Female Infertility (1)

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Definition

Today in this country, and of course, other parts of the world, infertility {both male and female} is on the increase. In some cases, especially amongst female within the reproductive age brackets, this sad development has assumed a very disturbing dimension. Men of course, are not spared of this medical health challenge of our time. However, this article is all about female infertility. Interestingly however, as a General Practitioner {GP}, I have the rare privilege of handling both male and female infertility with remarkable degree of successes in my practice. Therefore, those men who are suffering from various forms of infertility {Impotency, Erectile Dysfunction, Weak Erection, Low Sperm Count, etc.}, are advised to reach out to us for close clinical examinations of their medical health challenges with a view of availing themselves of our services.

Research findings available in medical cycles have shown clearly that a number of reasons are responsible for the rising profile of female infertility in this country today. One of the most outstanding factors that had been visibly implicated in this regard is our lifestyle. Our increasing embrace of Western lifestyles, our unbridled passions for denature foods, otherwise referred to as “junk foods” has done incalculable harm to the lives of many innocent young men and women in our midst today. Another important factor that has also been implicated as contributing factor is the indiscriminate use of contraceptives by the young female victims of primary or even secondary infertility.Today in this country, and of course, other parts of the world, infertility {both male and female} is on the increase. In some cases, especially amongst female within the reproductive age brackets, this sad development has assumed a very disturbing dimension. Men of course, are not spared of this medical health challenge of our time. However, this article is all about female infertility. Interestingly however, as a General Practitioner {GP}, I have the rare privilege of handling both male and female infertility with remarkable degree of successes in my practice. Therefore, those men who are suffering from various forms of infertility {Impotency, Erectile Dysfunction, Weak Erection, Low Sperm Count, etc.}, are advised to reach out to us for close clinical examinations of their medical health challenges with a view of availing themselves of our services.

Most times, you find that many of these victims, during their singlehood days were engaged in indiscriminate use of contraceptives to outright abortions in their attempts to avoid unwanted pregnancies. Some of these abortions, as evidence has shown turned out to be very unsafe. Unknown to them, some of these abortions have been carried out by quack doctors who were not skilled in this medical field, thus, resulting in the damage of some delicate reproductive organs in the body. By the time they later get married, they come down with various complex medical conditions that turn out to be too costly to manage or handle on the long run. In this article, we shall be looking at specific causes and symptoms of this lamentable disease condition and the remediating methods in medical cycles in resolving each of the various types of female infertility.

But what exactly is female infertility? Like in most discipline, there are no universally accepted definitions of female infertility. However, leading professional views opine that “a woman of reproductive age, who has not conceived after one year of unprotected vaginal sexual intercourse, in the absence of any known cause of fertility, should be offered further clinical assessment and investigation along with her partner.” At this stage in the life of such couples or individual, it is important or needful to seek the assistance of Fertility Specialist for a thorough diagnostic examination.

According to professional views, this examination should be more needful “if the woman is 35 years old or over. This becomes more compelling if there is a known clinical cause of infertility or a history of predisposing factors of infertility in the family. In most part, infertility affects both partners. In practice, when diagnosing a female partner with infertility problem, it is often needful to also test the male partner at the same time.”

According to the New International Standard Medical and Health Encyclopedia by Richard J. Wagman, M.D., “it is estimated that as high as one in 10 couples cannot conceive a child. There is an estimated 1.8 million women in the United States who are classified as infertile which is about 5 per cent of the female adult population of reproductive years.”

Infertility is usually a medical problem that “stems from male reproductive system about 40% of the time. It is often a combination of medical problems shared by both partners in a relationship or marriage union. Here, in this article, our focus is on female infertility.

Primary or Common Causes or Risk Factors of Female Infertility

Female infertility may be caused by an underlying medical condition that damages the Fallopian Tubes, interferes with ovulation, or causes hormonal complications. These medical conditions include:

{a}     Pelvic inflammatory disease, {PID}.

{b}     Endometriosis

{c}      Polycystic ovary syndrome

{d}     Premature ovarian failure

{e}     Uterine fibroids.

 

Pelvic Inflammatory Disease, {PID}

Pelvic Inflammatory Disease, {PID} is an infection of the female reproductive organs. PID is one of the most serious complications of the sexually Transmitted Disease in women. It can lead to irreversible damage to the Uterus, Ovaries, Fallopian tubes or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

There are many predisposing factors that cause PID. Normally the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a sexually transmitted disease – such as gonorrhea and or Chlamydia, the cervix itself becomes infected and less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. When left untreated, gonorrhea and Chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.

What are the Symptoms of P.I.D

The symptoms of PID can vary, but may include the following:

{a}     Dull pain or tenderness in the stomach or lower abdominal area, or pain the right upper abdomen.

{b}     Abnormal vaginal discharge that is yellowish or greenish in colour or that has an unusual offensive odour.

{c}      Painful urination.

{d}     Chills or high fever.

{e}     Nausea and vomiting.

{f}      Pain during sex

Endometriosis

What is endometriosis? Endometriosis is a gynecological condition in which cells from the lining of the uterus {endometrium} appear and flourish outside the uterine cavity, most commonly on the membrane which lines the abdominal cavity, the peritoneum. The uterine cavity is lined with endometrial cells, which are under the influence of female hormones. Endometrial cells in areas outside the uterus are also by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms of the endometriosis are pain and infertility. The pain often is worse with the menstrual cycle and is the most common cause of secondary dysmenorrheal. Endometriosis was first identified by Baron Cal von Rokitansky in 1860.

Endometriosis is typically seen during the reproductive years. It has been estimated that endometriosis occurs in roughly 6-10% in women. Symptoms may depend on the site of active endometriosis.  Its main, but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility. It has a significant social and psychological impact on ladies with this medical condition.

About a year ago, a young lady banker who has lost two marriage proposals came to me with this medical challenge, almost in tears. She was visibly disturbed about her bad luck. According to her, she has passed through series of tests and treatments, yet her condition did not seem to mitigate. During her menstrual cycles, she said, the pains that occasion her menstrual cycle “was like hell!” After going through her past medical reports and subsequently carrying out physical examinations of her condition, I recommended few other tests to establish the current status of her case. After these preliminary tests were carried out, I commenced treatment with my customized treatment plan and within a record time, she began to notice improved condition. The first improvement she noticed, she said to me on the phone was that the pains “went down” within few days that she commenced my treatment.  Shortly afterwards, other improvement followed.

OK

 

 

Signs and Symptoms

One of the major symptoms of endometriosis is recurring pelvic pain. The pain can range from mild to severe or stabbing pain that occurs on both sides of the pelvis, the lower back and rectal area, and even down the legs.

The amount of pain a women feels correlates poorly with the extent or stage {I through 4} of endometriosis. Sometimes some women have little or no pain despite having extensive endometriosis or endometriosis with scarring while other women may have severe pain even though they have only a few small areas of endometriosis. Symptoms of endometriosis related pain may include:

{a}     Dysmenorrheal: Painful, sometimes disabling cramps or menses. Pain may get worse over time {progressive pain} may also be experienced at the lower back linked to the pelvis.

{b}     Chronic Pelvic Pain: This is typically accompanied by lower back pain or abdominal pain.

{c}      Dyspareunia: Painful sex.

{d}     Dysuria: Urinary urgency, frequency, and sometimes painful voiding. Throbbing, gnawing, and dragging pain to the legs are reported more commonly by women with endometriosis. Compared with women with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of insides being pulled down.

In individual, pain areas and pain intensity appears to be unrelated to surgical diagnosis, and the area of pain unrelated to area of endometriosis. Endometriosis lesions react to hormonal stimulation and may “bleed” at the time of menstruation. The blood accumulates locally, causes swelling, and triggers inflammatory responses with the activation of cytokines from adhesions {internal scar tissues} binding internal organs to each other, causing organ dislocation.

Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be bound together in ways that a painful on a daily basis, not just during menstrual period may be experienced by patients. Sometimes, endometriosis lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the central nervous system, potentially producing a variety of individual differences in pain that can, in some women, become independent of the disease itself.

Polycystic Ovary Symptoms

What is Polycystic Ovary Syndrome? What causes it? How many women may have it? These are some of the reoccurring questions that go on the minds of most women within reproductive age brackets across the nations of the world.

Polycystic Ovary Symptoms, {PCOS} is one of the common or primary endocrine disorders amongst females. PCOS has a diverse range of causes that are not entirely understood, but there is strong evidence that it is largely a genetic disease. PCOS produces symptoms in an approximately 5% – 10% of women within the reproductive age brackets globally. That is women within the ages of 12 – 45 years old. It is thought to be one of the leading causes of female sub-fertility and the most frequent endocrine problem in women of reproductive age.

The most common immediate symptoms are anovulation, excess androgenic hormones, and insulin resistance. Anovulation results in irregular menstruation, amenorrhea, and ovulation-related infertility. Hormone imbalance generally causes acne and hirsutism. Insulin resistance is associated with obesity, Type II Diabetes, and high cholesterol levels. The systems and severity of the syndrome vary greatly among affected women.

Causes

Polycystic Ovary Symptoms is often a heterogeneous disorder of uncertain etiology. There is strong evidence that it is a genetic disease. Such evidence includes the familial clustering of cases, greater concordance in monozygstic compared with dizygotic twins and heritability of endocrine and metabolic features of PCOS.

The genetic component appears to be inherited in an autosomal dominant fashion with high genetic penetrance but variable expressivity in females; this means that each child has a 50% chance of inheriting the predisposing genetic variants{s}, the daughter will have the disease to some degree. The genetic variant{s} can be inherited from either the father or the mother, and can be passed along to both sons {who may be asymptomatic carriers or may have symptoms such as early baldness and or excessive hair} and who will show signs of PCOS.

Signs and Symptoms

Here are some common symptoms of PCOS.

{a}     Menstrual Disorders: PCOS mostly produces oligomenorrhea, {few menstrual periods} or amenorrhea {no menstrual periods}, but other types of menstrual disorders may also occur.

{b}    Infertility: This generally results directly from chronic anovulation {lack of ovulation}.

{c}      High Levels of Masculinizing Hormones: The most common signs are acne and hirsutism {male pattern of hair growth}, but it may produce hyper-menorrhea {very frequent menstrual periods}, androgenic alopecia {increase hair tinning or diffuse hair loss, or other symptoms. With PCOS {by the diagnostic criteria of {NIH/NICHD 1990} have evidence if hyperandrogenemia.

{d}     Metabolic Syndrome: This appears as a tendency towards central obesity and other symptoms associated with insulin resistance. Serum insulin, insulin resistance andhomocysteine levels are higher in women with PCOS.

Premature Ovarian Failure

Premature Ovarian Failure {POF} is also interchangeably referred to as Primary Ovarian Insufficiency, {POI}. Premature Ovarian Failure or Primary Ovarian Insufficiency is the loss of function of the ovaries before age 40. In medical circle, a commonly cited triad for the diagnosis is amenorrhea, hypergonadotropinism, and hypoestrogenism. If it has a genetic cause, it may be called gonal dysgenesis.

        Causes

The cause of POF is usually idiopathic. Some cases of POF are attributed to auto-immune disorders, others to genetic disorders such as Turn Syndrome and Fragile X Syndrome. In many cases, chemotherapy and radiation treatments for cancer can sometimes cause Ovarian Failure. In natural menopause, this varies, but in chemotherapy or radiation-induced POF, the ovaries will often ease all functioning and hormone levels will be similar to those of a woman whose ovaries have been removed. Women who have had a hysterectomy tend to go through menopause several years earlier than average, likely due to decreased blood flow to the ovaries. Family history and ovarian or other pelvic surgery earlier in life are also implicated as risk factors of POF.

There are two basic kinds of Premature Ovarian Failure, namely:

{a}     A case where there are few to no remaining follicles, and

{b}     A case where there are an abundant number of follicles.

In the first situation, the causes include genetic disorders, autoimmune damage, and chemotherapy, radiation to the pelvic region, surgery, endometriosis and infection. In most cases the cause is unknown. In the second case, one of the frequent causes is autoimmune ovarian disease which damages maturing follicles, but leaves the primordial follicles intact. Sometimes, in some women, FSH may bind to the FSH receptors site, and become inactive. By lowering the endogenous FSH levels with ethinyl estradiol {EE} or with a GnRH-a receptor sites are free and treatment with exogenous recombinant FSH activates the receptors and normal follicles growth and ovulation can occur. {Since the serum anti-mullerian hormone {AMH} level is correlated with the number of remaining primordial follicles. Some researchers believe the above two phenotypes can be distinguished by measuring serum AMH levels.

Uterine Fibroids

In this country, most women are familiar with Uterine Fibroids and the health implications it poses to their inability to get pregnant. But what exactly is Uterine Fibroids? By way of definition, Uterine Fibroids can be defined as “a leiomyoma {benign tumour from smooth muscles tissue} that originates from the smooth muscle layer {myometrium of the uterus. Fibroids are often multiple and if the uterus contains too many leiomyomata to count, it is referred to as diffuse uterine leiomyomyamatosis. The malignant version of a fibroid is extremely uncommon is termed leiomysosarcoma. Other common names are uterine lesiomyoma, myoma, firbromyoma, fibroleiomyoma.

Fibroids are the most common benign tumours in females and typically found during the middle and later reproductive years. While most fibroids and asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Some fibroids may interfere with pregnancy. In the United States for instances, symptoms caused by Uterine Fibroids are a very frequent indication for hysterectomy.

Signs and Symptoms

Most times, particularly when small, fibroids may be entirely asymptomatic.  Symptoms depend on the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, outright infertility. Sometimes, there may also be pain during intercourse, depending on the location of the Fibroid. During pregnancy, they may also be the cause for miscarriage, bleeding, premature labour, or interference with position of the fetus.

While Fibroids are common, they are not a typical cause for infertility. It accounts for about only 3% of the reasons why a woman may not be able to have a child. Typically, in such cases a Fibroid is located in a submucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to implant. Also larger Fibroids may distort or block the Fallopian tubes.

Further causes or risk factors of female infertility can basically be classified along the following strata:

{a}     whether they are acquired

{b}     whether they are genetic or

{c}      strictly by location

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

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-to be continue in next edition