Chapter I - Understand Fertility, Infertility, Causes and The Causes of Cause of Infertility
**Fertility is a natural process to insure the survival of human species. Through natural selection, we produce many offspring when the reproductive system works at it's peak in the suitable environment with plenty of food around. On the other hand, the reproductive system may completely shut down or work at it's minimum state and we produce less offspring, when the environment is hostile including less foods around, war, epidemic, but regardless of all these factors, most women are capable of conceiving during their menstrual cycle before reaching the stage of menopause.
**Infertility is defined as the inability of a couple to conceive after 12 months of unprotected sexual intercourse. It effects over 5 millions couple alone in the U. S. and many times more in the world. Because of an unawareness of treatments, only 10% seeks help from professional specialist.
A. Overcome Infertility --Understand Fertility
I. The rate of pregnancy
Statistics show that before:
1) the age of 31, 73% will get pregnant within one year, and 90% within four years
2) the age of 36, 65% will get pregnant within one year, and 82% within four years.
3) the age of 41, 40% will get pregnant within one year, and 60% within four years
You can see the rate of pregnancy goes down with age.
Although women can get pregnant anytime during their menstrual cycle, the best days to get pregnant are 2 days before and after ovulation because the sperm can only survive 2-3 days(sperm may survive up to 6 days) in the uterus after ejaculating into the vagina.
II. The natural process
1. Men produce sperm as soon as they reach puberty and at any time of the month, but their sperm quality and quantity may dip occasionally, depending to their internal cycle, therefore it is easy to understand that some women can conceive with her partner at the age of 95.
2. The female is born with a finite number of eggs in their ovaries. When females reach the age of puberty, every month some of the eggs in their ovaries mature and are extruded and only one can get into the Fallopian tube for fertility, the rest degenerate and die. When the eggs are less than a certain number in the ovaries, she enters the menopause state.
III. The long journey
1. The egg (ovum)
If the menstrual cycle is 28 days:
a ) In the early stage of the menstrual cycle the levels of estrogen rise. It stimulates the production of FSH(follicle-stimulating hormone) hormones from the pituitary gland and the follicles mature 2 to 3 days before ovulation. As the estrogen levels reaches it's peak, it stimulates the cervix to make cervical mucus which is friendly to the sperm invasion and the pituitary gland releases LH (luteinizing hormone) which triggers ovulation within 48 hours and the egg starts the long journey of travelling through the Fallopian tube toward the uterus.
b) After ovulation, the follicle starts to produce progesterone, the cervical mucus starts to become more sticky and unfriendly day by day to sperm invasion and the cervix opening to the vagina starts to close dramatically. The endometrial lining to the uterus now softens and is ready for the nourishing of the fertilized egg, if pregnancy occurs. Now you know how many experts tell you that the best days to get conceived is 2 days before and after ovulation, because sperm also needs about 2 days to get into the Fallopian tube.
c) If pregnancy does not occur,the corpus luteum creases to produce progesterone and subsequently stop, the soft lining is shed and the woman menstruates. During menstruation the levels of estrogen decrease, which again triggers the increase in FSH and the menstrual cycle starts over again.
2. The sperm
a) After ejaculating into the vagina, if the cervix is closed dramatically or the cervical mucus is hostile to the sperm, there is little change. One of them will make it to Fallopian tube. On the other hand, if the cervix is opened and the cervical mucus is friendly to the sperm, then the sperm will travel toward the opening of the cervix and one of the winners will enter the fallopian tube to fertilize the mature egg and travel toward the uterus for implantation in the soft lining.
b) After one sperm penetrates (by releasing acrosome, then acrosin so it can pass through the tough cumulus oophorus and break through the zone pellucida accordingly) into the egg and the egg is fertilized. It then continuously divides itself into a fetus then into a baby.
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B. Overcome Infertility --Understand Female Biological Clock
Here are some important statistics
I. Fertility rate : Out of one hundred healthy couple
1) Only 25% of unprotected sexual intercourse achieve pregnancy during first menstrual cycle
2) There are 20% more for each month after ward ( from the 2nd- 11th month )
3) At the 12 months, the rate of conception decreases to 8%
For those couple can not conceive after the 12th months, they are considered as infertility couple.
II. Women are born with finite number of eggs, some women have more, some are less, every month during menstrual cycle approximate thousand of eggs are mature and only one can have the chance to be fertilized by there partner 's sperm.
1) Eggs and Age
Eggs in the ovaries decreases with increasing of age
Assuming there are 150,000 follicle in the ovaries
a) Between the age of 18 - 30 around 120,000 left and this the time of optimal fertility
b) Between the age of 31-37 around 100,000 left and the fertility rate is on the downward trend
c) Between the age 38- 41 around 50,000 left and the infertility rate increases at the fastest rate.
d) Between the age 41- 45 around 10,000 left and you reach the end of fertile.
2). Infertility risk and age
a) In the late of 20 and early 30, 84 % are fertile and only 16 are infertile b) In the mid 30 - 39 , 75 % are fertile and only 25% are infertile
c) By age 40 the 50% are fertile and 50% are infertile
Assuming the couple are healthy. Remember the older you age, the risk of reproductive organ malfunction also increase including endometriosis and fibroid.
III. Some unfertilized women and men sometimes ago are fertilizing, because of what ever reasons.
Here are most common reasons
1. Persuade a personal career
2. Try to be financial stability before having children
3. Too young to be a parent, raising a child needs efforts, time and money.
4. Enjoy the couple childless years before committing
5. Etc.
Most of women delay to conceive by taking contraceptive pill or condom or other methods to prevent unwanted pregnancy. Unfortunately, by the time they think that they are ready to have children, they are in their mid thirty, their period now becomes irregular ( may be caused by withdrawal symptoms from years of taking contraceptive pill ) and the risk of infertility is high according to the statistics.
Since our body need at least six months to adjust to the effects of withdrawal medicine, some women may take longer and some may never see their period coming back again. Statistic show that if a couple decide to have children and not conceive within 12 months, it may cause unnecessary stress which may make conception even more difficult. Therefore, planning yourself and if you want to have children, have it as early as possible. Otherwise, please consult with your doctor and aware that there are many type of treatment in case you are infertility.
C. Understand Male Biological Clock
Even though the sperm in the male reproductive organ do not change much, the quality and quantity of sperm may be reduced by low levels of testosterone due to ageing. Therefore, you can see why a couple in their late 20's is easier to conceive than a couple with a wife in her 20's and a husband at the age of 40 and more. Study shows that the odds of male fertility rate decreases at an alarming rate of 11% every year and the chance for his partner to conceive declines even further.
According to the study of European Society of Human Reproduction and Embryology, the rate of miscarriage also increases substantially when the father was over the age of 35.
1. Nearly 17 percent if the father was over 34 years old.
2. Around 20 percent if the father was between the ages of 35 and 39.
3. Over 32 percent if the father was older than 44.
Most couple delay unwanted conception by having the female partner take contraceptive pill or by using condoms, or other methods. Unfortunately, by the time they think that they are ready to have children, they are in their mid thirties and according to the above statistics, the rate of fertility is low and the risk of miscarriage is increased substantially, not counting the risk of giving birth to a child with a defection, including chromosomal abnormalities. Like an old car, no matter how much money which you spend each year to fix it, it will never work like when it was new.
It is wise for a couple to conceive no later then the age of late 20's and early 30's to prevent any unnecessary stress caused by infertility within 12 months after they decide to have a baby.
D. Causes Of Infertility
Immunity Causes of Infertility
I. Definition
Malfunction of immune system interferes with the reproductive processes including the inflammation to cells. These natural processes are vital for preparation of ovulation, implantation of a embryo ( malfunction of immune system may cause abnormal endometrial lining) and production of sperm quality and quantity (Malfunction of immune system may cause antibody attack his own sperm), etc.
II. How immune system causes infertility
1. Sperm agglutination
Sperm agglutination is a condition in which sperms clumping together due to infection or antibody reaction because of immune system attacking the sperm thereby, reducing the sperm ability to fertilize the egg and increasing the risk of infection.
2. Testicular injure
Testicle injure caused by what ever reason may increase the risk of immune system attacking the man's sperm due to inflammation and infection.
3. Testicular cancer
Testicular cancer is defined as abnormal cells growth caused by inability of immune system failure to regulate cells duplication, become cancerous in the testicle leading to poor sperm count and decreasing the risk of fertility. Researchers believe men with poor quality of sperm production is considered as high risk to develop testicle cancer than others who do not.
4. Antisperm antibody
Antibody is an chemical made by our body to help the immune system to identify foreign invasion such as bacteria and virus. In case of anti sperm antibody, the immune system attacks fetus and the sperm which interferes the sperm quality, movement and sperm cervical invasion resulting in increasing the risk of infertility for women and men alike.
5. Pyospermia
Pyospermia is condition in which high levels of white blood cell count exists in the sperm. It is caused by infection of sexual transmitted disease somewhere in the body. Sometimse such infection may cause the immune system recognizes the sperm as an invader and kill it.
6 Aniphospholipid antibody
It is defined as a condition in which a class of protein attacks an early development of pregnancy.
8. Antinuclear antibody
Antinuclear antibody is antibody directed against contents of the cell nucleus leading to miscarriage caused by immunity disorder.
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Ejaculation Causes of Infertility
I. Definition
Ejaculation is a natural process of the male reproductive organs, it is defined as ejecting of semen from a penis in the final stage sexual intercourse or sexual stimulation. It is vital component and necessary step for natural conception.
II. Ejaculation causes of infertility
1. Premature ejaculation
Premature ejaculation is defined as persistent or recurrent ejaculation with minimum stimulation before, during or shortly after vagina penetration against the person wish. Most men with premature ejaculation have a weak yang or yi kidney leading to lower quality and quantity sperm count resulting in increasing the risk of infertility.
2. Delayed ejaculation
Delayed ejaculation is a medical condition in which a male is unable to ejaculate, either during intercourse or with manual stimulation in the presence of a partner. It is caused by psychological and physical problem including less interest in sex with his partner, sex is sinful, medication and nerve damage to the spinal cord.
3. Retrograde ejaculation
Retrograde ejaculation is caused abnormal function of the sphincter muscle at the base of the bladder. During the ejaculation, the sperm travel backward into the bladder instead to the open of the penis head causing infection to the reproductive organs, including the bladder thereby, no seminal fluid emerges from the penis head.
4. Anejaculation
Anejaculation is defined as inability to ejaculate caused by psychological or physical problem including sexual inhibition, nervous system malfunction or medication.
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Lifestyle Causes of Infertility
1. Unhealthy diet
a) Unsaturated fat and trans fat
Intake of high levels of saturated fat and trans fat not only cause high levels of cholesterol in the bloodstream leading to heart disease and strokes but also decreases the liver in fat and protein metabolism and blood flow to the reproductive organs causing hormone imbalance resulting in disrupting the menstrual cycle in women and increasing the risk o ferectile dysfunction in men.
b) Caffeine
Moderate intake of caffeine does not causes either infertility or miscarry, but over dose of caffeine liking drinking a lot of coffee will increase the risk of infertility and miscarry because caffeine is stimulant causing over production of certain hormones which affect ovulation and hamper conception.
c) Alcohol
Moderate drinking helps to improve blood circulation to the reproductive organ leading to increase the chance of fertility of men and women alike. Excessive drinking in women may increase the production of hormone prolactin which interferes which the ovulation leading to infertility. In men, alcohol interferes with production of testosterone leading low quality of sperm and sexual desire causing male infertility.
2. Biking
Biking may cause the scrotum problem including low sperm count. It is advice for people who like to bike in off road mountain to take precaution to avoid swelling, pain or damaging the reproductive system leading to infertility.
3. Exercise
While rigid exercise reduces the chance of fertility because it interferes with the production of sperm and egg as well as decreasing the brain message to test and ovaries, moderate exercise improves it. It not only decreases the blood flow to the reproductive organs, but also signals the false message to the nervous system to divert all energy to organs other than reproductive system disrupting the flow of qi in the abdomen and stopping ovulation resulting in increasing the risk of infertility.
4. Hot bath and Sun bath
The male body temperature is important for sperm production, it only needs a temperature slight below the core body temperature to interfere with the function of the reproductive system . Hot tubs, saunas, steam room or working in the high heat environment may decrease quality and quantity of sperm resulting in increasing the risk of infertility.
5. Herbs Abuse
Some herbs may be helpful to improve fertility by establishing normal hormonal functioning, nourishing & toning the uterus, reducing stress and relaxing the nervous system such as red clover, nettle leave, dong quai, etc. Others may increase the risk of infertility such as St john wort, please disclose all herbs taken to your herbalist or doctor if you are on infertility treatment.
6. Tight underware
There may be no proof that underware causes infertility, but researchers believe that tight cloth causes high temperature, thereby reducing the sperm production.
7. Weight
a) Substantial weight loss interferes the production of the gonadotropin- releasing hormone which is vital for sperm an eggs development.
b)Over weight or obesity effects hormone signals and increases the insulin levels leading to over production of male hormone from ovaries which interferes with ovaries in eggs releasing.
6. Drugs and smoking
Drugs are high toxic and addictive, they are not only harmful to the nervous system and increase the risk of arteries blockage and lung diseases, bot also interferes the natural processes of the reproductive system including hormone imbalance, low the quality and sperm count.
Psycological Causes of Infertility
1. Slimness effect
The obsession with slimness at all cost may interferes the production of the gonadotropin-releasing hormone which not only causes delay or abnormal sperm and eggs development but also interferes with primitive process of natural selection in the brain leading to absence of period as blood redirected to other organs need causing nutrients deficiency.
2. Failure to conceive
Many couple after several tries to conceive but fail or just having a miscarriage, feel dramatic pressure and stress which cause hormone imbalance and interfere with the production of sperm in men and normal cycle in women resulting in increasing the risk of inability to conceive.
3. Stress
Stress interferes with hormone production ( increasing the secretion of adrenaline hormone that suppress the production of progesterone which is necessary for the soften of uterine lining for fertilized egg implantation) increasing the risk of absence of ovulation leading to infertility in women. In men, it causes low sperm count and reduce quality of sperm.
4. Depression
Depression increases the production of certain hormone in the nervous system and the glands leading to hormone imbalance and interferes the normal procedure of menstrual cycles in women and lowering sperm count in men, leading to infertility.
5. Medical problem
Some medication may have side effects leading to nervous tension and the risk of malfunction of some organs in the the body such as hypertension medication has an effect to kidney function, causing psychological problem such as stress and anxiety.
Cervical Causes of Infertility
I. Definition
Cervix is a lower neck of uterus, it joins on top with the uterus and the bottom with the vagina. It normally is hostile to the sperm with thick and sticky mucus and only produces sperm friendly mucus a few day before ovulation to invite sperm invasion for conception.
II. Cervical causes of infertility
1. Cervical damage
Damage to cervix caused by medical surgery such as several abortions may lead to abnormal function of cervix such as not open for sperm invasion or closed to allow pregnancy to proceed to term resulting in miscarry and infertility.
2. Cervical stenosis
Cervical stenosis is defined as a blockage or narrowing of the cervical canal, it is caused by birth defect or medical surgery thereby, limiting the chance of sperm uterine invasion causing infertility.
3. Cervicitis
Cervicitis is defined as a medical condition caused by inflammation or infection to the cervix leading to abnormal production of cervical mucus and the risk of infertility.
4. Cervical problems
Cervical problems are caused by abnormal formation of cervix at birth or after medical surgery leading to interferes with sperm invasion through the cervix and into the uterus as resulting of thicken mucus or mucus hostile to sperm.
a) Congenital problem
The abnormal formation of cervix is caused by medication taking by the mother during pregnancy resulting in effecting the mucus production thereby, increasing the risk of infertility and miscarry.
b) Medical problem
Damage to cervix is caused by medical surgery such as several abortions leading to abnormal function of cervix such as not open for sperm invasion or closed to allow pregnancy to proceed to term resulting in miscarry and infertility.
c) Hormone problem
It is caused by not enough estrogen to stimulate the production of cervical mucus which are friendly to sperm invasion.
Endometrial Lining Causes of Infertility
I. Definition
The endometrium is the inner membrane of the mammalian uterus. It helps to support the fertilized egg. Under influence of the high levels of estrogen at the early part of the menstrual cycle the endometrial lining become thick then become soft once ovulation occurs when progesterone is produced with high amount.
II. Endometrial lining Causes of infertility
1. Adenomyosis
Adenomyosis happens most likely in the late of woman life and who has had several pregnancy. It is classified as a medical condition of endometrial cell grows within the muscular walls of the uterus causing symptoms similar to those of endometriosis. It may interfere with the embryo implantation if the uterine tissue extends through entire region of the uterine wall resulting in infertility and miscarriage.
2. Endometrial hyperplasia
Endometrial hyperplasia is defined as overgrowth or thickening of the uterus lining as resulting of high levels of estrogen and insufficient levels by of progesterone leading miss ovulation and infertility.
3. Endometriosis
Endometriosis is defined as cells of endometrium grow somewhere else other than in the endometrium. Normally, endometriosis not travel far but around the uterus region. It interferes with the ovulation and embryo implantation leading to infertility and miscarriage.
4. Endometritis
Endometritis is defined as infection or inflammation of the uterine lining caused by pelvic infection or sexual transmitting diseases leading to miscarriage for pregnant women.
Environment Causes of Infertility
1. Workplace hazards
workplace containing high amount of hazardous chemicals may disrupt the processes of reproductive organs leading to eggs and sperm damaging, conception difficult, lower sexual desire and other reproductive diseases.
2. Pesticides
Pesticides is one of the environment toxins which causes damage or interferes with reproductive processes including hormone imbalance (high levels of estrogen and low levels of progesterone, interrupt ovulation, lower sperm count, sperm movement, etc.) leading to conception difficulty.
3. Environment factors
Expose yourself in certain chemical environment may interfere the body hormone production leading to reproductive abnormal function resulting in increasing the risk of birth defect, stillborn, infertility and miscarriage.
4. Xanoestrogen
Xanoestrogen is also known as environment estrogen acts as estrogen, it can remain in the body for a long time and block and interfere with body's natural normal functions leading to many disorders including low sperm count, abnormal sperm production and movement in men and abnormal overgrowth of vagina lining, premature breast growth in women and infertility in both.
5. Chemicals
Chemicals such as DDT, PCP, furans and men made estrogen reduce the sperm quality and lower the sperm count in men leading to infertility. In women, such chemicals may cause child defect and miscarry because of it's toxic effect.
Birth Defects Causes of Infertility
I. Definition
A birth defect is a problem that happens while a baby is developing in the mother's body due to injure or gene defects. Some of them can be treated by medical attention, some can not.
II. Birth defect causes infertility
1. Congenital adrenal hyperplasia
As a genetic passing through condition, congenital adrenal hyperplasia is present at birth and can affect both boy and girl alike. It is caused the lack an enzyme which is vital for the adrenal gland to make the hormones cortisol and aldosterone resulting in higher than normal testosterone hormone in the body. While girl is born with muscular appearance with high levels of testosterone hormone, it leads to abnormal menstrual period and causing infertility. The disease may be difficult to diagnosis in boy, but it may interfere with the growth and normal function of the reproductive organ including the test and penis leading to infertility.
2. Congenital abnormality
Abnormalities present at birth may interfere with the fertility and carry the pregnancy to term.
a) In men
Epididymis, crytorchidism, etc.
b) In women
Abnormal formation of cervix, cervical canal, septate uterus, etc
3. Crytorchidism
Crytorchilism also known as undesenced testicles, It uses to happen to premature child. If it is not repaired by age six, it may causespermanent infertility because of no sperm in the semen.
4. Cystic fibrosis
It is a genetic disease present at birth. Men with cystic fibroisis was born with absence of the vas deferens where it connect the testicle and epididymis to the ejaculating duct leading to infertility as resulting of impossible for sperm to pass through the penis.
5. Epipadas
Epipadas is a type of abnormal formation of the penis at birth in which the urethra ends in an opening on the upper aspect of the penis. Men with epipadas have normal sperm production, but the ejaculating sperm can not deposit to the cervix interfering with sexual erection and leading to infertility.
6. Chromosomes
Normally men carry X and Y chromosome and women carry X chromosome, study show infertility may be caused by genetic abnormality including abnormality part of Y chromosome and loss of large part of Y chromosome leading to lower sperm count and interfering with fertility.
7. Sepate uterus
Sepate uterus is a condition in which the uterus is divided by septum into separate half. Since the uterus is divided, each half has little space for the fetus to grow. It may not interferes with implantation of fertilized eggs but the pregnancy may end with premature birth of miscarriage.
8. Testicle feminization
It is caused by enzymatic defect. Men with testicle feminization look like a women but have both X any Y chromosomes and fail to response to the male hormone testosterone.
Syndrome Causes of Infertility
I. Definition
Syndrome is defined as the aggregate of symptoms and signs associated with series of operations, events, or steps which lead to disease due to unhealthy or unwholesome process.
II. Types of syndrome cause infertility
1. Anticardiolipin antibody syndrome
Antiphospholipid antibody syndrome is a disorder of coagulation, which causes blood clots. Women with high levels of anticardiolipin antibodies has a high risk of miscarriage. There are several types of such antibodies but the Ig G type is the one that correlates the most with pregnancy loss. It is said that intakes of low dose of aspirin or blood thinner will help to avert the problem. Make sure you check your antibody every eight weeks to prevent early miscarry.
2. Rokitansky syndrome