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8.2 Causes Of Infertility In Women




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This article is from the Infertility FAQ, by Rebecca Smith Waddell bec@fertilityplus.org with numerous contributions by others.

8.2 Causes Of Infertility In Women

Adhesions and scarring: Can be caused by sexually transmitted diseases
left untreated, Chlamydia being the most common. Scarring can lead to
blockage of the fallopian tubes, or damage to the delicate membranes
within the tubes. It can also be formed by endometriosis and prior
surgeries in the abdominal area.

Age: A woman's fertility begins falling off after the age of 25,
though pregnancy can be achieved and maintained for most women into
their early 40s. The rate of miscarriage and birth defects increases
after 35. See
http://noah.cuny.edu/pregnancy/march_of_dimes/pre_preg.plan/after30.html

Asherman's Syndrome: This is a condition where the walls of the uterus
adhered to each other. Usually caused by uterine inflammation.

Cancer treatment: Chemotherapy and radiation can cause early
menopause. Information on how cancer treatment affects fertility is
posted at http://oncolink.upenn.edu/specialty/med_onc/bmt/bmt_11.html

DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s
and 60s to prevent miscarriage. Can cause abnormalities in the
reproductive organs such as shortened cervix, deformities of the
vagina or cervix, T-shaped uterus, abnormal fallopian tubes, ovulation
problems, increased risks of ectopic pregnancy, repeated miscarriage,
and premature delivery. See hhttp://www.teleport.com/~skeely/

Endometriosis: Growth of endometrial tissue outside the uterus. Can
cause blockage of the fallopian tubes and adhesions. May not cause any
symptoms beyond infertility, but could cause crampy periods and
painful intercourse. FAQ posted at
http://www.bioscience.org/books/endomet/babaknia.htm.

Environmental hazards: Pesticides may damage a woman's eggs leading to
early menopause. Some materials are linked to early
miscarriage. Ethylene oxide, used in chemical sterilization of
surgical instruments. Exposure by healthcare professionals (including
veterinary) to nitrous oxide. Vinyl chloride, used in plastics, and
metallic compounds including manganese, arsenic, and nickel.

Hyperprolactinemia (elevated levels of the hormone prolactin): Can be
caused by pituitary tumors, and breast milk production after giving
birth. May lead to weak or skipped ovulation. Lowering prolactin
levels can be achieved with Bromocriptine (Parlodel).

Hypothyroid: Underactivity of the thyroid gland. Symptoms include low
basal body temperature and unexplained weight gain. Can throw off the
endocrine system leading to ovulation problems and to miscarriage. An
article about thyroid disease and pregnancy, fertility and pregnancy
loss is posted in two parts at
http://thyroid.miningco.com/library/weekly/aa063097.htm (part 1) and
http://thyroid.miningco.com/library/weekly/aa070797.htm (part 2).

Immunological problems: The most common immune problems, testing
positive for anti-phospholipid antibodies or the lupus anticoagulant,
can lead to blood clots in the placenta that prevent nourishment from
reaching a fetus. There are other more controversial causes of
immunological fertility problems -- please check http://www.inciid.org
for more information.

Luteal phase defect (LPD): There are two types of luteal phase
problems that fall under the category of LPD. One is a short luteal
phase -- 10 days or less. The second is when the length of the phase
is not necessarily shorter than the standard 12-16 days, but it is out
of phase and progesterone production is low. Typical treatment is to
enhance ovulation and/or to use hCG or progesterone support after
ovulation.

Luteinized unruptured follicle syndrome (LUFS): Failure of the
follicle to release an egg even though it has reached
maturity. Commonly seen when an LH surge is not followed by
ovulation. Can be confirmed with ultrasound. May account for 5-30% of
women with unexplained infertility.

Medication: Non-steroidal anti-inflammatory drugs (NSAIDs -- see
http://www.fertilityplus.org/faq/nsaids.html), radiation and
chemotherapy for cancer treatment, antihistamine and decongestants may
lead to fertility problems. Vitamin C in large doses is also
considered an antihistamine - which can lead to cervical mucus drying
out.

Menopause: When a woman stops having regular ovulation and
menses. Pregnancy may still be achieved through drug therapy and
perhaps IVF with donor egg.

Obesity: Excess weight can lead to elevated estrogen levels which act
as birth control and prevent a woman from ovulating. Drugs to induce
ovulation can bypass this problem. For more information on weight and
infertility, please check
http://www.fertilityplus.org/faq/bbwfaq.html.

Polycystic Ovary Syndrome (PCOS): Symptoms include infertility,
irregular cycles, obesity, acne, excess facial and body hair, obesity,
skin tags, dark skin patches (back of neck, under arms, under breasts,
groin), cystic ovaries, excess male hormones, insulin resistance, and
dyslipidemia. It should be diagnosed through a combination of a
physcial exam, ultrasound evaluation to look for possible cysts in the
ovaries or ovarian enlargment, and blood tests to check LH and FSH
(check ratio as well as levels on these two as LH higher than FSH is
indicative of PCOS, especially when 2:1 or 3:1), testosterone, DHEAS,
SHBG, androstenedione, prolactin, TSH, fasting glucose and insulin
testing. Check http://www.inciid.org/faq/pcos.html and
http://www.pcosupport.org for lots of information and support options.

Premature ovarian failure (POF): Characterized by high FSH in a
younger woman (usually in her 30s). Cancer treatment and environmental
hazards may play a role in the development of POF.

Recurrent miscarriage/pregnancy loss (RPL): When a woman miscarries
more than one pregnancy. Testing can be done to try to determine the
cause of such losses. If an underlying condition is found, the woman
may need to be treated for the problem before a pregnancy can be
carried to term. Testing information can be found at
http://www.fertilityplus.org/faq/miscarriage/rpl.html.

Smoking: Associated with an approximately 5% increase in miscarriage
rate. Smoking also doubles the chances of an ectopic pregnancy by
damaging the cilia in the tubes. Studies have shown a marked decrease
in effectiveness of IVF and GIFT. More information on smoking and GIFT
can be found in the April 2, 1997 section of "What's up Doc?" at
http://www.ivf-et.com/ (direct to the information is
http://www.ivf-et.com/wud970407.html)

Tubal ligation (and failed surgery to reverse): Surgical sterilization
of a woman by obstructing or tying of the fallopian tubes. May be
reversed surgically with varying degrees of success.

Turner's Syndrome: Women should have cells that are 46XX, but Turner's
women are missing an X -- hence a karyotype of 45XO or a mosaicism of
46XX and 45XO. Turner's women with a 45XO karyotype are sterile while
those with a mosaicism may be able to get pregnant and carry to
term. Women tend to be ultra-feminine and small in stature. Check
http://www.onr.com/ts-texas.

Uterine abnormalities: Include problems from DES exposure, septums,
T-and heart-shaped uterus.

Vegetarian lifestyle: Vegetarians may experience irregular ovulation
that reduces the chances of conception.

SECTION 9 - TREATING INFERTILITY

Please note, information on drugs mentioned appears after the male and
female sections, as does methods of impregnation (IUI, IVF).



 

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