Conception is something that almost every woman desires when they aspire for motherhood. But there are conditions that can prevent a woman from achieving the goal of becoming a vessel for another life.
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Regina Tan-Espiritu, M.D., is an obstetrician–gynecologist practicing at several institutions like the University of the Philippines-Philippine General Hospital, United Doctors Medical Center, and HealthWoRx Clinic on Panay Avenue, Quezon City. A specialist in reproductive endocrinology and infertility, she considers the couple involved as the patient unit, since a combination of both female and male factors can cause infertility—and hinder conception.
The seventh edition of Female Infertility, Clinical Gynecologic Endocrinology and Infertility lists the following factors that may hinder conception: male problems, 35 percent; tubal and pelvic problems, 35 percent; ovulatory problems, 15 percent; unexplained infertility, 10 percent; and unusual problems, 5 percent.
Endometriosis and ovulatory problems
Dr. Tan-Espiritu says endometriosis is a major cause of infertility. The condition occurs when the tissue from the inner lining of the uterus or endometrium grows outside of the uterus such as the surface of the uterus or the ovaries. These endometriotic implants continue to act as they should—thickening, breaking down and bleeding with the menstrual cycle. Unable to exit the system, these emigrant tissues can irritate surrounding tissue and cause adhesions or scarring. These can prevent the egg from being picked up by the fallopian tube. Endometriosis can be suspected with the following symptoms: dysmenorrhea, painful intercourse, low back pain, irregular periods or abdominal pain.
Ovulation depends on a complex balance of hormones, and ovulatory disorders are the most common reasons why women are unable to conceive, claims Dr. Tan-Espiritu. Polycystic ovarian syndrome or PCOS is the most common type of hormonal imbalance that disrupts ovulation. The ovaries do not produce normal follicles where the eggs can mature, and ovulation is rare if the eggs are immature. Symptoms include absent or sometimes heavy and irregular menstruation; excessive hair growth on the face, chest, back; acne and oily skin; weight gain; hypertension; and repeated miscarriages. Interventions like birth control pills can help PCOS patients regulate their menstrual cycle and address the excessive hair growth and acne. Other treatments include ovulation-inducers and surgery, depending on the discretion of the doctor.
Pelvic cancers—ovarian, endometrial and cervical—do not necessarily cause infertility, says Dr. Tan-Espiritu. However, women with these cancers undergo surgery to remove the uterus and ovaries. Or they require chemotherapy or radiotherapy that may also lead to premature ovarian failure, causing follicles to be depleted.
Aside from possible damage to the fallopian tubes, extensive, invasive or multiple surgeries for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred. This in turn inhibits the follicles from maturing properly, so no ovulation occurs.
Primary ovarian insufficiency
Also known as premature menopause, Dr. Tan-Espiritu says this rare and unexplainable cause of failure of ovulation is found in women less than 40 years of age who stop menstruating without any apparent cause. Other causes may be genetic, auto-immune or drug-induced, including radiation therapy and chemotherapy.
Problems with the uterus include myomas, polyps, adenomyosis, adhesions or uterine malformations. Myomas or fibroids are solid growths within the muscle wall, on the outer covering or within the cavity of the uterus. Not all myomas will impede conception. This will depend on the location within the uterus or if they change the shape of the cavity. The most common symptoms is heavy and prolonged bleeding possibly with blood clots, enlarging abdomen, abdominal pain, urinary and bowel symptoms when the myoma presses on other structures in the pelvic area.
Polyps grow within the inner lining of the uterus. Most are small and do not compromise the reproductive capacity of women. Larger and multiple polyps are the ones that may interfere with reproduction. They may present with irregular menstrual bleeding or bleeding between menstrual periods. Congenital anomalies of the uterus are rare. They do not cause infertility but can be associated with recurrent miscarriages.