Research shows that fertility issues are relatively common among both men and women. Even after a year of trying, around fifteen percent of couples do not achieve successful conception after one year. Around one-third of those that are unsuccessful in the first year will be able to conceive after a year, leaving fully one in ten couples unable to conceive a child even after two years of trying.
Age plays a major role in fertility. Younger men and women have higher success rates in creating a pregnancy than older couples. Among couples under the age of thirty with no medical issues, between twenty and thirty-seven percent of couples that are trying to have children succeed in conception in a matter of months. Fertility remains high until around the age of thirty, when it slowly starts to decline for both sexes, associated with various forms of hormone decline, among other variables.
Menstrual Issues that Lead to Fertility Issues
Every woman has her own particular menstrual patterns. When women first experience puberty, these menstrual cycles can be somewhat erratic, but over the course of three years or so, their bodies usually enter a stable pattern of hormone release. Women usually have a cycle which lasts anywhere from three to six weeks.
A minority of women have issues with their cycle, however. Around one in seven women either have heavy flow during them menstrual cycle, or their body does not experience the cycle in a normal pattern. There are three primary categories of irregularity which can impact fertility: Ovulatory Infertility, Anovulatory Infertility, and Oligoovulation.
Ovulatory Infertility means that the patient releases eggs and experiences her menstrual cycle in a normal pattern, but there are issues which limit fertility unrelated to the release of eggs. For example, if the woman can experience fertilization but not implantation, this is a form of Ovulatory Infertility. Another example is when ovulation occurs, but sperm is not able to reach the egg. Ovulatory Infertility is the cause of sixty to seventy percent of female infertility.
Anovulatory Infertility means that the patient does not experience her period in a normal pattern, or goes for long periods of time without experiencing her period. In some cases, the woman may experience her period without ovulation. This condition is also known as Ovulatory Dysfunction.
Thirty to forty percent of women that experience fertility issues have such issues because they are unable or have trouble ovulating. This form of infertility is easy to treat for most patients, and seven out of ten women can conceive with the help of medications which encourage ovulation and promote a normal cycle, such as Repronex and Clomiphene Citrate.
Oligoovulation is a condition in which ovulation occurs, but occurs in an irregular pattern which makes it harder to conceive.
What Conditions Prevent or Inhibit Ovulation and Fertility in Women?
There are four categories of issues which inhibit ovulation:, Hormonal Issues, Follicle Issues, Early Menopause, and Ovarian Damage.
Hormonal Issues Which Inhibit Fertility
Most women that have trouble ovulating have issues as a result of Hormone Imbalances which prevent normal ovulation. There are three main categories of Hormone Irregularity:
Pituitary Malfunction-In both men and women, the pituitary gland is responsible for producing two hormones vital for fertility: Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). In order to be sufficiently fertile, women need to produce a specific amount of both of these hormones.
There are a number of issues that can contribute to this, including tumors, physical injury to the pituitary, and any other cause of Hormonal Imbalance.
Hypothalamic Malfunction-In order for FSH and LH to be produced, they receive signals from the Hypothalamus in the form of Gonadotropin-Releasing Hormone (GnRH). If the Hypothalamus does not send the correct signal to the pituitary, it can prevent a woman’s eggs from reaching maturity, which prevents ovulation. Around one in five women do not ovulate for this reason.
Inability of Eggs to Reach Maturity-This is the most common reason why women have trouble ovulating. Around half of women that are unable to ovulate are unable to do so because their ovaries do not produce the follicles necessary for implantation, which leads the eggs to not be released. This is most commonly the result of inhibited production of FSH in relationship to Testosterone, Estrogen, and LH.
The most common condition which leads to this issue is polycystic ovary syndrome. This condition is characterized by elevated Testosterone and Androgen Levels, long menstrual cycles, and follicles which remain embedded in the ovaries, containing immature eggs. When this occurs, the ovary or ovaries are referred to as polycystic. This is associated with elevated Estrogen Levels and can lead to breast cancer.
Follicular Malfunction can Inhibit Fertility
Some women experience a rare issue known as Unruptured Follicle Syndrome, in which ovulation occurs, and the follicle absorbs the egg, but the egg is never released from the follicle, which prevents conception.
Early Menopause Can Prematurely Lead to Total Infertility
A small subset of women stop ovulating much earlier than normal, causing them to enter menopause. This condition is not fully understood, but there are several hypotheses regarding as to why this occurs. For example, there is evidence that some women have a genetic predisposition to deplete their store of eggs more quickly than normal.
One particular group of women for which this issue is most common are women that maintain a highly active and athletic lifestyle, associated with heavy exercise and low body weight.
Damaged Ovaries Can Lead to Infertility
As a damaged pituitary can inhibit the release of vital precursor hormones necessary for ovulation, damaged ovaries can inhibit or prevent ovulation. Because of this, the Ovaries may not have the capacity to produce fully-matured eggs, which inhibits fertility.
Fallopian Tube Malfunctions Can Inhibit Fertility
This is the second most common category of Fertility issues for women. The Fallopian Tubes are the means by which sperm reach the implanted egg in the ovaries. If sperm never reaches the egg, then ovulation, of course, does not occur. The Fallopian Tube is also the route by which the fertilized egg travels to the uterus where it attaches to the wall of the organ and begins to develop. If the fertilized egg cannot implant into the uterus, the female body is designed to shut down the pregnancy.
Because most fertility issues caused by Fallopian Tube Issues are the result of malformations and blockages, the most common form of fertility treatment for these conditions is surgery. By taking surgical steps to open up the pathway to and from the ovaries, it is possible to increase fertility by between thirty and sixty-five percent, dependent upon the procedure.
There are five main categories of issues which affect the normal function of the Fallopian Tubes: Genetic Defect, Ectopic Pregnancy, Surgical Damage / Trauma, Disease, Infection.
Genetic / Prenatal Defect – In rare cases, women are born with issues which prevent their Fallopian Tubes from fulfilling their normal function. Often, these defects are paired with problems which impact the function of the uterus.
Ectopic Pregnancy – Very rarely, after an egg has been fertilized, it does not make the full trip to the uterus, and instead implants into the Fallopian Tube. Normally, the female body can recognize this and flush the pregnancy, but in some cases, the fertilized egg begins to grow, which inevitably leads to a dangerous and potentially fatal situation if left untreated.
The developing fertilized egg will likely damage the Fallopian tube, even if it is treated before it can threaten the health of the woman. This may or may not be treated successfully with surgery, depending upon the level of damage done.
Surgical Damage / Trauma – Damage to the Fallopian Tube caused by accident or surgery can alter the function of the Fallopian Tubes. Also, Any surgery in the area around the Fallopian Tubes can lead to partial or total blockages which limit the ability of the tube to perform its normal function.
Disease – There are a number of medical conditions which can lead to direct damage to the Fallopian Tubes or create conditions in which the Fallopian Tubes are partially or totally blocked, including colitis and appendicitis.
Infection – Any form of infection which afflicts the Fallopian Tubes can conflict with the ability of sperm or fertilized egg from passing through the vicinity. In some cases, the infection can block the tube with scars, and in other cases, the Fallopian Tube can be blocked, preventing anything from passing through.
Endometriosis Inhibits Fertility
Around one in ten women that are infertile are unable to conceive because of a condition known as Endometriosis. The condition itself is a relatively common malady, affecting around six percent of women in the United States. Some women can still conceive normally, or with only mild issues, even with this condition, but between thirty and forty percent of women with Endometriosis are unable to conceive normally.
Women with Endometriosis are considerably more likely to be infertile than their peers, as infertility afflicts only ten to twenty percent of American women as a whole.
Endometriosis is a condition in which the Uterus functions abnormally. The Endometrium is the inner lining of the Uterus, and goes through a pattern of development and shedding along the pattern of the menstrual cycle. In women with Endometriosis, the lining of the uterus grows thicker than normal, sometimes so thick that it invades other areas of the female reproductive system, including the pelvic cavity, ovaries, and fallopian tubes.
Endometriosis can inhibit fertility because of the various ways that this lining can suppress the normal function of the female reproductive system. For example, it may lead to blockages in the Fallopian Tube. It also increases the risk of infection and scarring of the reproductive organs. The Endometrium also has hormonal influence, which can inhibit the normal and healthy menstrual cycle that is conducive to pregnancy.
Ironically, one of the best treatments to improve fertility for patients with Endometriosis is the birth control pill. The fertility-suppressing mechanisms of the birth control pill also limit the issues associated with Endometriosis. Because Endometriosis is a cumulative condition which gets worse the longer that it is allowed to go on unimpeded, the patient can stop using birth control when she wishes to become pregnant, and her body will be more receptive to fertilization than it would be otherwise.
Surgery is also an option, if the patient is experiencing structural issues such as blockages resulting from the condition. Many women opt for in vitro fertilization that suffer from Endometriosis.
Other Physiological Issues Which Can Impact Female Fertility
A minimum of ten percent of fertility issues are the result of the malfunction of the uterus or a malformation of the organ. There are a number of Uterine issues which can block the passage of the Fallopian Tubes to the Uterus.
Around three percent of women are unable to conceive because of issues related to Cervical Mucus. This fluid is necessary in specific quantity and viscosity for sperm to be able to travel to the implanted egg successfully.
Other Prenatal and Genetic Defects aside from those related to the Fallopian Tubes can also inhibit fertility, or increase the risk of miscarriage.
Drugs that Impact Fertility in Women
Spironolactone – This is a medication designed to treat edema, which can temporarily suppress fertility. The body quickly restores full fertility within a couple of months of the final dose.
Neuroleptics – These drugs belong to the larger class of antipsychotic drugs, and can impact fertility. Neuroleptics have the side effect of increasing prolactin levels in the blood stream, which can contribute to reproductive hormone imbalance in women that can lead to anovulation or irregular period.
Chemotherapy – Chemotherapy is designed to suppress the activity of cancer in an attempt to destroy the cancer or starve it out of existence. Of course, treatments that affect the cancer can also impact other, healthy tissue, including that of the reproductive system, which can inhibit fertility.
NSAIDS – NSAIDS are drugs like aspirin and ibuprofen that are designed to alleviate inflammation without the use of steroids. If used at high doses or on a long and regular basis, they can suppress fertility.
Cocaine and Marijuana – A number of illicit drugs also impact fertility, most notably cocaine and marijuana. Both of these drugs make it harder for a woman to ovulate, which inhibits conception. Both can also affect the development of the child, especially cocaine, which is associated with a number of prenatal abnormalities.
Lifestyle Issues that Impact Fertility in Women
Alcohol Use – Alcohol is a compound which influences hormone balance by promoting estrogen dominance. The abuse of alcohol is associated with a number of issues that impact fertility. For example, women that drink frequently are more likely to have their period without ovulating. Also, these women are more likely to have irregular periods which affect their ability to conceive.
Smoking – Smoking is associated with a number of issues related to infertility. For example, there are chemicals and carcinogens in cigarettes and other forms of tobacco which can cause stored eggs to die off or degrade more quickly. It is estimated that being a smoker doubles the risk of infertility for both sexes, and that overall risk is correlated with the severity of the smoking habit. On average, women that smoke reach menopause between one and four years earlier than their non-smoking peers. Also, smoking effects the cervical mucus, making it harder for sperm to reach the egg in the ovaries.
Exercise and Diet – Fertility depends partially on healthy nutrition. Women that don’t eat enough or eat too much can experience issues with ovulation. Women that are underweight due to anorexia or low body fat due to physical training can frequently miss periods. Being overweight or obese can also alter the normal hormone patterns conducive to optimal fertility.
Age-Associated Issues which Reduce Fertility among Women
As we mentioned earlier, women remain optimally fertile until their late twenties/early thirties. The specific age at which fertility starts to decline on average is around the age of thirty-two. During the mid thirties, fertility remains quite high, but around thirty-seven, fertility starts to fall more rapidly.
Doctors recommend that women thirty-five or older should see a fertility specialist if they are unable to conceive with their partner over the course of a six month period. If a woman is forty years or older, they urgently need to see a specialist if they are interested in conception and are unable to do so in a matter of months.
The overwhelming majority of women should be able to have children successfully at any point up the age of forty, but beyond forty, and the odds start to drop at a rapid pace. There are a number of reasons for this:
Hormone production starts to fall out of balance
Egg quality starts to degrade
The number of eggs available for fertilization starts to dwindle
There are also a number of physiological conditions which inhibit fertility which become more likely with age
Female Infertility Treatment Options
In Vitro Fertilization – For many women, In Vitro Fertilization is the best option for conception. In this process, eggs are artificially brought to maturation and drawn from the ovaries using a special needle. Egg and sperm are introduced in a laboratory dish, and the fertilized egg is implanted into the Uterus, where it then develops.
Clomiphene Citrate – Clomiphene Citrate is an oral medication known as a Selective-Estrogen Receptor Modulator (SERM). In particular, Clomiphene suppresses the influence of Estrogen upon the hypothalamus. It is used to promote ovulation in women that ovulate irregularly or are not ovulating at all. Clomiphene is administered during a specific period of every menstrual cycle in order to promote a normal reproductive cycle.
Clomiphene has a high success rate, increasing the odds of conception to around 5.5% per month. If the patient does not conceive after six months, they are generally recommended to undergo other forms of therapy. Clomiphene is successful at inducing ovulation in eighty percent of patients, though other issues may still impede conception.
Because Clomiphene stimulates ovulation, it increases the odds of experiencing multiple pregnancies of two or more fertilized eggs.
Repronex – Repronex is a medication which stimulates the production of two vital sexual hormones produced by the pituitary which promote fertility and a normal menstrual cycle—Follicle Stimulating Hormone and Luteinizing Hormone. This form of treatment is often paired with Human Chorionic Gonadotropin in order to maximize the odds of fertility. Repronex encourages the female body to produce eggs.
Surgery – For patients suffering from reproductive irregularities or obstructions, surgery is often necessary to encourage fertility. The best example of this is with regard to the fallopian tubes. If these tubes are blocked, then sperm cannot reach the egg for fertilization.
In the case of Endometriosis, surgery can be used to remove thick areas of Endometrium which are inhibiting pregnancy. For patients with Endometriosis, surgery increases the odds of successful pregnancy by 100%. Surgery is also used to eliminate a number of other issues that can inhibit fertility, such as uterine scarring, polyps, and fibroids.
Cabergoline / Bromocriptine – Elevated prolactin levels can inhibit fertility for women. Both Cabergoline and Bromocriptine have the ability to suppress prolactin levels, allowing women to ovulate in a normal pattern. For women with fertility issues resulting from elevated levels of prolactin, nine out of ten patients can have the condition alleviated through the use of these treatments. After Prolactin Levels have been normalized, 85% of patients return to normal ovulation patterns.
Human Chorionic Gonadotropin – This hormone, also known as HCG, is naturally produced by the female body after the fertilized egg is implanted in the female uterus, encouraging the development of the placenta. HCG is a close relative of the Luteinizing Hormone, and Bio-Identical HCG Therapy is often used in order to simulate the production of Luteinizing Hormone at the appropriate point in the menstrual cycle in order to encourage normal ovulation and increase odds of conception.
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