Infertility

The Health Implications of Female Infertility

Infertility is the inability to conceive for over one year, despite regular, unprotected sex between a male and female.

Medicines are often used to treat ovulation problems in women. Some of the most common infertility medicines include clomiphene

Approximately 30% of the time, couples are unable to conceive because of problems with female fertility, and the WHO estimates that approximately 10% of the female population suffer from such problems.

Though the definition of infertility is simply the inability to conceive, being infertile or treating infertility can cause other health problems, both physical and mental.

iTHINK examines the causes and treatments of female infertility and what other effects each of these has on the female body and mind.

Causes

Infertility

The causes of female infertility are numerous and varied. Some of them are present from birth, while others may develop as you age, and others still may be caused by ovarian diseases.

For a woman to get pregnant, each step of the ovulation and fertilisation processes needs to occur correctly and at the right time. If any of the steps go wrong, then conception will not be successful.

Ovulation Problems

The most common causes of infertility are related to the process of ovulation. Some completely stop the release of eggs from the ovaries, while others change the timing of the release and make it less frequent.

Polycystic Ovary Syndrome (PCOS) is one of the conditions that can cause infertility. It’s very common and affects approximately 1 in 5 women in the UK, according to the NHS.

PCOS can result in irregular periods, which in turn means that ovulation is irregular. It may also cause your ovaries to become enlarged and full of fluid-filled sacks that prevent ovulation altogether.

A non-fertility related effect of PCOS is an increase in the level of ‘male’ hormones in the female body, which can result in excessive hair growth on areas such as the face or the back, or hair loss on the head.

Overactive or underactive thyroids (hyperthyroidism and hypothyroidism, respectively) can also impact the regularity of your menstrual cycle, and similarly cause infertility.

Other symptoms of hyperthyroidism include chronic tiredness, swelling on the neck, mood swings, and difficulty sleeping. Similarly, hypothyroidism can cause tiredness, aching muscles, and dry skin and hair.

However, failure to ovulate may also be a result of premature ovarian failure, in which a woman’s ovaries stop releasing eggs before the age of 40.

Fallopian Tubes or Fertilisation Problems

Blockages in the fallopian tubes can also cause infertility because it prevents the egg from reaching the womb for fertilisation.

This can be a result of scar tissue from pelvic surgery, inflammation of the upper female genital tract as a result of STIs, or endometriosis, which is a condition where endometrium tissue begins to grow in the ovaries and other areas in the body rather than just the womb.

On top of reducing fertility, endometriosis can cause pelvic pain that intensifies during your period, pain after or during sex, and pain when going to the bathroom during your period.

An excess of cervical mucus may cause difficulty during fertilisation because the sperm will be unable to get to the womb. There are many reasons why you may have an excess of mucus, and most of them are harmless, but sometimes it can be a sign of STIs.

Fibroids (non-cancerous growths) in your womb can prevent implantation after the egg has been fertilised, also resulting in a failure to conceive. Fibroids can also cause lower back pain, abdominal pain, constipation, and pain during sex.

Treatments

The treatments for infertility depend largely on what is causing it, but there are three main types of treatment.

Medicines are often used to treat ovulation problems in women. Some of the most common infertility medicines include clomiphene (which helps with regular ovulation), metformin (which is particularly useful for those with PCOS and does increase fertility despite not being an official fertility treatment), and gonadotrophins (which stimulate ovulation).

However, these medications may have side-effects, including headaches, nausea, or bloating.

Clomiphene may cause hot flashes, weight gain, mood-swings, breast tenderness, and blurred vision. Metformin can cause gastro-intestinal problems such as gas, abdominal discomfort and diarrhoea. Gonadotrophins can result in mood swings, general aches, and acne.

Surgical procedures to treat infertility tend to target endometriosis, fibroids, or blocked fallopian tubes.

Treating the former two problems is done through laparoscopy. This is a minimally invasive surgery that does not require a large incision for a doctor to access the reproductive system.

Laparoscopy can occasionally result in infection, minor bleeding, or nausea, but does not normally have any major side-effects.

Fallopian tube surgery can remove scar tissue and other blockages that prevent eggs from getting from your ovaries to your uterus. However, the extent to which this will be successful depends on how bad the initial problem is.

Furthermore, fallopian tube surgery carries the risk of ectopic pregnancy, which is the implantation of a fertilised egg in the fallopian tube. This can lead to further complications such as intense abdominal pain, fainting, or vaginal bleeding outside of your period.

The pregnancy will also have to be terminated as the fertilised egg will not develop into a baby in your fallopian tube.

Assisted conception is a third treatment for female infertility and can take the form of in vitro fertilisation (IVF) or egg donation.

For IVF, you will first be given fertility medications to increase the production of eggs in the ovaries. These eggs will be removed surgically and fertilised outside the body. The resulting embryo is then placed back in the womb.

Possible side-effects of the fertility medications include hot flushes, irritability, and headaches. Additionally, the chance of success for women under the age of 35 is 29%, meaning that there is a possibility that the procedure won’t work.

Egg donation is, as its name suggests, when the egg used in the pregnancy is produced by someone other than you. IVF is then used to complete the procedure, thus egg donation carries similar risks.

Mental Health

Infertility

Though the discovery that you are infertile can come with additional physiological issues, it can also take a huge toll on your mental health.

Finding out that you will be unable to bear a child often understandably comes as a great loss and can cause many of the problems of loss-related grief. Feelings of frustration and sadness, as well as loss of self-esteem and perceived control over your life are quite common.

Furthermore, experiencing your friends’ and family’s reactions to your infertility can bring about more stress, sadness, and even anger. Whether they succumb to any cultural stigmas surrounding infertility, or they try to provide what they think is helpful advice your relationships with them can suffer.

Your relationship with your partner might also experience some turbulence in the form of sexual dysfunction due to anxiety.

According to Harvard Health Publishing, though those diagnosed with infertility might face intense mental health problems temporarily, their rates of anxiety, depression and other disorders is not greater than those of the general population.

Attempting treatment for infertility can also cause mental health problems, particularly those related to money and the expectation of success. For example, IVF is an expensive process, and though the NHS may offer 1 to 3 cycles of it depending on your age and other criteria, you may need to resort to private IVF treatment.

If IVF or other treatments are unsuccessful, it can result in feelings of hopelessness and helplessness, which may further any mental health problems you are experiencing from discovering your infertility.

Getting the Support You Need

Finding out that you are infertile can be an incredibly isolating experience. Friction with friends, family, and significant others can leave you feeling lonely. Suffering from physical pains and additional symptoms can make you feel hopeless and lacking control over your life.

But it’s important to remember that you don’t have to face this alone, that there are other people facing the same problem that you can talk to, as well as doctors and counsellors to help you.

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