Infertility is a complex disorder with significant medical, psychosocial, and economic consequences. The prevalence of infertility varies depending on the criteria (clinical – 1 year, epidemiological – 2 years, demographic – 5 years) and whether the outcome is pregnancy or births. Nonetheless, its prevalence is particularly high in sub-Sahara ranging from 20% to 60% of couples. (Ogunniyi et al., 1999).

In Nigeria for example, it is estimated that female factors account for 50-80% while the male factor accounts for 20-50% of the cause of infertility in different parts of Nigeria (Esimai et al., 2002).  

What is infertility in women?

Infertility is the inability of a couple to achieve pregnancy over an average period of one year (in a woman under 35 years of age) or 6 months (in a woman above 35 years of age) despite adequate, regular (3-4 times per week), unprotected sexual intercourse (Cooper et al.,2009).

What are the types of infertility in women?

 Types of infertility includes;

  • Primary infertility; the woman has never been able to conceive.
  • Secondary infertility; the woman is experiencing difficulty in conceiving after having conceived (either carried the pregnancy to term or had a miscarriage).
  • Cervical infertility; this involves the inability of sperm cells to get into the womb as a result of cervix injury or cervical factors. Some of the cervical factors include; cervical stenosis, anti-sperm antibodies, inadequate, negative or non-receptive cervical mucus, and cervical infections from sexually transmitted diseases.
  • Unexplained infertility; In this case, fertility testing hasn’t found a reason why the woman is unable to conceive. 

What are the causes of infertility in women?

The female reproductive organs (ovary) produce eggs and hormones (progesterone and estrogen). These hormones enable a woman to become pregnant. A woman’s cycle begins with the release of an egg from the ovaries (ovulation). Infertility in females may be caused by a low number or poor quality eggs. Women are usually born with all the eggs they will have for their reproductive lifetime. Each egg is enclosed in a set of cells that make up a follicle. Follicle supports egg maturation and after hormonal stimulation, one follicle is ovulated every month. 

Draw a labelled diagram of female reproductive system.

Diagram of the female reproductive system.

Here are some common causes of infertility in women that are worth knowing;

Hormonal imbalance

This is an important cause of anovulation, that is the absence of ovulation in women. Women with hormonal imbalances won’t make enough follicles to guarantee the egg’s development. Stress may play a huge role in altering the balance of hormones in women. (Gohil et al., 2001).

Hyperprolactinemia

This is the presence of abnormally-high prolactin levels in the blood. In women who are not pregnant or nursing, this causes milk production. It results in infertility by causing the brain to release more dopamine, which suppresses the production of gonadotrophin-releasing hormone (GnRH) which regulates sex (ovarian) hormones, ovarian steroid production, and ultimately infertility.

Sexually transmitted diseases

This is a leading cause of infertility. They are diseases transmitted through sexual activity with an infected partner caused by viruses, bacteria, or parasitic microorganisms. They often do not have many symptoms and if left untreated can lead to infertility.

Pelvic inflammatory diseases

This includes a wide range of infections that affect the pelvic organs such as the bladder and uterus. They may be caused by many pathogens, including bacteria, as well as inflammatory diseases that impact the gastrointestinal system in the pelvic area. It may also be brought on by two sexually transmitted diseases; Chlamydia trachomatis and Gonorrhea. These disease can lead to further infections, wounds, tubal blockage, tubal damage, ectopic pregnancy, and infertility.

Cancer treatment

Although aggressive chemotherapy and radiation therapy have significantly increased the life expectancy of young cancer patients, they also increase the risk of infertility by massively destroying ovarian tissue and causing premature ovarian failure (POF). It is for this reason that young women may often be advised to have their eggs stored ahead of any cancer treatment. 

Genetics also plays a huge role in infertility among women.

What role does medications and lifestyle play in female infertility?

There are many lifestyle changes that have the potential to positively or negatively affect a woman’s fertility.

  • Smoking increases the thickness of the zona pellucida (a strong membrane that forms around the egg as it develops) which makes sperm penetration difficult (Ilaqua et al.,2018).
  • Hormonal system disruption may result from prolonged alcohol use. (Oremosu &Akang, 2015).
  • Sexual carelessness greatly increases the risk of sexually transmitted diseases, such as gonorrhoea, chlamydia trachomatis, herpes, syphilis, and HIV which may cause infertility if left untreated.
  • Drug abuse and use of recreational drugs such as heroin and methadone.
  • Overall poor health and obesity can negatively affect the fertility of a woman.
  • Anxiety and depression could activate an inhibitory effect on the female reproductive system resulting in infertility (Abasiubong et al., 2008).
  • Poor nutrition such as a high fat diet, low amounts of vegetable, legumes and high red meat intake can negatively affect the overall woman’s health.

What fertility treatments are available?

Across West Africa, infertility treatment includes medications, surgical procedures as well as assisted reproductive interventions which include;

  • Weight reducing drugs can be he helpful in obese infertile women who do not ovulate. In this case, a 5-to 10% weight loss is sufficient to restore reproductive function in 55–100% of cases in just six months. (Clark et al., 1995).
  • The use of drugs and hormones to induce ovulation in a consistent manner. The choice of medication will be dependent on the cause of the lack of ovulation.
  • Artificial Insemination be achieved by intracervical or intrauterine insemination. It is performed in an ovulating woman with patent tubes. 
  • In Vitro Fertilization (IVF) could be used to treat women with damaged fallopian tubes and endometriosis or in cases of unexplained infertility. A standard IVF requires the presence of a functioning fallopian tube.
  • Intracytoplasmic Sperm Injection (ICSI) is used when male infertility is the main problem. It involves injecting a single sperm into an egg obtained from in vitro fertilization (IVF).

REFERENCES

Abasiubong F, Bassey E, Ekett J, Umoiyoho A, Umoh A.2008. The burden of psychological symptoms in gynaecological conditions among women in Uyo, Akwa Ibom, Nigeria. Nigerian Journal of Psychiatry 6 21–2. [Google Scholar] [Ref list]

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Cooper, T. G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H. G., Behre, H. M., Haugen, T. B., Kruger, T., Wang, C., Mbizvo, M. T., & Vogelsong, K. M. (2009, November 24). World Health Organization reference values for human semen characteristics*‡. Human Reproduction Update, 16(3), 231–245. https://doi.org/10.1093/humupd/dmp048.

Esimai ,O.A., Orji, E.O., Lasisi , A.R. Niger J Med., 2002, 11:70-72.

Gohil, B. C., Rosenblum, L. A., Coplan, J. D., & Kral, J. G. (2001, July). Hypothalamic-Pituitary-Adrenal Axis Function and the Metabolic Syndrome X of Obesity. CNS Spectrums, 6(7), 581–589. https://doi.org/10.1017/s1092852900002121.

Ilacqua A, Izzo G, Emerenziani GP, Balari C, Aversa A.2018. Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reproductive Biology and Endocrinology 16 115. ( 10.1186/s12958-018-0436-9) [PMC free article] [PubMed] [CrossRef] [Google Scholar]

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SO Ogunniyi, OO Makinde, and FO Dare. African Journal of Medicine and Medical Science, 1999, 19(4): 271 – 274.

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