Female Infertility: Review and key takehome considerations for women

By Sande Elison Oundo

There are few things which make people happier than having kids. So why is it that some people can’t have kids and are there some things that they can do to overcome infertility? 

The World Health Organization defines Infertility as a disease of the reproductive system characterized by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or lack of menstruation). 

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Male infertility is responsible for 20–30% of the cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts. In 10–20% of cases, no cause is found. The rates are increasing in Sub-Saharan Africa.

Infertility in a woman often leads to cultural and social stigma alongside depression and poor self esteem. Marital disputes, domestic abuse, infidelity, and polygamy, especially in cultures which normalized it, can be the consequences for an infertile woman.

Women, unlike men, have a designated period for being fertile, so age is definitely a factor. A woman’s fertility peaks in the early and mid 20s, after which it starts to decline, with this decline being accelerated after age 35.  The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of a woman and the fertility of the male partner. There are women who go through early menopause due to unknown factors, possibly genetic, called premature ovarian failure.

Polycystic ovarian syndrome (PCOS) has become the leading cause of female infertility, up to 10% of women have it. From the word polycystic, there are a lot of cysts in ovaries and appear like chains of pearls on Ultrasound scan. It presents with irregular menstrual periods, heavy periods, excess hair, acne, pelvic pain, and skin patches. Obesity (abdominal) is one of the risk factors for getting PCOS due to insulin hormone insensitivity (diabetes) leading to overproduction of insulin resulting in high levels of male hormones (testosterone) in the body. Testosterone stops the natural menstrual cycle and thus results in infertility. Cysts are immature eggs who were arrested from developing to fertile eggs for reproduction but kept growing. 

Adhesion (fibrous bands) in the pelvis also leads to infertility. Adhesions can be a consequence of sexually transmitted infections, pelvic inflammatory disease, endometriosis (where by the lining of the uterus appears in other parts of the body) and surgeries like for abortions and removing fibroids (muscle tumors), which can themselves lead to infertility by reducing the space of the uterus.

Tobacco smoking is harmful to the ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to manufacture estrogen, which is responsible for reproduction.  

Stress interferes with fertility, because the body can only get pregnant when it confirms the habitability for a fetus, any extreme and persistent stressors can endanger a pregnancy, and lead to miscarriage, or can make the uterus hostile to any fertilization.

Other Genetic conditions like Mayer-Rokitansky-Küstner-Hauser Syndrome (where the woman has no uterus), turner syndrome (45X, one part of sex chromosomes is missing) and intersex conditions (where the genitals are ambiguous) lead to infertility.

Antisperm antibodies, defense cells made by the female body against sperm cells impair fertilization. This has been linked with unorthodox sexual activities. 

Environmental chemicals like external estrogens, found in cosmetic and skin care, and others which disrupt the hormonal system of the body leading to infertility and even cancers to women.

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There are multiple procedures which can assist with reproduction like In Vitro Fertilization(IVF), however such procedures are expensive and don’t guarantee success in getting pregnant. And as such here are some core things you can do to prevent/overcome infertility. They include;

  1. Having a healthy weight through fasting and exercising, this is a key prevention and treatment for PCOS. 
  2. Reducing stress through sleep and meditation.
  3. Having support from your spouse and family.
  4. Avoiding lifestyle which predispose you to adhesions (STIs and abortions).
  5. Caution from chemicals which can harm you and your children (when pregnant).
  6. Not smoking tobacco and reducing alcohol intake.
  7. Preferably having children before the age of 35.
  8. Getting early treatment for fibroid and endometriosis.

The World Health Organization (WHO) recognizes infertility as a worldwide problem and a major public health problem that demands major efforts in health education and significant changes in social behavior and sexual practices in order to make a significant reduction in its causes since the cornerstone to the management of any disease including infertility is prevention. 

Sande Elison Oundo is a holistic health practitioner and President of Vigilant Living, A counseling and coaching company

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