It’s harder to get pregnant than one might think. That may be music to some if they’re young, single, and nowhere near ready for kids. But for many couples trying to conceive, the reality of infertility is daunting, stressful, and extremely life-interrupting[1]. While the truth is that most causes of infertility are silent, there are five possible reasons of one unable to conceive.

 

  1. Polycystic Ovary Syndrome (PCOS)

 

As the most common cause of infertility in women[2], the Polycystic Ovary Syndrome is caused by a hormonal imbalance.

The pituitary gland, located at the base of the brain, secretes the Follicle Stimulating Hormone (FSH) and the Luteinising Hormone (LH) into the bloodstream. But, for someone who carries PCOS, their pituitary gland may release abnormally high amounts of LH which disrupts the menstrual cycle. Some of these follicles do not dissolve and remain as small cysts. As a result, the immature eggs in the follicles do not mature and ovulation does not occur. Shockingly, millions of women are living with it without even knowing, contributing to the 70 percent of irregular ovulation-related infertility cases.

Polycystic Ovary System may even cause spikes in the body’s insulin level. Too much insulin, combined with high levels of luteinising hormones, leads to the excess production of a male hormone called testosterone.

Medications for PCOS that may be recommended by a doctor would be the hormonal birth control, which, while preventing pregnancy, also regulates the menstrual cycle and reduces testosterone production in the ovaries. Besides that, would be an anti-androgen drug, which reduces abnormal hair growth and acne – a feature associated with PCOD. Metformin, a medication used to treat diabetes – another feature associated with PCOD – also lowers the insulin levels and regulates the menstrual cycle.

 

  1. Other Hormonal Factors

 

Hormonal-related imbalances take up about 25 percent as the main cause of infertility cases. It often impacts or interrupts ovulation in other ways, lessening the chance of conceiving.

Since the hypothalamus in the brain is attached to the pituitary gland and is responsible for secreting reproductive hormones; its dysfunction would cause dramatic changes in the levels of the follicle-stimulating hormone, luteinizing hormone, and hormone prolactin.

A similar disorder is the premature ovarian failure, or as is otherwise called the primary ovarian insufficiency, which is, by definition, the event of when a woman’s ovaries stop functioning normally or become depleted before they reach 40 years old. While the average age of menopause is at 51, there is still one or two, maybe less than 5%, who have a late menopause at ages 55 to 56. It’s not uncommon, however to be late in the 50s or early in the 40s, and even having menopause before the age of 45 is still considered relatively normal; because it can’t yet be classified as being premature.

A premature disorder by definition is abnormality – an occurrence which is not really meant to happen, and in the case of a premature ovarian failure disorder, before the age of 40. Menopausal stages experienced by women in their early 20s and 30s are usually associated with previous medical treatments that may have disrupted the natural cycle of their pituitary gland. Whether it be through a cancer recovery programme or a bone-marrow transplant and immunosuppression for leukemics; any deliberate attempt to shut the ovaries down for recovery purposes could contribute to infertility.

There are, in some cases, women who develop premature ovarian failure in secondary to a treatment that they desperately need. It could be genetically transmitted – linked to the fragile X syndrome, which although uncommon, revel in the group of women who are genetically predisposed to their ovaries packing up early. It could also by a secondary to severe pelvic infection – tuberculosis of the female genital tract or pelvic TB eats away the ovaries until there are none to produce oestrogen.

While there are many different reasons for primary ovarian insufficiency, a 20-30-year-old woman living without oestrogen could possibly face long-term health issues.

 

  1. Endometriosis

 

An often-painful disease, endometriosis is when tissue lining the uterus walls begin to grow in other places, like the ovaries, behind the uterus, or in the fallopian tubes. This could cause irritation and scar tissue (adhesions), and could be very difficult for a woman to get pregnant as the fallopian tubes are blocked. Endometriosis also disrupts implantation, causing an inflammation in the pelvis[3].

Pelvic surgeries or trauma to the reproductive organs, such as dilation and curettage (D&C) during pregnancy termination or miscarriage, or a previous C-section can also form adhesions.

However, Armando Hernandez-Rey, a reproductive endocrinology and infertility doctor at Conceptions Florida suggests that trying to get pregnant earlier may help the chances of getting pregnant despite having endometriosis[4].

The scar tissue could also be surgically removed. While treatment varies from person to person, dealing with endometriosis in surgery could possibly improve the chances of becoming pregnant especially when paired with other fertility treatments like IVF.

 

  1. Reproductive Infections and Growths

 

The most common physical change to the reproductive system directly impacts the fertility process and other anatomical changes in the uterus, ovaries, and fallopian tubes impacts a woman’s ability to get pregnant.

A common malfunction is when there is a blockage in the fallopian tubes. Tubal infection is a disorder that is most likely caused by an organism. It starts in the cervix and makes its way up into the fallopian tubes[5].

Women carrying a reproductive infection like gonorrhoea and chlamydia are at an even higher risk of conceiving. If is especially left untreated, the infection could cause the fallopian tubes to scar. As it is the destination for the egg and sperm to collide, the scarring blocks the passage and possibility of pregnancy altogether. Although it could be corrected surgically, IVF would be the first choice of fertility doctors if the fallopian tubes are extensively damaged.

 

  1. The Long Wait

 

For many women, simply waiting to get pregnant is a huge contributor to infertility. In the recent years, there has been an increasing number of women, about 20 percent, who won’t be expecting to have their first child until after the age of 35. This is contributing to the idea of age becoming a cause of fertility problems. In fact, about one-third of couples trying to conceive when the woman is over 35 have difficulties getting pregnant[6].

Alan B. Copperman says that the most important driver of infertility, in general, is the quality of the egg. As the director of the Division of Reproductive Endocrinology and Infertility at the Mount Sinai Hospital and medical director of the Reproductive Medicine Associates of New York, Copperman states that a woman is born with enough eggs throughout her lifetime. In a woman’s 20s, 90 percent of her eggs are normal, and in her 40s, 90 percent of those eggs are abnormal.

In a time where medical technology is continuing to advance, women are beginning to take better control of when they want to have children. “I’m seeing more women freezing their eggs; there’s more awareness in reproductive aging than ever before,” Copperman says.

More companies are including the egg freezing option in medical insurance plans, and gynaecologists are encouraging younger women to think about family planning. As more and more women start freezing their eggs, they could have an easier pregnancy should they choose to start expanding their family at 40. With the condition that the woman is in good health, there’s a better chance that an egg frozen at a younger age will implant better than a fresh egg at an age closer to menopause.

 

 

[1] https://www.self.com/story/top-causes-of-infertility-in-women

[2] https://www.cdc.gov/reproductivehealth/infertility/

[3] https://www.reproductivefacts.org/

[4] https://www.conceptionsflorida.com/about-us/meet-dr-hernandez-rey/#dr-hernandez

[5] https://fcionline.com/our-center/meet-our-doctors/dr-meike-l-uhler/

[6] https://www.womenshealth.gov/a-z-topics/infertility#17

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