatsApp, BBM or email above for one-on-one chat before proper clinical diagnostic test of any medical condition you may have come-down with right now.

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FEMALE INFERTILITY (2)

 

Acquired Versus Genetic

This can be examined together. Although causes {or factors} of female infertility can be classified as acquire versus genetic, female infertility is usually more or less a combination of nature and nurture. Also, the presence of any single risk factor of female infertility {such as smoking, mentioned later below} does not necessarily cause infertility, and even if a woman is definitely infertile, the infertility cannot be blamed on any single risk factor even where the risk factor is {or has been identified} to be present.

Acquired

According to the America Society for Reproductive Medicine {ASRM}, age, smoking, sexually transmitted infection {STI}, and factors such as being overweight or underweight can all affect fertility.

In a broad sense, acquired factors practically include any factor that is not based on a genetic mutation, including any intra-uterine exposure to toxins during fetal development, which may arise as infertility many years later in an adult age.

Age

A woman’s fertility is affected by her age. The average age of a girl’s first period {menarche} is 12-13 years in the United States, though this varies slightly from country to country. But in post-menarche girls, about 80% of the cycles are an ovulatory in the first year after menarche, 50% in the third and 10% in the sixth year. A woman’s fertility peaks in the early and mid-twenties, after which it starts declining, with this decline being accelerated after age 35. However, the exact estimates of the chances of a woman conceiving after a certain age are not clear, with research giving different results. The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of the woman and the fertility of the male partner.

 

Tobacco Smoking

Tobacco smoking is harmful to the Ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium. Some damages are irreversible, but putting an end to smoking can prevent further damage.

Smokers are 60% more likely to be infertile than non-smokers. Smoking reduces the chances of IVF producing a live birth by 34% and increase the risk of an IVF pregnancy miscarriage by 39%. Furthermore, female smokers have an earlier onset of menopause by approximately 1-4 years.

Sexually Transmitted Disease

Sexually transmitted diseases are leading causes of infertility. They often display few, if any visible symptoms with the risk of failing to seek proper treatment in time to prevent decreased fertility.

Body Weight and Eating Disorders

Twelve percent of all infertility cases are as a result of a woman either being underweight or overweight. Fat cells produce estrogen, in addition to the primary sex organs. Too much body fat causes production of too much estrogen and the body begins to react as if it is on birth control, thus, limiting the odds of getting pregnant. Too little body fat causes insufficient production of estrogen and disruption of the menstrual cycle. Both under and overweight women have irregular cycles in which ovulation does not occur or is inadequate. Proper nutrition in early life is also a major factor for later fertility. A study in the US indicates that approximate 20% of infertile women had a past or current eating disorder which is five times higher than the general lifetime prevalence rate.

A review from 2010 concluded that overweight and obese sub-fertile women have a reduced probability of successful fertility treatment and their pregnancies are associated with more complications and higher costs. In hypothetical group of 1000 women who underwent fertility care, the study counted approximately 800 live births for normal weight and 690 live births for overweight women and obese anovulatory women. For ovulatory women, the study counted approximately 700 live births for normal weight, 550 live births for overweight and 530 live births for obese women. The increase in cost per live birth in anovulatory overweight and obese women was, 54% and 100% respectively higher than their normal weight counterparts. For ovulatory women they were 44 and 70% respectively higher.

 Chemotherapy

Chemotherapy poses a higher risk in female infertility. Chemotherapies with high risk of infertility include procarbazine and other alkylating drugs such as cyclophosphamide, ifostamide, basulfan, melphalan, chlorambucil and chlomethine. Drugs with medium risk factors include doxorubicin and platinum analogs such as cisplatin and carboplatin.

However, female infertility by chemotherapy appears to be secondary to premature ovarian failure by loss of primordial follicles. This loss is not necessarily as a direct effect of the chemotherapeutic agents, but could be due to an increased rate of growth mutation to replace damaged developing follicles. Antral follicle count decreases after three series of chemotherapy whereas Follicle Stimulating Hormone, {FSH} reaches menopausal levels after four series.  Other hormonal changes in chemotherapy include decrease in inbibin B and anti-Mullerian hormone levels.

Patients may choose between several methods of fertility preservation prior to chemotherapy, including cryo preservation of ovarian tissue, oocyltes or embryos.

Other Factors that can Cause Acquired Infertility

There are several other factors that can cause acquired infertility. These are viz:

{a}     Adhesions

{b}     Diabetes Mellitus

{c}     Significant Liver or Kidney disease

{d}     Thrombophilia

{e}     Cannabis smoking {such as Marijuana. This causes disturbance in the endocannabinoid system, thus, leading to potential cause of infertility.}

Diagnosis

The diagnosis of infertility begins with a medical history and physical examination of the patient. The healthcare provider or doctor may order tests, including the following:

 

Lab Tests

Below is a comprehensive list of the tests that a doctor may request a patient to undergo to determine the exact extent of the infertility and the treatment plans.

{a}     Hormone testing: This measures the levels of female hormones at certain times during a menstrual cycle.

{b}     Day 2 or 3 measure of FSH and estrogen to assess ovarian reserve.

{c}     Measurements of Thyroid Function: A Thyroid stimulating hormone {TSH} level of between 1 and 2 is considered optimal for conception to take place.

{d}     Measure of progesterone in the second half of the cycle to help confirm ovulation.

{e}     Examination and imaging.

{f} An endometrial biopsy, to verify ovulation and inspect the lining of the uterus.

{g}     Laparoscopy, which allows the provider to inspect the pelvic organs.

{h}     Fertiloscopy, a relatively new surgical technique used for early diagnosis {and immediate treatment}.

{i} Pap Smear: This checks for signs of infection.

{j} Pelvic Exam: This seeks to establish for any form of abnormalities or infection.

{k}     A Postcoital Test: This is done soon after intercourse to check for problems with sperm surviving in cervical mucous {not commonly used now because of test unreliabiality}.

{l} Special X-ray Tests. This is called for at the instance of the doctor. The aim is to further establish facts that may not have been identified in the above tests.

There are genetic testing techniques under development to detect any mutation in genes associated with female infertility. In most parts of the world, initial diagnosis and treatment of infertility is usually made by obstetrician/gynecologists or women’s health nurse practitioners. If initial treatments are unsuccessful, referral is usually made to physicians who are fellowship trained as reproductive endocrinologists. Reproductive endocrinologists are usually obstetricians/gynecologists with advanced training in reproductive endocrinology and infertility. These physicians treat reproductive disorders affecting not only women but also men, children, and teens.

 

Prevention

Sometimes, some cases of female infertility may be prevented through identified interventions safety measures. Here below are some of such preventive safety measures.

{a}     Maintaining a Healthy Lifestyle: Excessive exercise, consumption of caffeine  and alcohol, and smoking are all associated with decreased fertility. Eating a well-balanced, nutritious diet, with plenty of fresh fruits and vegetables, and maintaining a normal weight, on the other hand, are associated with better fertility prospects.

{b}     Treating or Preventing  Existing Diseases. “A stitch in time,” says the popular maxim, “saves nine.” This could not be truer in the area of health. A disease condition that is nip in the bud, stands a lesser chance of causing irreversible damage. Therefore, identifying and controlling chronic diseases such as diabetes and hypothyroidism increases fertility prospects. Lifelong practice of safer sex reduces the likelihood that sexually transmitted diseases will impair fertility; obtaining prompt treatment for sexually transmitted diseases reduces the likelihood that such infections will do significant damage to the reproductive system. Regular physical examinations {including Pap Smears} help detect early signs of infections or abnormalities.

{c}     Not Delaying Parenthood: Fertility does not ultimately cease before menopause, but it starts declining after age 27 and drops at a somewhat greater rate after age 35. Women whose biological mothers had unusual or abnormal issues related to conceiving may be at particular risk for some conditions, such as premature menopause, that can be mitigated by not delaying parenthood.

The Menstrual Cycle

During a woman’s monthly menstrual cycle, her body prepares for conception and pregnancy. The average menstrual cycle is about 28 days but anywhere from 21 days to 35 days is considered normal. The menstrual cycle is divided into three phrases, namely: Follicular, Ovulatory and Luteal.

{a}     Follicular:  The follicular phase begins with the first day of menstrual bleeding:

{i} At the start of the follicular phase, estrogen and progesterone levels are at their lowest point. This causes the uterine lining to break down and shed.

{ii}     At the same time, the hypothalamus produces GnRH, which stimulates the production of follicle-stimulating hormone {FSH} and luteinizing hormone {LH}. FSH and LH trigger the production of estrogen.

{iii}    As FSH levels increase, they stimulate the growth and maturation of eggs in the follicles. At 15 – 20 follicles are stimulated, but only one follicle continues to mature.

{iv}    The dominant follicle produces estrogen. The other follicles stop growing and disintegrate.

{b}     Ovulatory Phase: The ovulatory phase occurs halfway through the menstrual cycle {about 14 days after the start of the follicular phase}.  Ovulation, the critical process for conception, occurs during the ovualtory phase. A woman’s fertile period starts about 3-5 days before ovulation and ends between 24 – 48 hours after it. During the ovulatory phase:-

{i} The increase in estrogen from the dominant follicle triggers a surge of LH. As estrogen levels rise, they also prompt the cervix to secrete more mucus to help nourish and propel sperm to the egg.

{ii}     The LH surge signals the dominant follicle to burst and release the developed eggs into the Fallopian Tube. The release of the egg is called ovulation. Once in the Fallopian tube, the egg is in place for fertilization.

{iii}    The egg can live for between 24 – 48 hours after being released. {Sperm can live for 3-5 days}. A woman is most likely to get pregnant if sex occurs in the between 3 -5 days before ovulation or on the day of ovulation.

Luteal Phase: The luteal phase begins immediately after ovulation and ends when the next menstrual period starts. The luteal phase lasts about 12 – 15 days. During the luteal phase:

{i} After releasing the egg, the ruptured follicle closes and form corpus luteum, a yellow mass of cells that provide a source of estrogen and progesterone during pregnancy. These hormones help the uterine lining to thicken and prepare for the egg’s implantation.

{ii}     If the egg is fertilized by a sperm cell, it implants in the uterus and pregnancy begins.

{iii}    If fertilization does not occur, the egg breaks apart. The corpus luteum degenerates, and estrogen and progesterone levels drops.

{iv}    Finally, the thickened uterine lining sloughs off and is shed along with the unfertilized egg during menstruation. The menstrual cycle begins again.

Fertilization and Pregnancy

For pregnancy to take place between couples, conception will occur when an egg is fertilized by a sperm. The so-called “fertile window” is about 6 days long. It starts about 5 days before ovulation and ends the day of ovulation. Fertilization occurs as follows:

{a}     Sperm can survive for 3 – 5  days after they enter the Fallopian Tube. The egg survives for between 24 – 48 hours unless it is fertilized by a sperm.

{b}     The fertilized egg is called a zygote. The zygote immediately begins to divide until it becomes a ball of cells known as a blastocyst.

{c}     The blastocyst moves from the Fallopian tube into the uterus where it is implanted in the uterine lining. Implantation takes place about 6 – 10 days after fertilization. Implantation is when pregnancy begins.

{d}     The inner cells of the blastocyst becomes the embryo, which develops into the fetus. The outer cells of the blastocyst become the placenta. The placenta is a thick blanket of blood vessels that nourishes the fetus as it develops,

Fallopian Tube Blockage

While there are many causes of infertility, a blockage of the Fallopian Tubes is often one of the leading causes or reasons why many women are unable to conceive and carry babies of their own. The Fallopian Tubes are the pathways in which the Ova travel from the Ovaries down into the Uterus, and if there is a blockage in these tubes, it can prevent pregnancy from occurring.

The Fallopian Tubes can sometimes become blocked or even damaged due to certain conditions that a woman may be exposed to health-wise. In rare cases, the blockage to the Fallopian Tubes may have been present at birth arising from a birth defect, but have gone undetected until the woman reached adulthood and now wish to raise a family.

The Fallopian Tubes connect to the Uterus at the utero-tubal junction where the Fallopian tubes open into the uterine cavity. These very thin tubules are lined with cilia, which are fine hair-like cells. From there they extend out and slightly around toward the Ovaries on both side of female body. Infundibulur is the end near the Ovary that is associated with the fimbriae. The fimbriae are a fringe of tissue at the distal end {opening side toward the Ovary} of the Fallopian Tubes. The fimbriae are covered in cilia, which look like tiny hairs. Just prior to ovulation sex hormones signal the fimbriae to fill with blood and move to touch the Ovary in a gentle sweeping motion. When an oocyte {ova} is released at ovulation, the fimbriia and cilia sweep the occyte into the Fallopian Tube to be moved toward the Uterus to wait for fertilization.

The ampullary is the section of lateral tube {central section moving toward the Uterus}. The ampullary is the main part of the Fallopian Tube. From there, it moves inward toward the Uterus the tube narrows into what connected to the Uterus at the utero-tubal junction.

Cells of the Fallopian Tubes: These are affected by hormones. There are two types of cells within the Fallopian Tubes. Ciliated Cells are most abundant in the inundibulume cilia cells in the Fallopian tubes. Scattered between the ciliated cells are peg cells which produce tubular fluid. This fluid contains important nutrients for both sperm, oocyte {ova}, zygotes {fertilized ova}. The secretions also promote capacitation of the sperm. You may not know it, but the sperm cannot mature for complete fertilization without this important fluid. Progesterone increases the number of peg cells. Estrogen increases the height and secretory activity of the peg cells. In addition, tubal fluid flows against the action of the cilia, near the fimbriated end. Not only is progesterone and estrogen balance vital to the menstrual cycle overall, but it is vital to the health and proper function of the Fallopian tubes as well.

Causes of Fallopian Tube Blockage

There are different types of Fallopian Tube blockages. Arising from the fact that Fallopian tubes have different parts, there are also different parts of the tube blocked from one woman to another. Each section has its own name. Doctors have also come to find out that there are patterns of disease or trauma that may affect certain parts of the Fallopian Tubes more than others. Some of these parts are as follows.

{a} Proximal Tubal Occlusion: This involves the isthmus. This can occur after infection such as complications arising from abortion, miscarriage, Cesarean section or Pelvic Inflammatory Disease, {PID}.

{b}     Midsegment Tubal Obstruction of the Ampullary is most often due to tubal ligation damage. Tubal ligation is a surgical procedure that permanently prevents pregnancy from occurring. Some women who have had Tubal Ligation sometimes do change their minds later in life and choose to have this procedure reversed. This can be done surgically. This procedure has 75% pregnancy success rate. However, Tubal ligation removal comes with its own risk. One of such risks is that it leads to the development of more scar tissue on top of the scar tissue already present from the initial tubal ligation procedure.

{c}     Digital Tubal Occlusion is the type of blockage that occurs on the part of the Fallopian Tube end towards the Ovary. This type of blockage is typically associated with hydrosalpinx. Hydrosalpinx is often caused by Chlamydia tranchomatis infection, which is a sexually transmitted disease. Untreated Chlamydia disease is known to cause both pelvic and Fallopian tube adhesions.

In less severe cases only the fimbriae may be damage. They may become stuck together in masses or may be damaged enough to such an extent that it no longer function, thus, resulting in infertility. As mentioned above, the fimbriae have the important role of sweeping the oocyte {ova} into the Fallopian Tube for fertilization. If they no longer function then the oocyte never makes it to its destination for fertilization. This will result in infertility. Where there is a strong indication that the cause of infertility is linked to any of these cases, then Staphitanmadin 7500 TVD Extra +, a top-of-the-brand staphylocculus Auerus  natural organic herbal extracts or supplement is highly recommended to deal with this medical condition. Damage to any part of the Fallopian Tubes can also be caused by Ectopic pregnancy. Pelvic Inflammatory Disease, {PID}, endometriosis, Uterine Fibroids or abdominal surgery is also sometimes

Diagnosing Blocked Fallopian Tubes

Medically there are outward signs that let you know if a woman is suffering from Blocked Fallopian Tubes. If she has ever suffered from Pelvic Inflammatory Disease, there is however a very good chance that her tubes are blocked, as doctors estimate that at least three out of four women who have had a sexually transmitted disease do suffer from Tubal Blockage, especially when poorly or badly managed.

The primary indictor that there is a blockage is an inability to conceive. Fortunately, there are medical tests that detect any abnormalities or blockages. As soon as this becomes necessary, further investigation is generally performed using a Laparoscopy which will help the doctor actually see into the Fallopian Tubes. Here are details on how blocked Fallopian Tubes are diagnosed.

{a} Hysterosalpingogram {HSG}: Hysterosalpingogram is an X-ray test, using a contrast dye to view any obstruction in the Fallopian Tubes. The dye is inserted through a thin tube that is placed up through the vagina into the Uterus. Filling the Uterus with this dye will then spill into the Fallopian Tubes. X-rays are then taken to determine if there is an injury or abnormal shape of the Uterus and the Fallopian Tubes, including obstruction in the tubes. This test is the number one test performed to determine if there is a blockage in the Fallopian Tubes.

{b}     Chromotubation: This test is similar to Hysterosalpingogram because Chromotubation include dye being passed into the Uterus and Fallopian tubes as well. This test is performed during Laparoscopy, so that doctors can see the dye spilling from the Fallopian tube. The dye used for this procedure can be seen on an X-ray. It is blue in colour. This test is considered the most reliable way to determine Fallopian tube blockage, but does require surgery. This is the sad angle of this method of determining Fallopian tubes blockage.

{c}     Sonohysterography: This is a non-invasive procedure where ultrasound imaging is used to determine if there are any abnormalities of the reproductive organs. However, this type of test is not always a reliable way to determine Fallopian Tube Blockage since the Tubes are so small. This test may help to determine hydrosalpinx or other issues such as Uterine Fibroids.

-to be continued