Infertility

Infertility is the inability or failure to conceive after a year of regular intercourse without contraception. There are two categories to classify infertility, primary and secondary. Primary infertility occurs in women who have never conceived while secondary infertility occurs in women who had a previous conception. Affecting about one in six couples, there are many causes of infertility. A little more than half of cases of infertility are attributed to female conditions. Female conditions include ovulatory dysfunction, tubal or pelvic factors, cervical problems and uterine factors. However, that does not rule out other conditions as well. These include the male factors and unexplained infertility. Male factors are pretesticular causes, testicular factors and posttesticular causes.

Recent research has shown that the increase of infertility in one in ten couples to one in six couples is due to lifestyle factors. Delayed childbearing, habits such as cigarette smoking and alcohol, changes in sexual behaviour and eliminations of most taboos contribute to the increase in infertility in many couples. Cigarette smoke and substance in it such as nicotine has adverse effects on reproduction. It also causes lower circulating levels of estrogen and earlier menopause. For males, smoking decreases sperm quality. Alcohol has found to increase the risk of tubal factor and cervical factor infertility and ovulatory dysfunctions. On males, alcohol is found to increase abnormal shapes in sperm, can lead to impotence, and adversely affect male hormone levels. These lifestyle factors have adverse effects on reproduction as they are found to be able to change the regulation of hormones in both the male and the female, resulting in infertility.

One of the most common female infertility factor is ovulatory dysfunction also known as anovulation, as mentioned eariler. It is a disorder where ovulation does not occur regularly. Causes of ovulatory disfunction range from the disruption of the hormone regulation of the female cycle to the underdevelopment of reproductive organs in a woman, they are mostly related to the imbalance of hormones. It can occur to any woman who has gone through puberty and is common in women approaching menopause, where women stop ovulating. The hypothalamus and pituitary glands in the brain regulates FSH and LH in the beginning of a woman's menstruation cycle, inadequate amounts would cause ovulatory dysfunction. Any changes in the function of the glands would affect ovulation and therefore, many causes of the dysfunction affect the glands in some way.

Premature ovarian failure, a cause of ovulatory dysfunction, is a disorder believed to be due to genetic abnormalies which leads to the faster depletion of eggs in an ovary. Women who have this disorder lose more eggs during menstruation than normal women, eventually leading to early menopause. Hypothyroidism and hyperthyroidism are diseases of the thyroid gland, also are causes of ovulatory dysfunction though it is not very clear how. Hypothyroidism is when the woman does not produce enough thyroid hormone while hyperthyroidism is where too much thyroid hormone is produced. These abnormalies lead to higher amounts of estrogen in a woman, and therefore interfere with the growth of the follicle and affect the amount of FSH and LH that is required for the release of the egg. Polycystic ovary syndrome is a disease which follicles don't mature, causing them to sometimes become ovarian cysts. Women with this disease don't ovulate for periods of time. A suggested theory is that high levels of LH found in these women cause ovulatory dysfunction. Hyperprolactinema is the too much prolactin in a woman's body. Prolactin is a hormone that is needed to produce breast milk and too much of it would cause a decrease in FSH and LH, affecting the maturing of a follicle. It would also disrupt the amount of other hormones needed for ovulation. Eating disorders such as anorexia and bulimia alters the normal activity of LH, it does not fluctuate as it should, during a normal menstruation cycle. That results in irregular or even absent menstruations. Medication can also cause ovulatory dysfunction by causing increases in hormones such as prolactin, which may lead to hyperprolactinema. Also, medication to do with the brain also might lead to hormonal imbalance, causing ovulatory dysfunction. Anovulation due to aging is one of the most common causes. Women approaching menopause have fewer eggs in their ovaries, therefore anovulation is evident in the later stages of a woman's life, especially when she is after the age of 35 and nearing 40. Excessive exercise also causes change in menstrual regularity due to dietary changes and stress.

There are ways to test for anovulation. A woman can track the time of ovulation through the most traditional method of charting her menstrual cycle. This is not reliable as women with ovulatory dysfunction might have irregular periods, the length of their menstrual cycle might be different each time. Another way to physically measure is to monitor basal body temperature or BBT. A woman's body temperature rise 0.5degrees during ovulation. Though reliable, it cannot predict ovulation, it can only tell when ovulation has occurred. Nowadays, as science progress, ovulator predictor kits are available for women to see if they were about to ovulate. The kit tests the amount of LH in urine, a surge meaning that ovulation was going to occur. Doctors test for the levels of different hormones to determine time of ovulation. The cause of anovulation can be determined by the levels of gonadotropins, prolactin, TSH (thyroid-stimulating hormone) and progesterone, when certain levels are irregular.

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