Factors contributing to female infertility

Written by Dr. Sylvester Ikhisemojie, Punch Nigeria. 

Dr. Sylvester Ikhisemojie

There is nowhere in the world where people do not have some ideas about why a woman may become infertile. Advancing age is among the most important reasons that ordinary people know about. It is a known fact that conception becomes increasingly difficult after the age of 35 years. And even during her most fertile period, many external factors and changes in her life style would play various roles in determining whether she can have normal and healthy babies. This worsens as the periods become less regular and the egg count reduces. It gets even worse as the menopause approaches and while this important landmark varies very much among women, it is nevertheless sometime between 45 and 55 years. Some women have become menopausal as early as 40 while others continue to menstruate into their late 40s or early 50s. As a result of these facts, advancing age is one of the most recognised causes of female infertility.

Another common factor is obesity. A woman who is grossly overweight with a body mass index of 25 to 29.9, or is frankly obese with a body mass index greater than 30, is at significant risk of having challenges with her fertility. Such a woman is carrying extra kilogrammes above what is healthy, and this extra load is known to adversely affect hormone function. As an extension, this affects the normal activity of the ovaries with a reduction of the normal cyclical changes in the ovaries that determine whether they are ready for the important function of achieving a pregnancy. Women who are obese at the age of 18 years are more likely to develop polycystic ovary syndrome and have problems with fertility. This disorder of the ovaries is the most common hormonal disorder in women of reproductive age. It is thus the leading cause of infertility among women in that age group.

As women who are obese tend to have challenges with fertility, so do those who are too thin. 

Women, whose body mass index is too low, at 18.5 or less, tend to also have challenges with getting pregnant. This is because they are lacking in the hormone that is responsible for controlling hunger and the feeling of satisfaction. That hormone, called Leptin, contributes to having absent periods when it is deficient. Therefore, achieving a healthy weight, something a woman can attain through a combination of smart feeding and a regular dose of moderate exercise, are two factors a woman must aim for to increase her chances of getting pregnant.

Certain chemicals in use at our various homes also play a role in determining the level of fertility in many women. The presence of these substances in the home and a woman's exposure to them are other factors that have been known to be associated with the onset of premature menopause for some 40 years. They have accordingly been banned in some advanced countries of the world. In developing countries, however, some of those chemicals found in plastics and other organic compounds that include nail polish and perfumes have been implicated. So have pesticides and a bye-product of industrial combustion called furan. Some of these compounds have been estimated to decrease fertility levels by nearly 30 per cent in some parts of the world. Some of the countries most commonly affected by this combination of events are the newly emerging markets where safeguards are not yet stringent enough to deal with the problem and where industrial pollution is seen as a major issue. The Bhopal chemical plants disaster in 1984 in India comes readily to mind, but then, so does the Fujian chemicals plant explosion in China just last month. Both incidents left many dead, but the long-term effects will result in some of the issues being discussed now on this page.

Smoking is another factor that causes infertility. While that act is not a widespread practice among women in our part of the world, it is nevertheless important for people to be aware of the hidden dangers as we continue to westernise in our habits. Cigarette smoking can damage a developing foetus in a variety of ways, including causing low birth weight. But among those who are expecting to get pregnant, that desire is much reduced by the act of smoking. Even those exposed to secondary smoke are equally at risk. Similarly, the consumption of alcohol in large amounts is known to predispose a woman to premature delivery. While there is no evidence that alcohol intake a few times a week or month would affect a pregnancy, it is nevertheless a wise thing to be cautious in the first few months of pregnancy. What is known for sure though is that the heaviest female consumers of alcohol are more than likely to seek fertility treatment than most other women. More than one drink a day has been linked to the onset of ovulation disorders.

A woman is born with a fixed set of follicles and these are used up over time. The speed with which they are used up differs widely among different women. As many of the problems which plague successive generations are found in their parents, it is often the case that the patient's mother is quizzed about when she began and ended her menstruation. The daughters are likely to be very similar to her in that regard. Because of this, it is important to remember that the detail missing in the mix may be in the genes.

Certain drugs are known to interfere with the normal pattern of ovulation. Many such drugs are hormone-based drugs which are often used for the purpose of birth control, or sometimes to achieve an abortion. Some of these drugs retain their function in the system beyond the period stipulated for their effectiveness. As a result, medications such as the injectable Depot Provera which is taken every three months, may act in such a profound manner that even six months after its administration or one year, fertility remains a distant dream. Some women are able to get pregnant the month following the effectiveness of the injection. Others are not able to do so for up to one year afterwards.

Breastfeeding is another activity that could interfere with fertility. It is a myth that a woman is unable to get pregnant while she is breastfeeding. The likelihood of a woman being able to get pregnant while breastfeeding is certainly reduced. In our traditional setting, women were often sent away from the home when they were breastfeeding to stay with their mothers so they could be properly cared for. That model is not easy to extrapolate in relation to what would happen in a normal setting. At any rate, women who live with their husbands all through the breastfeeding period tend to have some protection for the period in which they are breastfeeding their babies on demand. This pattern subsists for the first three months or thereabouts. After this time frame, women who do not desire to have a fresh pregnancy are advised to take some precautions because absolute safety is not guaranteed any longer.

Extreme physical exercise, especially among those persons who have suddenly discovered a need to lose weight or keep fit, can equally impact negatively on fertility. It is good to exercise in order to keep fit and strong, but exercises that are prolonged for five hours or more are not ideal in relation to fertility because such extreme sport is known to adversely affect it. However, Evelyn Ashford was already three months pregnant when she broke the women's 100 metres Olympic record at the 1984 Los Angeles Games and must have trained very hard for at least an entire year in physically demanding conditions before then. So, like in everything else, there are exceptions to the conventional rule. She accordingly, got pregnant even in the midst of such training.

Thyroid disease is another common cause of a woman being unable to get pregnant. This is especially true of women tending towards the end of their reproductive career and those who are otherwise being investigated for infertility. It is often the case that under-performance of the thyroid gland is to blame for the woman's fertility challenge. In other cases, the cause is thyroid over-activity as seen in thyrotoxicosis. Sometimes, the associated hormonal changes are so profound that the menstrual cycle would have no pattern that can be easily related to. It thus becomes imperative to first treat the thyroid disease before tackling the fertility problem associated with it. People with significant thyroid dysfunction will know they have a problem and seek medical help. For millions of other women, the changes are very subtle and they will have to see an expert on fertility before the challenge may be unmasked.

Finally, previous operations performed on any of the reproductive organs which include the fallopian tubes, the uterus or the ovaries are likely also to affect fertility. Of course, the more highly equipped a hospital is, the more likely it will be to minimise such problems. Besides, if the persons performing the operation have the requisite training and experience, the adverse effect on fertility of conducting such operations will be lessened. These assumptions are made without prejudice to the adverse complications that can arise, even from the best well-planned operations, where unforeseen problems like infection and similar cases, may be an additional problem weighing heavily on the eventual long-term outcome.

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Ask the doctor

Dear doctor, please I need advice on how to take care of my teeth. I lost a canine some years back and I decided to fix a plastic one to fill the gap. Afterwards, I noticed that the front teeth started to go in another direction, not as straight as they were before. Please what do I do to correct it? Thanks.

A visit to a dentist should resolve that. So, I urge you to pay a visit to one in your area or to a dental centre in any large hospital where you live.

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Dear doctor, Please I have a challenge with my manhood. Each time I am making love with my wife, she complains that my manhood is not strong enough to penetrate her, that she hardly feels me again. I hardly spend even one minute on her and I will ejaculate and that makes her even more sad. I went to the hospital for treatment and the doctor said it is poor erection and wrote some drugs for me but after using them, there has been no improvement. What can I do? Thanks.

It depends to a large degree on what kind of doctor you saw when you visited the hospital. For a problem like yours, my advice to you would be to see a urologist for the proper range of tests to be carried out before you are given a prescription for drugs. That is the only way you will get a positive result.

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Dear doctor, thanks for your reply last week. I feel a tingling sensation as if I am ejaculating and sometimes, it hurts a bit when I am urinating. What could this be, sir?

That sensation may mean nothing other than the discomfort associated with what you are feeling. However, since you also have pain when you urinate, I would advise you to see a doctor so he can recommend the appropriate urine test to be done at a proper laboratory. The result obtained will determine if treatment is needed.

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Dear doctor, I do feel pain at the right side of my chest. What can cause such?

It depends on a number of factors. It may be a muscle pain within the intercostal muscle group. It may have resulted from trauma, when something hit you on that side of the chest. It could be that you are coming down with pneumonia, especially if you also have a cough. Sometimes, the very act of coughing or sneezing repeatedly can cause you such pain. In addition, such a pain is possible if you sleep face down, on your chest.

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Dear doctor, I lost one of my front teeth. Is it possible to fix permanent white teeth?

I believe you can have white teeth fixed but they cannot be permanent. Only God can give you permanent teeth. You will have to visit a dentist in order to have the right kind of advice regarding the various types of such teeth available.

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Dear doctor, I read your article in SUNDAY PUNCH on the use of cannabis. Please, I would like to know if cannabis is good for the system, because I am a legendary cannabis smoker. Thanks for your reply.

Since you are legendary smoker of the product, I would say you should be able to tell us about its benefits. However, what the article was advocating is that the use of cannabis should not be seen as criminal. It should be regulated for medical and recreational uses because there is no evidence that its use is linked directly with an increase in crime. On the other hand, many respected persons take it and remain law-abiding people. On those two scores, its use can be legalised and approved because of its many positive benefits in the body, as that essay made clear.

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Dear doctor, I always have this unpleasant smell in my mouth. Please tell me what to do about it.

First of all, pay a visit to a dentist for a proper examination of your mouth. If he does not find something amiss and tells you so, if he has no suggestions for you regarding how you can take further care of your teeth, you should then have him refer you to an ENT Surgeon for a continuation of your treatment. That is the only way to determine what exactly the cause of the odour is.