By NUR ASHIKIN LOUIS
KUCHING: Infertility may come naturally but this does not mean one should lose hope.
State Health Department’s family health specialist Dr Azrene Abdullah said first and foremost the affected married couples should learn what caused their “failed attempts”.
“Only when causes are revealed, then it would be easier to identify the suitable treatments,” she said during a health talk titled “Difficulty in Conceiving? Know the Cause & Treatment” at the State Library here yesterday.
Some 143 participants, a majority of whom are civil servants, attended the talk.
She said infertility reflected the disability of a couple in achieving ovulation after a year without the usage of contraceptives.
Infertility can cause health problems and becomes a burden to a married couple especially the female. In most cases infertility can cause emotional distress which leads to a divorce.
According to Dr Azrene, 30 per cent of the factors of infertility involved men, another 40 per cent women, followed by men and women as well as unexplained infertility at 15 per cent each.
During the talk, Dr Azrene explained in detail to the audience the anatomy of the ovary, uterus and cervix.
“In a female reproductive system, there are five important parts -vagina, uterus, fallopian tubes and ovaries. If there is a problem in the path connecting to all of these parts in the female reproductive system, it could be a major cause for infertility.”
“An ovary is like a factory. A normal woman could produce 300,000 eggs in the ovary. After puberty, some seeds will grow and only one would be released during ovulation every month. In every cycle of menstruation, around 20 young eggs will grow but only a few would reach maturity while the rest of the immature eggs are removed to be reabsorbed into the body.”
She said a normal menstruation cycle for a woman is around 21 to 35 days.
She said if it was not within the period then it was not a regular cycle.
“If a woman’s regular menstruation cycle is around 28 days, ovulation happens at around day-14 which is right in the middle of the menstrual cycle. This time is where you have the highest chance in getting pregnant. It lasts for 24 hours. After a day, the egg will die or dissolve if it isn’t fertilised.”
However, a sperm can live up to five days. Therefore, a woman can still get pregnant if she has sex five days prior to ovulation.
Meanwhile, the factory in a male reproductive system is the testis. The testis will produce the sperms.
Infertility in men can be caused by varicocele which is the peculiarities or disabilities of the genitalia, inflammation or infections on the genitalia, cancer, genetic problem, chemotherapy or radiation treatment, diseases such as diabetics and high blood pressure, smoking and intake of alcohols as well as drugs.
Varicocele happens when there are swollen blood vessels due to problems with the valve. It can be felt and sometimes be seen as a tortuous mass on the surface of the scrotum.
“Every 4 out of 10 men who have varicocele would experience infertility. Treatment would be given if it brings trouble to the sperm which is when the number of sperm is low.”
She said, “Infertility caused by inflammation or sexually transmitted infections (STI/STD) such as chlamydia, gonorrhea and mumps are usually treated with antibiotics. Meanwhile, genetic problem such as Kallman Syndrome which is a condition of having low testosterone level or elevated follicle-stimulating hormone (FSH) is where we would provide genetic counselling.”
“Cancer is definitely a killer disease. Common cases are testicular cancer and prostate cancer. These cancers disrupt sperm production. Treatment for such cases is chemotherapy.
“At the same time, infertility in women is usually caused by Polycystic Ovarian Syndrome (PCOS), Endometriosis, STIs, defects in the female reproductive system, disturbance in fallopian tubes and aging.
“PCOS is a condition where there is an imbalance on hormones which leads to irregular menstruation cycle. Most of them are caused by acne, hirsutism where excessive body hair is present, infertility and gaining weight. The treatment for PCOS is clomiphene citrate (clomid), reducing body weight, metformin and hormone treatment.
“Meanwhile, endometriosis is where tissue of the womb is present outside the uterus. It affects fertilisation. It leads to scars, blocking the path for production, chronic inflammation, adhesions, and menstrual cramps. All of these are the little details which contribute to infertility. There are no medicines which could eliminate endometriosis directly but we can still depend on other alternatives such as painkillers, hormone pills and even surgery. It is even better if the patient seek medical advice regularly.
“There are also unexplained infertility cases. It could not be identified unless we perform In Vitro Fertilisation (IVF). IVF is the process of extracting both the eggs and sperm from its factory, and manually doing the fertilisation by combining them in a laboratory dish. The embryo(s) would then be implanted back into the uterus,” Dr Azrene said.
