The issue of infertility has been a major source of
worry for both young and old couples in recent times. Some couples have
undergone several medical screening and yet, no remedy. In this expository
article written by the fertility expert who pioneered the
IVF program in Nigeria in 1984, Professor Oladapo Ashiru, he brought to the
fore causes of infertility in women and how it could be handled.
An ovulation occurs in 10 per cent of most cases of
infertility. The female may go through a menstrual cycle but she is not
ovulating, that is, not producing eggs. The process of ovulation is complex and
involves secretions of several hormones in the brain, hypothalamus, pituitary
and the ovary as well as other related endocrine glands like the thyroid gland,
adrenal, pancreas and the parathyroid.
These endocrine glands secrete hormones, which work
like the orchestra in a symposium to cause ovulation. If any of these hormones
should play out of tune, ovulation will not occur. It is now possible to
control this process externally by administering various hormones to the
patient. This is done after a very careful analysis of the patients’ hormonal
status and deficiencies.
Tubal
blockage
The tubes that carry the egg to the site of fertilisation may be blocked or restricted in their movement. This may result in failure to conceive, even though the patient may be ovulating normally. Blocked tubes occur in about 20 per cent of infertility cases.
The cause is usually from previous infections. Sometimes, the woman may not know she had these infections. Even a simple appendicitis, can lead to a scarring around the area of the tube which can interfere with the pickup mechanism of the eggs from the ovary. An X-ray called “hysterosal-phinogram”(HSG), which is a slightly painful but non-surgical procedure and does not require hospitalisation, can determine if the tubes are structurally sound.
Most recently, there is a virtually painless procedure that is able to determine whether the tube is structurally intact. It is the use of ultrasonography with saline infusion. It is called Hystero-sonography.
The tubes that carry the egg to the site of fertilisation may be blocked or restricted in their movement. This may result in failure to conceive, even though the patient may be ovulating normally. Blocked tubes occur in about 20 per cent of infertility cases.
The cause is usually from previous infections. Sometimes, the woman may not know she had these infections. Even a simple appendicitis, can lead to a scarring around the area of the tube which can interfere with the pickup mechanism of the eggs from the ovary. An X-ray called “hysterosal-phinogram”(HSG), which is a slightly painful but non-surgical procedure and does not require hospitalisation, can determine if the tubes are structurally sound.
Most recently, there is a virtually painless procedure that is able to determine whether the tube is structurally intact. It is the use of ultrasonography with saline infusion. It is called Hystero-sonography.
Immunology
This includes cervical hostility. In this situation, the woman’s cervix recognises the sperm as a hostile foreign body (antigen) and immediately produces antibodies to kill the sperm. Invariably, most of the sperm cells are destroyed just at the cervical entrance and do not pass beyond the cervix.
This condition can be detected by examining a swab of the sperm removed from the cervix after intercourse. It is called Post Coital Cervical Sperm Analysis. There are a number of other immunological factors that can affect pregnancy, conception on to the implantation of embryo phase.
This includes cervical hostility. In this situation, the woman’s cervix recognises the sperm as a hostile foreign body (antigen) and immediately produces antibodies to kill the sperm. Invariably, most of the sperm cells are destroyed just at the cervical entrance and do not pass beyond the cervix.
This condition can be detected by examining a swab of the sperm removed from the cervix after intercourse. It is called Post Coital Cervical Sperm Analysis. There are a number of other immunological factors that can affect pregnancy, conception on to the implantation of embryo phase.
Hormonal
factors
Apart from the hormones that control ovulation directly, some hormones can indirectly affect ovulation. Prolactin, a stress hormone, is one of such. The elevation of this hormone can cause the secretion of milk in the breast of a non-pregnant woman. This is a disaster situation if left untreated. It makes ovulation difficult, if not impossible. Even if ovulation does occur, this hormone will attack fertilisation and embryo implantation processes, doing everything possible to terminate the conception.
In layman terms, the high prolactin acts as if the woman is already pregnant and tries to prevent the occurrence of another pregnancy in that pregnant cycle. New hormones have recently been recognised as having an inhibitory effect on ovulation or implantation.
They include prostaglandin, the growth factors and receptor hormones. They can disrupt any of the conception stages. Measuring the hormones in the blood and getting a good interpretation of the result with good clinical judgment can detect a number of these conditions.
Apart from the hormones that control ovulation directly, some hormones can indirectly affect ovulation. Prolactin, a stress hormone, is one of such. The elevation of this hormone can cause the secretion of milk in the breast of a non-pregnant woman. This is a disaster situation if left untreated. It makes ovulation difficult, if not impossible. Even if ovulation does occur, this hormone will attack fertilisation and embryo implantation processes, doing everything possible to terminate the conception.
In layman terms, the high prolactin acts as if the woman is already pregnant and tries to prevent the occurrence of another pregnancy in that pregnant cycle. New hormones have recently been recognised as having an inhibitory effect on ovulation or implantation.
They include prostaglandin, the growth factors and receptor hormones. They can disrupt any of the conception stages. Measuring the hormones in the blood and getting a good interpretation of the result with good clinical judgment can detect a number of these conditions.
High FSH
hormone level
Specifically, some women may have elevated FSH (follicle stimulating hormone). This is only normally elevated just before ovulation. When it is elevated at other times of the cycle, like the third day of the period when it is supposed to be very low, there is a big problem. FSH is also high in women who have reached menopause. Consequently, the ovary of the menopausal woman is inactive. A high FSH level in a woman still desiring to have children means that the ovary is sleeping or inactive. It is not possible for such a woman to ovulate and get pregnant. This condition is detected by taking the blood from the patient on the third day of her period to measure the FSH level. It is called “Day 3 FSH”.
Endometriosis
This is an inflammation usually around the uterus and sometimes in the ovary and the tubes. It makes the process of fertilisation very difficult. The United States of America statistics shows that many of the professional women who marry in their 30s because of their careers end up with endometriosis. This is one of the factors responsible for infertility in this age group. A history of painful intercourse should suggest endometriosis. It can be confirmed with a laparoscopy.
Unexplained
Infertility
In about five per cent of the cases there would be no reason found for infertility. The wife and the husband can both be perfectly normal and all of the known causes are ruled out, yet they do not get pregnant.
The discovery of new technology has helped in reducing the percentage of infertility described as unknown or unexplained. Modern Mayr medicine has helped to reduce the percentage in this category through the discovery and ability to remove heavy metal toxins and other allergies from the body system.
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