INFERTILITY IN WOMEN

Infertility is a condition defined as not being able to become  pregnant after at least one year of unprotected, regular, well-  timed intercourse. Women who suffer from multiple  miscarriages may also be diagnosed as infertile. Infertility may  be classified into two groups, primary and secondary  infertility.

Primary infertility

Infertile Person has never had a child.

Secondary infertility

Infertile person has had one or more children in the past

Experiencing infertility is emotionally painful for women. Feelings of frustration, guilt, anger, anxiety, depression and confusion may dominate daily life.

The female reproductive cycle includes the release of the mature egg from the ovary, fertilization of the egg and implantation and growth of the egg in the uterus. The cause of infertility in women could be hidden in any of these stages. Therefore we should first understand the complex process of Conception.

Organs involved

Uterus:

Pear-shaped organ located between the bladder and lower intestine. It consists of two parts, the body and the cervix. When a woman is not pregnant the body of the uterus is about the size of a fist, with its walls collapsed and flattened against each other. During pregnancy the walls of the uterus are pushed apart as the fetus grows. The main function of the uterus is to nourish the developing fetus prior to birth.

Cervix:

Lower portion of the uterus, it has a canal opening into the vagina with an opening called the os, which allows menstrual blood to flow out of the uterus into the vagina.

Fallopian tube:

Two tubes each side of the body of the uterus known as the fallopian tubes. Near the end of each tube is an ovary.

Ovary:

Ovaries are egg-producing organs that hold 200,000 – 400,000 follicles. These cellular sacks contain the materials needed to produce ripened eggs, or ova. Men produce sperms throughout their reproductive years. However, women are born with a specified number of eggs, whose number reduces with age. In order to become pregnant, a woman must release an egg from one of her ovaries. This egg must enter the fallopian tube and head towards the uterus. The sperm must then penetrate and fertilize the egg along the way. The fertilized egg must attach to the inside of the uterus so that implantation can occur. Any interference that occurs during this fertilization process may bring about infertility.

Reproductive hormones:

In women, six key hormones serve as chemical messengers that regulate the reproductive system, the hypothalamus (an area in the brain) and the pituitary gland regulate the reproductive hormones.

Ovulation

– With the start of each menstrual cycle, follicle-stimulating hormone (FSH) stimulates several follicles to mature over a 2-week period until their eggs nearly triple in size.

– Only one follicle becomes dominant, however, during a cycle. FSH signals this dominant follicle to produce estrogen, which enters the bloodstream and reaches the uterus.

– Estrogen stimulates the cells in the uterine lining to reproduce, therefore thickening the walls.

– Estrogen levels reach their peak around the 14th day of the cycle (counting days beginning with the first day of a period). At that time, they trigger a surge of luteinizing hormone (LH).

– LH serves two important roles:

A – LH surge around the 14th cycle day stimulates ovulation. It does this by causing the dominant follicle to burst and release its egg into one of the two fallopian tubes. Once in the fallopian tube, the egg is in place for fertilization.

B – LH causes the ruptured follicle to develop into the corpus luteum. The corpus luteum provides a source of estrogen and progesterone during pregnancy.

Fertilization

The so-called “fertile window” is 6 days long and starts 5 days before ovulation and ends the day of ovulation. Fertilization occurs as follows:

The sperm can survive for up to 3 days once it enters the fallopian tube. The egg survives 12 – 24 hours unless it is fertilized by a sperm.

If the egg is fertilized, about 2 – 4 days later it moves from the fallopian tube into the uterus where it is implanted in the uterine lining and begins its 9-month incubation.

The placenta forms at the site of the implantation. The placenta is a thick blanket of blood vessels that nourishes the fertilized egg as it develops.

Causes

Uterine causes

– Fibroids and polyps:

Fibroids are benign lumps of tissue growing in or on the myometrium (the wall of the uterus surrounding the endometrium).

These can make conceiving difficult by blocking the fallopian tubes or disrupting implantation. This mostly occurs amongst women in the 30s. But facts reveal that many women with fibroids can become pregnant.

– Congenital:

Some women are born with uterine abnormalities like abnormally shaped uterus. Presence of complete or incomplete septum, these women can face problems in conceiving or carrying on their pregnancy.

Cervical cause:

– Antibody:

Presence of antibody for the sperm entering the uterus, Hence the sperm unable to reach the uterus and the ovum which fails to fertilize.

– Hormonal imbalance:

Causing cervical mucus consistency to be thick thus preventing swimming of sperm to travel up to the fallopian tubes.

– Cervical narrowing or blockage:

This defect is also known as cervical stenosis. The reason for cervical stenosis can be inherited malformation or damage to the cervix. These results into the cervix being incapable of producing the quality mucus required for sperm mobility and fertilization. Also the cervical opening can be closed stopping the sperms from reaching the egg.

Fallopian tube cause:

– Fallopian Tube Damage:

The fallopian tube carries the fertilized egg to the uterus and also is the passage for the sperms to meet the egg. Any kind of damage or blockage in the fallopian tube will make conception difficult. A fallopian tube could be damaged by inflammation of the fallopian tubes, a previous history of ectopic pregnancy wherein the fertilized egg continues to develop in the fallopian tube itself or a previous surgery of abdomen or pelvis.

– Tubal blockage:

It is present due to tuberculosis of the fallopian tubes.

Endometriosis

Endometrial tissues form the lining of the uterus. Endometriosis occurs when endometrial tissue, grows outside the uterus. If a part of these tissues grows outside the uterus, it blocks the passage of the egg, resulting in infertility. Between 25 and 50 percent of infertile women are estimated to have this condition.

Diagnosis: A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly.

Symptoms: includes heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, there will be no symptoms at all.

Ovarian causes:

– Polycystic ovary syndrome:

It is often responsible for infertility in women.

Elevated insulin levels stimulate excess production of the hormone androgen, which cause some of the unfertilized eggs to disintegrate, leading to inconsistent or no ovulation. Most women with PCOS have multiple benign cysts in their ovaries.

– Ovulation Disorder:

Ovulation disorders are caused because of the malfunction of the reproductive hormones in the hypothalamus or the pituitary gland or by certain problems in the ovary. Following could be some reasons to look at –

– FSH and LH secretion:

These hormones secreted by the pituitary gland regulate ovulation. They are secreted each month in a specific pattern. Any disturbance in this pattern caused by excess physical or emotional stress, a very high or very low body weight, recent substantial weight gain or loss can affect the ovulation process greatly. A major indicator of this malfunction is irregular or no menstruation.

– Luteal phase defect:

This defect occurs when the ovary does not produce the required amounts of progesterone after ovulation. Progesterone is an important hormone playing an important part in preparing the uterine lining for the fertilized egg to be placed.

– Premature ovarian failure:

Caused usually by an autoimmune response, this leads to loss of eggs in the ovary and decrease in estrogen production.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a major cause of female infertility worldwide. PID comprises a variety of infections caused by different bacteria that affect the reproductive organs, appendix, and parts of the intestine that lie in the pelvic area. The sites of infection most often implicated in infertility are in the fallopian tubes, a specific condition referred to as salpingitis.

Causes of PID.

– Sexually transmitted diseases (cause of most PID). Chlamydia trachomatis is an infectious organism that causes 75% of infertility in the fallopian tubes. Gonorrhea is responsible for most of the remaining cases.

– Pelvic tuberculosis

– Non sterile abortions

– Ruptured appendix

Effects of PID.

Severe or frequent attacks of PID can eventually cause scarring, abscess formation, and tubal damage that result in infertility. About 20% of women who develop symptomatic PID become infertile. PID also significantly increases the risk of ectopic pregnancy (implantation of the embryo in the fallopian tubes). The severity of the infection, not the number of the infections, appears to pose the greatest risk for infertility.

Infection

like tuberculosis, sexually transmitted diseases-causing hydrosalpinx and tubo -ovarian masses

Abdominal Diseases

The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage

Previous Surgeries

Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.

Ectopic Pregnancy

This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition

Lifestyle causes

Infertility in women is not necessarily related to any abnormalities in the reproductive organs. It might occur due to various causes.

– Age

Female fertility declines sharply after the age of 35

Dr. Sherman has quoted in his book about infertility in woman as “Only 1% of women in their early 20’s are infertile, in late 20’s 6% women are infertile, and in around mid 30’s about 25% of women are infertile and lastly among the women around 40 years old about 60% are infertile, beyond this age fertility is unsure”.

– Weight

Being overweight or obese (fat levels that are 10 – 15% above normal) can contribute to infertility in various ways. Obesity is also associated with polycystic ovarian syndrome (PCOS), an endocrine disorder that can cause infertility.

Being Underweight. Body fat levels 10 – 15% below normal can completely shut down the reproductive process. Women at risk include: Women with eating disorders, such as anorexia or bulimia.

Women on very low-calorie or restrictive diets are at risk, especially if their periods are irregular.

Strict vegetarians might have difficulties if they lack important nutrients, such as vitamin B12, zinc, iron, and folic acid.

– Smoking

Cigarette smoking can harm a woman’s ovaries and contribute to a decrease in eggs. Studies show that women who smoke are more likely to reach menopause earlier than women who do not smoke.

– Alcohol and Caffeine

Excessive Alcohol and caffeine use may contribute to infertility.

– Stress

High stress levels may interfere with ovulation and the body’s ability to conceive. When planning to fall pregnant, women should learn to manage their stress through relaxation techniques

– Marathon runners, dancers, and others who exercise very intensely.

– Exposure to environmental hazards (such as herbicides, pesticides, and industrial solvents) may affect fertility.

Diagnosis

If you have been unable to conceive after 1 year of unprotected sex, talk with your doctor about having your fertility evaluated. Fertility testing should especially be performed if a woman is over 35 years old or if either partner has known risk factors for infertility. An analysis of the man’s semen should be performed before the female partner undergoes any invasive testing.

Tests to determine infertility

– Blood tests

– Ultrasound of the ovaries

– Hysterosalpingography to check for physical problems of the uterus and fallopian tubes

– Laparoscopy to check the ovaries, fallopian tubes, and uterus for disease and physical problems

Prevention

Lifestyle changes

There are various changes in the lifestyle that women have adopted as a norm and part of their life that can be a cause to the infertility. Some of these lifestyle changes that cause infertility are explained below:

Weight

Women should have enough body weight if they will be able to have a baby. It is considered unsafe during pregnancy if the weight of the pregnant woman is less than the recommended. women who are very underweight have been found to be having a lesser chance of getting pregnant than women who are not very lean. Many adolescents go to extreme lengths to maintain their weight and this may cause infertility.

Obesity

Women who are minimally overweight may not encounter any problems, but women who are grossly obese and overweight can be infertile.

Smoking and alcoholism

This has had a major impact on the ability of women to become pregnant and have children. This is because of the fact that these habits along with substance abuse can cause a person to become impotent.

Sexually transmitted diseases

With increasing pre marital sex and also affairs within a marriage, there is a higher risk of women being affected by sexually transmitted diseases. This is seen in the high number of HIV victims all over the world. Infidelity and infertility can have a link because of the risk of contracting sexually transmitted diseases.

Late marriage

When women are past their prime, the fertility decreases. So late marriages have been an increasing reason for women being infertile.

Lack of exercise

Women are increasingly participating in desk jobs around the world, leading to a sedentary lifestyle. This has had an impact on their physical fitness leading to infertility.

Diet

– Staying hydrated by consuming a lot of water will not only help in proper functioning of all your reproductive organs but will also provide natural fluid for the sperms to reach the cervix. So drink filtered or spring water and increase your fertility levels.

– Green leafy vegetables especially spinach is loaded with antioxidants, iron and folic acid all needed to maintain the good health of your reproductive organs. Folic acid present in spinach not only assists you in getting pregnant by generating viable eggs but also prevents defects in newborns.

– Include a healthy dose of orange and yellow vegetable in your daily diet as they are good sources of antioxidants and beta carotene. Beta carotene helps in correcting hormonal imbalance and also eliminates the chance of miscarriage.

– Suffering from endometriosis or uterus fibroids then gorge on broccoli, cabbage and other cruciferous vegetables. These vegetables contain phyto-nutrients which helps in regulating estrogens metabolism.

– If your problem is irregular menstrual cycles them sweet potatoes, carrots and peas are must haves. These vegetables contain beta carotene which helps in regulating menstrual flow thereby increasing your fertility.

– Enjoy a daily serving of fruits rich in Vitamin C such as blueberries, papaya, oranges, kiwi and strawberries which offer lot of nutritional benefits to women that are planning to conceive.

– Dairy products and lean animal proteins such as fish are rich sources of amino acid that helps in generating fertility hormones FSH and LH. So include them in your diet and see your dream of getting pregnant realized soon.

– Reach out for whole grain bread and tortillas instead of bakery products made of fine flour as they are rich sources of iron and vitamin B needed for enhancing fertility hormones.

– You need to eat right fats if you wish to get pregnant. So a handful of nuts like almonds or walnuts which are great sources of omega 3 fatty acid should be included in your diet.

– Lastly consume vegetable proteins in moderations especially tofu and other soy products which will help you in attaining ideal pre pregnancy weight and will therefore help you in getting pregnant.

Homeopathic symptoms and cure

Homeopathic remedies are prescribed on the basis of symptoms rather than conditions, as each case of a particular illness can manifest differently in different people. There are many symptoms which can be effectively treated by homeopathy few symptoms are given below. If your symptoms are matching to any of the symptoms given below, it can be cured mail the disease and symptom number at drraishyam@gmail.com to know your medicine.

1. Menses too early and painful, thick and almost black. Yeast infection during menses. Ovarian neuralgia left sided with neuralgic pains going down the thigh (electric like Pains). Neuralgic pains during menses with neuralgic headaches. Weakness and difficulty assimilating nutrients from the diet.

2. Ovaritis or ovarian inflammation which is worse on the right side with soreness and stinging pains. Painful menses with severe ovarian pains. Great tenderness of uterine region.

3. Chronic pelvic disorders, Itchy white vaginal discharge that smells like fish. Sterility, endometriosis, intense menstrual colicky pains. Warts on genitals, ovarian pain worse on the left side or that goes from one ovary to the other. Menses have an offensive odor and are dark. Ailments after suppressed gonorrhea.

4. Left ovary very painful and swollen (cysts). Swollen, burning uterus. Pain relieved by menstrual flow. PMS with inflamed and swollen breasts. Worse from suppressed menses caused by birth control pill or other hormonal therapies

5. Very irritable, Menses are irregular, too early and last too long. The blood can be dark with fainting spells. Metrorrhagia (abnormal menstrual bleeding) with sensation of passing stool. Irritable bladder

6. Menses too early and too scanty, lasting too long with hemorrhages from the uterus between periods. White discharges that are burning and come instead of menses. Uterine polyps and amenorrhea with bleeding in other parts of the body (nose bleeds).

7. Menses too early, too profuse, too long. Uterine polyps and sterility with heavy menstrual flow and cutting pain in the uterus during menses. Swollen breasts before menses.

8. Hemorrhages from uterine fibroids with aching in the back and a general bruised feeling. Heavy clots during uterine cramps. Bleeding between periods. Menses are too frequent and heavy. Every other period is very heavy. Difficulty recovering from a period before another begins.

9. Anemia with dizziness, uterine hemorrhages from fibroids with cramp-like pains and a sensation of broken hips. Threatened miscarriages with gushing of bright blood on the least movement.

10. Flabby conditions of the uterus with hemorrhages. Uterus becomes hypertrophied; the cervix bleeds easily, ovaries burn and become swollen. Profuse menses after miscarriage. Blood flow can be clotted forming long black strings.

11. Threatened abortions about the third month. Brown discharges. Menses irregular, heavy dark flow. Burning pain in the uterus. Hemorrhages. Menstrual colic.

12. Cramps and colicky pains in the pelvic region. Menses are too late and when they come they are scanty and last for a few hours. Bearing down pains before menses. Ovarian region feels heavy and congested. Aching in sacral area extending to the front of the thighs. Frequent miscarriage early on during a pregnancy may be due to luteal phase defect.

13. Profuse dark menses. Pain in ovaries and amenorrhea (absent menses).Hormonal acne. Pains immediately before menses which are profuse, offensive, dark coagulated blood with backache.

14. Weak uterus, painful small joints and thrush. The cervix is very rigid. False labor and failure to progress during labor. Needle-like pains in the cervix. Painful periods with pains flying to other parts of the body.

15. Hemorrhage from the uterus, profuse and bright red. Leucorrhea (white discharges) between periods with urinary irritation. Bloody discharges on exertion. Weak uterus. Nose bleeds instead of menses (vicarious menstruation).

16. Ovarian inflammation (ovaritis) with sterility. Infertility with increase sexual desire. Vaginismus and itchy vagina. Menses too early, too profuse, dark clotted with spasms and bearing down pains.

17. Congestion and ante-version of uterus with bearing down sensation. Early, scanty, dark clotted menses with the flow only when moving about.

18. Menses too late with recurrent amenorrhea (absent menses), bladder inflammation and congested kidneys accompanied by back pain. Nervous and irritable an unable to concentrate on one thing.

19. Scanty menses, sterility, transparent discharges often staining yellow. Nervous palpitations with recurrent nose bleeds. Lowered sex drive.

20. Menstrual colic worse right ovary with dark and irregular menses with brown discharges during the entire cycle. Continuous watery blood discharges until the next period. Never been well since a miscarriage or pregnancy

21. Warts on vulva and perineum. Vaginal discharge is profuse, thick and green in color. Severe pain in the left ovary and left inguinal region. Menses are scanty and late. Polypi and fleshy growths. Profuse perspiration before menses. Ailments from vaccinations.

22. Enlargements of the uterus, fibroid growths and prolapsed uterus. Uterine tumors with bearing down sensation and painful periods.

23. Bleeding with uterine fibroids. Irritability before and during menses. Pain in the ovaries and difficult menses.

24. Very tired women with a weight and a dragging sensation in the uterus with tendency to Prolapse especially after miscarriages. Back pain after miscarriages. Malposition of the uterus. Itchy vagina and vulva with white discharges. Constant pain over the kidneys. Diabetes mellitus and insipidus.

25. Weepy and moody before period. Cramping painful periods with cramps before period arrives. Nausea, vomiting before periods aggravated by eating fatty foods. Bloating feeling, swollen breasts and back pain before period. Weight gain before menses.

26. Infertility after birth control, miscarriages, abortions. Cramps before period with a dragging sensation as if the uterus would fall out. For this reason, patient tends to cross their legs and suffer from poor circulation to the uterus and pelvic region. Itchy, burning white, yellow-green discharges.  Worse after intercourse and dread having sex because it can be painful or they feel exhausted afterward. Violent stitching pains going upwards in the vagina, from uterus to umbilicus.

27. Infertility in cases of underdeveloped ovaries.

28. Infertility after recurrent miscarriage

29. Low sex drive and depression are the cause of infertility

30. Anxiety and stress are contributing to infertility

31. Low immunity level causes infertility.

32. Burning in ovaries and uterus. Tumors and polyps of uterus.

33. Uterine displacements, Lack of tone in the uterus. Worse standing and walking.

34. Vaginal discharges like egg white with sensation as if warm water was flowing.

35. Ovaries have exhausted their energy after undergoing a series of infertility treatments.

36. Boring pain in left ovary. Round, small cysts in the ovaries or broad ligaments. Painful menses with bearing down cramps which are better by bending double.