Causes, prevention and treatment of female infertility

Female infertility is the inability of a wife to get pregnant after one year of unprotected and regular sexual intercourse with her husband who has been proven to be fertile.

In discussing the causes of female infertility, as we did when we looked at the causes of male infertility, we have to note that certain steps have to take place for pregnancy to occur. Whatever hinders these steps can potentially cause infertility.

The steps that should be in place for pregnancy to occur are:
1. The woman must be menstruating monthly. The monthly menstrual cycle leads to the maturing and release of an egg during the ovulation period.
2. The point of release of the egg is the fimbrial end of the Fallopian tube. The egg released is guided into the tube by the hair-like structures known as the fimbrae.

3. It is important that regular sexual intercourse takes place between the man and his wife, especially during her fertile period; the ovulation period.
4. The vagina is one of the two most acidic areas in the woman. It is therefore necessary for the sperm cells to remain alive while passing through the vagina. From the vagina, the sperms pass through the cervical os (where it interacts with the cervical mucus), into the uterus. The sperms will continue their journey into the Fallopian tubes where one will meet the egg at the fimbrial end. I shall discuss the effect of acidity/alkalinity on the fertility of the woman in detail soon.

5. The first egg that meets the egg, penetrates it and fertilization is said to have occured.
6. After the fertilization, the fertilized egg travels back through the Fallopian tube to the uterus.
7. When it gets to the uterus after about eight days’ journey, the fertilized egg now known as an embryo, gets implanted in the wall of the uterus where it will grow for the next 8+ months or so.
8. During the monthly menstrual cycle and throughout the duration of the pregnancy, certain female hormones are at work maintaining every step.
Causes of female infertility

As I mentioned earlier, whatever hinders those steps that lead to conception can potentially cause infertility. Apart from such factors, other factors that have to do with the age of the woman, anatomical disposition, diseases, drugs and such habits as cigarette smoking can cause female infertility. I will discuss these causes of female infertility before those that hinder the process of pregnancy directly.

Age: The peak period of a woman’s fertility is between the ages of 22 and 26 years. After this time her fertility begins to decline and her ability to get pregnant diminishes faster as she gets to age 35.

Obesity: Being overweight or underweight both affect a woman’s chances of getting pregnant. It has to do with the amount of fat cells. Apart from the sex organs, fat cells are known to produce eostrogen. In a woman who is overweight more eostrogen gets produced simulating the effect of contraceptive pills in preventing pregnancy. Also, this excess amount of eostrogen produced does not have the commensurate balancing effect of progesterone. The result is that oestrogen continues its proliferative function without the check by progesterone and pregnancy would not occur. In an underweight woman with too little fat cells there will in turn be insufficient eostrogen in circulation leading to menstrual disorder. The cycle may become irregular with anovulatory cycles.

Sexually transmitted diseases: What makes sexually transmitted diseases an important causative factor in female infertility is the fact that these diseases are usually silent in the woman; they may present with or without symptoms. As a result the woman does not seek treatment early enough to avoid infertility. Diagnosis of these diseases, especially, gonorrhoea in the woman is by contact tracing when the disease would have been passed to the husband. One major complication of sexually transmitted diseases that leads to infertility is blockage of the fallopian tubes.

Cigarette smoking: Nicotine is a chemical in cigarettes that interferes with the woman’s ability to produce oestrogen. Where oestrogen production is inadequate most of the processes of conception, from the development of the egg to transportation of the fertilized egg in the fallopian tube and implanting of the embryo in the uterus become hindered. The endometrial wall of the uterus will not have been well prepared to receive the embryo.

Chemotherapy: This affects the sexual hormones the most and can only be considered in a woman who has been diagnosed of cancer and placed on cchemotherapeutic drugs.