Doctor's Corner - Infertility in women with a focus on mobility impaired females
A woman with mobility impairment does not have reduced fertility compared to the general population. Women therefore have the same issues when it comes to causes and probably treatment of infertility.
Infertility is either primary meaning a woman has never conceived, and secondary where there has been a previous pregnancy and now has an inability to achieve pregnancy in one year with adequate sexual exposure.
“Sterility” means that a woman has a condition that would prevent pregnancy and is irreversible.
The incidence of infertility is 15-20% (one in every five to six couples).
Causes and frequencies of infertility
Unexplained - 3.4%
Abnormal semen - 36%
Anovulation - 29%
Tubal damage - 57%
Abnormal cervical mucus - 7%
Uterine factors - 6%
Endometriosis - 4%
Percentage of women failing to conceive in 12 cycles
Age % infertile
Abnormalities with the vagina, cervix, uterus, fallopian tubes or ovaries may impair fertility and need to be excluded.
The general health of an individual also influence fertility and diseases of the heart, liver, kidneys, thyroid gland will impact on the ability to fall pregnant.
Certain medication can impair fertility especially chemotherapy and other forms of cancer treatment. Cigarette smoking is one of the evils of normal fertility and sometimes is a good place to start when wanting to fall pregnant.
This is when the ovaries are not able to produce or excrete an egg that will meet sperm to form a fetus and future baby.
Indications of ovulatory problems are abnormal menstruation, no periods and long cycles resulting in fewer periods per year. Certain tests can be performed to confirm ovulation or not and allow possible treatment. The physical features and ultrasound findings may reveal polycystic ovarian disease or syndrome (PCOS) and for that the treatment may be a long and frustrating course requiring patience from all concerned. This is often the easiest to correct.
Women that are obese increase their risk of anovulation and other medical conditions that may impair fertility. In some conditions loosing 5% of body mass may improve the chances of pregnancy significantly. Weight loss should be discussed with a dietician or doctor, because there is no quick fix when it comes to that. The over the counter pills and mixtures may not be studied and have more side effects than benefits so be very careful when choosing it as an option. The old saying healthy diet and exercise will serve you well, so consult somebodydealing with nutrition and weight loss exercise programs.
When the problem is with the tubes, which is very often the case in about half of infertile women and will require specialist care. There are tests like hysterosalpingograms (HSG) that will give valuable information regarding the patency of the tubes, and in combination with laparoscopy may even be able to diagnose and treat, depending on the problem. The most common causes of tubal pathology include infections, previous operations to the area and endometriosis
There are many hormones involved in making sure that someone is able to conceive and just as many hormones that may cause problems with fertility. As mentioned diseases with the thyroid gland, adrenals, pancreas in diabetes and pituitary gland need to be assessed and treated to help with fertility.
The investigations and treatment involved in infertility is very expensive and medical aids do not cover it, and state hospitals are currently unable to assist couples with fertility issues. Fortunately as seen above many causes of infertility can be fixed with small adjustments to your lifestyle or health. The first step should be to decide early that you are ready to become a parent and to seek help early. There is a reason the biological clock starts ticking and it is important to look inwards and ask the hard questions. Regular periods, normal duration, minimal pain during menses, healthy lifestyle, regular intercourse with a healthy partner who also know their fertility status (semen analysis), and if some of these questions cause doubt help should be sought. Getting to a diagnosis often allows directed treatment and save time, money and heartache.
This is just an overview of potential causes of infertility, but the investigations and treatment warrants another sitting.