Recently, a consortium of fertility experts from various international organizations both in Europe and Africa met under the auspices of the World Health Organization and came up with a new definition of “Infertility” which was published in the Fertility and Sterility Journal, September, 2017.
In the new definition, infertility is the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse due to impairment of a person’s capacity to reproduce either as an individual or with his/ her partner.
Furthermore, they opine that fertility interventions may be less than one- year based on medical, sexual and reproductive history, age, physical findings and diagnostic test.
The most common cause of infertility in female is the inability to produce eggs that are normal. Disorders of egg production accounts for more than 30 per cent of infertility in women.
Hormones are chemicals that are produced by glands in the endocrine system. Hormones travel through the bloodstream to the tissues and organs, delivering messages that tell the organs what to do and when to do it.
Hormones are important for regulating most major bodily processes, so a hormonal imbalance can affect a wide range of bodily functions. Hormones help to regulate:
- metabolism and appetite
- heart rate
- sleep cycles
- reproductive cycles and sexual function
- general growth and development
- mood and stress levels
- body temperature
Men and women alike can be affected by imbalances in insulin, steroids, growth hormones, and adrenaline.
Women may also experience imbalances in estrogen and progesterone levels, while men are more likely to experience imbalances in testosterone levels.
These are the most common causes of anovulation. The ovulatory mechanism is controlled by the complex balance of hormones and I liken it to an orchestra in the symphony, any disruption in this process can hinder ovulation. Three main factors causing this are:
Malfunction of the pituitary gland
The pituitary’s responsibility lies in producing and secreting FSH and LH. It is easily termed as the musical conductor. The ovaries will be unable to ovulate properly if either too much or too little of these substances are produced. This can occur due to physical injury, a tumour or chemical imbalance in the pituitary.
Also, physical damage to the ovaries may result in failed ovulation. For instance, extensive, invasive, or multiple surgeries for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur.
In Nigeria, a great number of ladies had been sent into premature ovarian failure because they were attempting to terminate a pregnancy. A termination of pregnancy by D and C (dilatation and curettage) by unskilled hand with excess bleeding may lead to ovarian short down and scarring.
Another rare case and an unexplainable cause of anovulation. Some women cease menstruating and begin menopause before normal age. It is hypothesised that their natural supply of eggs has been depleted. A majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise.
Failure to produce mature eggs
In about 50 per cent cases of anovulation, the ovaries do not produce normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilisation becomes almost non-existent. Even when a substantial amount of ovulatory support hormones like FSH are given, and we obtain like 12 eggs, seven of the eggs would be fully matured while five eggs are immature and cannot be fertilised even using “brute force” with Intra cytoplasmic sperm injection.
This syndrome is characterised by a reduced production of FSH, and normal or high levels of LH, estrogen, and testosterone. The current hypothesis is that the suppression of FSH associated with this condition causes partial development of ovarian follicles, and follicular cysts can be detected in an ultrasound scan.
The affected ovary often becomes surrounded by a smooth white capsule and doubles its normal size. The increased level of oestrogen raises the risk of breast cancer. This condition has also been linked with the inadequate carbohydrate metabolism especially with resistance to insulin.
Insulin is the hormone produced by the body to help us to manage our sugar intake. This can be successfully managed by dietary regulation, detoxification and the use of anti-diabetic drugs like metformin. The thyroid gland and the adrenal gland also play a significant role in the manifestations of some of the infertility problems at this level.
Malfunction of the hypothalamus
The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. It can be regarded as the director of music for the symphony orchestra for ovulation.
If the hypothalamus fails to trigger and control this process, immature eggs will result. This amounts to 20 per cent of cases with ovarian failure. We now know that some of the malfunctions of the hypothalamus can be due to poor diet: malnutrition, bad eating habits, stress, and some environmental and occupational toxins.
Research suggests that there’s a big connection between weight and infertility. That’s why most docs urge their patients to maintain a healthy bodyweight. “The more normal someone’s body is, the more likely they are to not have an infertility problem,” says Ginsburg. While obesity has been linked to infertility, the same issue seems to crop up if you clock in fairly underweight, too. Some marathoners and long-distance runners tend to have decreased fertility because of a lower percentage of body fat, says Minkin. The issue likely boils down to hormones, which can be impacted by body-fat levels and thus affect signaling between your pituitary gland, which secretes hormones to various parts of the body, and your ovaries.
Randomly getting busy likely isn’t your best plan of action if you want a baby. “There’s between a 12- and 24-hour window when an egg can be fertilized during intercourse,” says Styer. So your best bet is to have sex before and around ovulation, which happens two weeks before your period. Try every few days around that time, suggests Ginsburg. An ovulation predictor kit is worth considering, too—they can be super helpful in making sure you’re hitting your most fertile time.
Other 5 reasons why you’re not getting pregnant
Keep getting negative results every time you pee on a stick? Here are five fertility saboteurs that could be the reasons you’re not getting pregnant.
You already know the drill—when you’re trying to conceive you can’t leave the house without seeing pregnant bellies. Every time you turn on the TV there’s a sweet baby in a diaper commercial staring back at you. You always seem to spot at least four newborns snuggled up in carriers perched on top of grocery carts when you run into the supermarket, but it seems like you can’t get pregnant.
Whether you’re a few months into trying or are thinking about starting a family soon (here are nine things to do before you conceive), you know doubt have babies on the brain. By now you likely know that many of us don’t get pregnant the first time we try. But what might be surprising news is that there are fertility myths that can wreak havoc on your chances of conceiving. Here’s how to deal with five possible reasons you’re not getting pregnant.
When you mention to friends and family that you’re “trying,” you’ll almost guaranteed to hear someone say, “Just relax and it will happen.” Easier said than done. Stress, good or bad, is going to take its toll on you both physically and mentally. According to naturopathic doctor Via Bitidis, co-director of the North Toronto Naturopathic Clinic, balance and calm are a crucial part of trying to conceive. “When you’re stressed your adrenal system takes a hit. Your body isn’t going to say, ‘Okay, let’s get pregnant.’ Learning to say no and to take time for yourself is important for improving your chances of having a baby.” Megan Karnis, medical director of The ONE Fertility Clinic in Burlington, Ont., agrees with a word of caution: “A lot of women think the best thing to do when you’re stressed is to take time off work. In my experience, that doesn’t help, because it makes a woman feel she has to get pregnant in that time and then the stress to get pregnant is so much higher,” she says. Instead of altering your day-to-day routine entirely, Karnis recommends counselling, art therapy, meditation and exercise to reduce stress levels.
2. Sleep deprivation
You already know that catching an adequate number of zzz’s makes that morning department meeting more bearable, but here’s another reason to get yourself to bed before the wee hours. Sleep deprivation puts stress on the body (there’s that pesky s-word again) and when you’re tired, you don’t run on all cylinders. “For people who don’t get enough sleep, their immune systems are down a little bit and they’re more likely to get infections, which will affect the reproductive cycle,” Karnis says. “This applies to men as well. Infections can cause fever and that excess heat can damage the sperm temporarily,” she says. “Women who don’t get enough sleep can also start to feel anxious, which may cause missed periods.” Keeping yourself healthy is the baby bottom line, so set the PVR to record Mad Men and enforce a new bedtime.
3. Weight issues
A woman who is underweight or overweight may have some difficulty conceiving a baby. “An undernourished body may not ovulate properly,” says Bitidis. On the other hand, excess weight can have a significant effect on fertility. “Just being over your ideal weight decreases your chance of getting pregnant even if you are ovulating regularly,” says Karnis. “The further you stray above 25 on the Body Mass Index, the worse it gets.” Maintaining a healthy diet and developing a reasonable exercise routine will do wonders for your mind and body,”
4. Cycle confusion
“A lot of women don’t understand their own cycles,” says Bitidis. Most of us were taught the typical 28-day cycle in health class back in high school, but every woman is different and cycles vary in length. “The biggest thing is timing,” Karnis says. “We teach women that ovulation is two weeks before your period. Most people think that it’s two weeks after, but that’s only if you have a four-week cycle,” she says. You’ll have better luck conceiving if you monitor ovulation and start having sex at the right time. “We also teach people about sperm life—they can live for three days in the cervix, so you don’t have to have sex on the day of ovulation, it could be the day before. We also find that a lot of people don’t know that lubricant decreases sperm motility and transfer, so you shouldn’t use lubricant when you’re trying to get pregnant,” says Karnis.
“Keeping a positive attitude is incredibly important. There is a huge mind-body connection. Try not to listen to the negative stories and try to be patient,” the advises. Preparing for pregnancy up to a year in advance may be a good idea if you’re planning to start a family in the near future, that way you can focus on making lifestyle changes. If you’re trying now, remember that it can take time—experts say up to a year— to conceive. If you’re concerned that it has taken too long, speak to your healthcare provider about your options for fertility counselling and treatment.