Women with a mobility impairment do not have reducedfertility when compared to the general population, they therefore have the sameissues when it comes to the causes and probable treatment of infertility.However: the investigating and treatment of infertility issues can be veryexpensive and medical aids do not cover them. State hospitals are currentlyunable to assist couples with fertility issues.

 

57% of couples who are trying conceive within threemonths and 93% in two years. Infertility is either primary (meaning a woman hasnever conceived) or secondary when there has been a previous pregnancy but nowhas an inability to achieve pregnancy in one year with adequate sexualexposure. Abnormalities with the vagina, cervix, uterus, fallopian tubes orovaries may impair fertility and need to be excluded. Sterility means that awoman has an irreversible condition that would prevent pregnancy.

The incidence of infertility is 15-20% (one in everyfive to six couples). Within those numbers the causes include: tubal damage(57%), abnormal semen (36%), absence of ovulation (29%), abnormal cervicalmucus (7%), uterine factors (6%), endometriosis (4%) and unexplained (3.4%) andit is obvious from these figures that there are often multiple causes. Age alsoplays a significant role in the ability to conceive. The percentage of womenfailing to conceive in 12 cycles is generally: age 20-24 (4.0%), 25-29 (5.5%),30-34 (9.4%) and 35-39 (20%).

The general health of a woman also influencesfertility and diseases of the heart, liver, kidneys and thyroid gland willimpact on the ability to fall pregnant. Certain medications can also impairfertility especially chemotherapy and other forms of cancer treatment.Cigarette smoking is one of the evils of normal fertility and is sometimes agood place to start when wanting to fall pregnant.

The absence of ovulation(anovulation) is when the ovaries are not able to produce or excrete an eggthat will meet sperm to form a fetus and future baby. Indications of ovulatoryproblems are: abnormal menstruation, no periods and longer than averagemenstrual cycles resulting in fewer periods per year. Certain tests can beperformed to confirm ovulation, or the lack thereof, and allow possibletreatment. The physical features and ultrasound findings may reveal PolyCysticOvarian Syndrome (PCOS) and for that the treatment may be a long and frustratingcourse requiring patience from all concerned.

When the problem is with the tubes, which isvery often the case, it may require specialist care. There are tests likehysterosalpingograms (HSG) that will give valuable information regarding thepotential of the tubes and, in combination with laparoscopy, may even be ableto diagnose and treat - depending on the problem. The most common causes oftubal problems include infections, previous operations to the area andendometriosis (when the lining of the uterus occurs in the pelvis - which maycause pain, interfere with normal structures and prevent fertility).

There are many hormones involved inmaking sure that someone is able to conceive and just as many hormones that maycause problems with fertility. As mentioned above, diseases with the thyroidgland, adrenals, pancreas (such as diabetes) and pituitary gland need to beassessed and treated to help with fertility.

Women who are obese increasetheir risk of anovulation and other medical conditions that may impairfertility. In some conditions loosing 5% of body mass may improve the chancesof pregnancy significantly. Weight loss should be discussed with a dietician ordoctor, because there is no quick fix. Over-the-counter pills and mixturesshould not be considered and have more side effects than benefits - so be verycareful when choosing these as an option. The old saying “healthy diet andexercise” will serve you well, so consult somebody specialising in nutritionand weight loss exercise programs.

In the next issue I shall discuss the investigatingand treatment of infertility. I look forward to receiving your questions andbeing able to address your concerns directly.

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