Thu | Mar 30, 2023

Infertility in women

Published:Wednesday | February 1, 2023 | 12:16 AMKeisha Hill/Senior Gleaner Writer

Getting pregnant and carrying a pregnancy to term is actually a very complicated process. Many things can go wrong during these processes that can lead to infertility. ‘Infertility’ means not being able to get pregnant after one year of trying, or six months if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant, a woman’s body must release an egg from one of her ovaries. The egg must go through a fallopian tube towards the uterus, and the man’s sperm must join to (fertilise) the egg along the way. The fertilised egg must attach to the inside of the uterus. Infertility can happen if there are problems with any of these steps.

According to Dr Kamali Carroll, embryologist at the Hugh Wynter Fertility Management Unit, Faculty of Medical Sciences at The University of the West Indies, Mona campus, the most common overall cause of female infertility is the failure to ovulate, which occurs in 40 per cent of women with infertility issues.

Not ovulating can result from several causes, such as ovarian or gynaecological conditions, including primary ovarian insufficiency or polycystic ovary syndrome; ageing, including diminished ovarian reserve, which refers to a low number of eggs in a woman’s ovaries due to normal ageing.

Endocrine disorders, such as thyroid disease or problems with the hypothalamus – which affect the hormones produced by the body, so that there might be too much or too little of a hormone or group of hormones – and lifestyle and environmental factors, are other known causes.

“Structural problems usually involving the presence of abnormal tissue in the fallopian tubes or uterus can result in infertility. If the fallopian tubes are blocked, eggs are not able to move from the ovaries to the uterus, and sperm is not able to reach the egg for fertilisation. Structural problems with the uterus, such as those that may interfere with implantation, can also cause infertility,” Dr Carroll said.

Some specific structural problems that can cause infertility include endometriosis, when tissue that normally lines the inside of the uterus is found in other places; blocking of the fallopian tubes; uterine fibroids; growths that appear within and around the wall of the uterus, although most women with fibroids do not have problems with fertility and can get pregnant.

“Some women with fibroids may not be able to get pregnant naturally, or may have multiple miscarriages or preterm labour,” Dr Carroll said.

“Other structural problems include polyps, which are non-cancerous growths on the inside surface of the uterus. Polyps can interfere with the function of the uterus and make it difficult for a woman to remain pregnant after conception. Surgical removal of the polyps can increase the chances for a woman to get pregnant,” she added.

Infections can also cause infertility in men and women. Untreated gonorrhoea and chlamydia in women can lead to pelvic inflammatory disease, which might cause scarring that blocks the fallopian tubes. Untreated syphilis increases the risk for a pregnant woman to have a stillbirth.

“Chronic infections in the cervix and surgical treatment of cervical lesions associated with human papillomavirus infection can also reduce the amount or quality of cervical mucus. Problems with this sticky or slippery substance that collects on the cervix and in the vagina can make it difficult for women to get pregnant,” Dr Carroll said.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So do not worry if the problem is not found right away. Doctors will do an infertility check-up that involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can identify the problem. However, most of the time, the doctor will need to do more tests.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this, and a woman can track her ovulation at home by writing down changes in her morning body temperature for several months, recording how her cervical mucus looks for several months, using a home ovulation test kit.

Doctors can also check ovulation with blood tests, or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Dr Carroll is also the lab director at the Hugh Wynter Fertility Management Unit. She was guest presenter at the fourth staging of the Medical Disposables Annual Continuing Education Seminar for Pharmacists-MPowered 2023.