Do you think about starting or enlarging your family? Or maybe you are already trying for a child? It is worth checking in advance whether you are not going to encounter problems with fertility, and take remedies at the right time. Certain symptoms may indicate ailments which make getting pregnant difficult. Be sure to check if you are at risk of infertility.
Regularity of menstruations – in case of every woman – depends on the normally occurring ovulation. It is considered that a normal menstrual cycle should last from 21 to 35 days. Then, menstruation occurs at more or less equal intervals. If your cycle is once longer and another time shorter, and you are unable to calculate the approximate date of bleeding – then we can already talk about irregularity the underlying causes of which should be examined.
Irregular menstruations can often indicate hormonal imbalance and, in consequence, disturbed process of ovulation. They can be related to thyroid diseases, polycystic ovary syndrome (PCOS) or luteal phase disorders. If ovulation does not proceed in due fashion, problems with getting pregnant appear.
In case of bleeding/spotting which is irregular or occurs in the middle of the cycle, a woman should see a gynecologist. Usually, in order to diagnose the cause of the problem, the doctor will recommend carrying out a test panel and determining the levels of hormones which take part in the regulation of the menstrual cycle. The gynecologist will also carry out ultrasound exam and propose a diagnostic path which is optimal for the patient’s medical situation.
Hyperprolactinemia, i.e. the excessively increased prolactin level, also can be the cause of problems with conceiving. Prolactin is a hormone produced by the pituitary gland, and its physiological function is mammary gland stimulation during pregnancy and lactation. Its significantly increased level impairs the proper function of hormones which take part in the menstrual cycle. Symptoms of hyperprolactinemia may include irregular menstruations, spotting, abdominal pain, dizziness or vision disorders.
In order to diagnose hyperprolactinemia, blood prolactin level is checked, in some cases supplemented by the head MRI and eye exam.
Painful menstruations/painful intercourse
Pain during menstruation and also during sexual intercourse may suggest inflammation within the uterus or endometriosis. Inflammatory conditions can occur due to bacterial or viral agents within reproductive organs and in surrounding area (appendix, intestines) and lead to the formation of lesions which hinder or prevent pregnancy.
Endometriosis is a hormonal and immunological disease which occurs in girls and women of childbearing age. It is associated with the excessive growth of the uterine mucosa (endometrium) and its presence in abdominal cavity. Endometrial cells produce mediators (chemical substances) which to a significant extent negatively affect the process of ovulation, fertilization and, later on, embryo implantation in the uterus.
In order to identify the cause of the problem, laboratory tests as well as the examination of uterine fundus and/or laparoscopy are performed. If endometriosis is confirmed, the physician chooses a therapy to increase a patient’s fertility – depending on the severity and intensity of the disease. Sometimes – when the course of the disease is mild or mild to moderate – the treatment consists in limiting the symptoms, but in more difficult cases it may require in vitro fertilization.
Consequences of past surgeries
Past surgical interventions, in particular within abdominal cavity, can lead to the formation of adhesions causing obstruction in fallopian tubes, which is a physical obstacle for the sperm to join the egg.
The examination which allows diagnosis is tubal patency assessment during laparoscopy or ultrasound exam with a contrast media introduced to the reproductive tract. In case of confirmed serious abnormalities, the doctor can propose in vitro fertilization .
Recurrent, untreated or improperly treated infections within the lesser pelvis such as inflammations of adnexa or urinary bladder may result in the formation of adhesions. These in turn cause the obstruction of fallopian tubes and, consequently, problems with fertilization.
If you think about having children, you should first see a gynecologist. During ultrasound examination, the doctor will assess the condition of your reproductive organs. Problems with conceiving a child can emerge for example in connection with uterine hypoplasia or uterine septum, retroverted uterus or congenital defects of fallopian tube structure.
Abnormal body mass
Both underweight and overweight can contribute to problems with getting pregnant. The most popular method of determining the proper body mass is the calculation of BMI, based on the weight to height ratio of a given individual. It is considered that the acceptable BMI value ranges from 18.5 to 24.5. Higher values indicate overweight or obesity, while lower values – too low body mass. In both cases, abnormal body weight correlates to difficulties with conception.
It is worth to take care of your health condition and proper body mass already at the stage of planning a child. You can consult a dietician and pay more attention to your diet. Sometimes it is necessary to see a specialist who will check whether the abnormal body weight is not related to other conditions, e.g. thyroid function disorders.
If you have diabetes or other metabolic diseases, you should also see the doctor before you start trying for a child. In some cases, the consequences of these diseases may affect the ability to conceive. For some women, it may prove necessary to undergo extended diagnosis and take further medical steps.
In case of some couples, a woman’s body produces the so-called antisperm antibodies which damage and destroy her partner’s sperm. Such situation is usually defined as “cervical mucus hostility”. Partners can verify it they are going to have a problem of this etiology by carrying out the post-coital test in the Fertility Clinic. Immune system disorders can also be the cause of miscarriages, but in such cases detailed diagnosis is necessary.
In many cases (35% of couples facing infertility), the cause of problems with obtaining pregnancy is the so-called male factor. For various reasons, temporarily or permanently, the male partner’s semen has abnormal parameters (among others, sperm count, motility, morphology, volume of ejaculate). The causes of problems can for example go back to childhood diseases such like mumps (inflammation of salivary glands) which, if complicated, can induce orchitis in some cases leading to permanent infertility. Typically, abnormalities occur also in cancer patients subjected to radio- or chemotherapy.
Also abnormal semen parameters can be related to the consequences of past surgeries involving testicles or urinary bladder, working in high temperatures or exposure to toxic substances (heavy metals). In addition, male fertility can be affected by wearing improper underwear (too tight-fitting, elastic), cigarette smoking, stress or chronic use of certain medications.
Most often, in order to determine male fertility, laboratory semen analysis is performed, which allows to determine parameters which impact the success of the fertilization process.