What is #Female #Fertility
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FEMALE FERTILITY

Fertility is the natural capability to produce offspring. As a measure, fertility rate is the number of offspring born per mating individual, pair or population. It is worthy to note that fertility is different from fecundity, which is defined as the potential for reproduction (influenced by gamete production, fertilization and carrying a pregnancy to full term).

A lack of fertility is infertility while a lack of fecundity is referred to as sterility.

Human fertility depends on several factors which includes nutrition, sexual behavior, consanguinity, culture, instinct, endocrinology, timing, economics, way of life, and emotions.

One of the most remarkable occurrences in a couple's life is to create a family. Many things must come to pass, and be in order in order to conceive a child. Perhaps the most important aspect of achieving pregnancy is the level of hormones in a woman's body. It is the hormones that dictate if the egg will mature and make the journey to the uterus and if the embryo will find a safe place to gestate within the womb for the next nine months. Hormones have everything to do with fertility, pregnancy.

WHAT ARE HORMONES?

Hormones are chemicals that are secreted into the bloodstream by the endocrine system. The endocrine system is made up of glands, and each gland is responsible for different functions in the body. When we go through puberty, it is our pituitary gland that signaled the growth of bones, tissues and told the body it was time to mature. Glands in the human body namely the thymus, the thyroid, the pancreas, the ovaries, the testes, as well as the pituitary, pineal, and adrenal glands are responsible for secreting their respective hormones to allow human bodies to function appropriately as expected. However some of these glands like all things, can malfunction and cause serious issues. From diabetes, to hyperthyroidism and even infertility, hormones can cause very serious, and emotionally taxing issues.

FERTILITY HORMONES

Many hormones work together to create an ideal environment for an embryo to grow. At Diamed Diagnostic Center, we take our patients through as many tests as needed to discover if the patient's fertility issues are rooted in hormone function. A complex web of hormones are secreted every month to ready the female body for pregnancy, but many are the factors that can deter and alter these hormones in/on their performance journey.

Follicle Stimulating Hormone and Luteinizing Hormone - The first hormones to be released are called Follicle Stimulating Hormone and Luteinizing Hormone, or FSH and LH respectively these are secreted by the pituitary glands and they stimulate the ovaries. A burst of LH floods the ovaries and stimulates the maturation of an egg cell. This burst sets of a reaction that releases progesterone and estradiol, to begin to ready the uterus for a possible implantation.

Immediately after ovulation begins with the rush of LH, FSH begins to work to encourage the ovaries to mature an egg cell. FSH will be shut off when an egg cell is mature. Then LH will ramp up its production and cause the matured egg to make the journey down the fallopian tube to meet a sperm that is feasible.

Many factors can disrupt these hormones from being regularly secreted. These include;

  • High or low body weight,
  • Excess stress and severe,
  • Rapid weight fluctuation

These disruptions are normally marked by irregular periods and can be tested with a simple blood test.

Progesterone (HCG and hPL) - Another very important hormone that can determine a woman's fertility is Progesterone. The production of progesterone begins as soon as LH begins the ovulation process. Progesterone is responsible for the preparation of the womb for pregnancy. In doing this, it thickens the endometrial lining to give a fertilized oocyte a safe place to implant and develop into a fetus. If a viable sperm is able to meet the matured egg and is implanted onto the readied uterine lining, HCG is produced and pregnancy is said to have occurred. Present only during pregnancy, HCG is what provides the fresh embryo with the nourishment it needs to develop further. This hormone drops off and hPL takes over at 11 weeks of pregnancy, to continue to provide the nourishment a fetus needs to develop into a baby. Progesterone still continues to play a vital role in prohibiting contractions that would reject the embryo.

However, too much, or not enough progesterone can also cause many problems for a woman seeking pregnancy. Levels must be optimal if implantation is to happen.

Hormones are extremely important for fertility. Usually, some of the first things doctors check in a patient who is experiencing issues with fertility are hormone levels. This enables the doctor to help out in the appropriate methods including stimulating the follicles with LH or FSH, or upping progesterone to create an optimal environment.

Ordinarily, there are 2 types of infertility:

Primary infertility : In which someone who has never conceived a child in the past continues to have difficulty conceiving.

Secondary infertility : In which someone who has had 1 or more pregnancies in the past, is having difficulty conceiving again.

THE CAUSES OF INFERTILITY

There are many possible causes of infertility and all must know that fertility problems can affect any of the partners. In a lot of cases it is not even possible to identify the cause.

Common causes of infertility include:

  • Poor quality semen
  • Lack of the monthly release of an egg (regular ovulation)
  • Where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb (Endometriosis)
  • Blocked or damaged fallopian tubes

Risk factors

There are also several factors of risk that can affect fertility, these include:

  • Age : Human fertility declines as we age,
  • Weight : Studies have revealed that being overweight or obese reduces fertility. (E.g. being overweight or severely underweight can affect ovulation),
  • Sexually transmitted infections (STIs) : STIs, (e.g. chlamydia) can affect fertility,
  • Smoking : Direct smoking and even passive smoking affects the chance of conception. It can reduce quality of semen,
  • Alcohol : Drinking too much alcohol can also affect the quality of sperm to keep risks to a minimum the best approach is not to drink alcohol at all.
  • Environmental factors : Exposure to certain pesticides and solvents has been shown to affect fertility, particularly in men
  • Stress : Can affect the relationship between partners and cause a loss of sex drive; in severe cases, stress may also affect ovulation and sperm production.

THE FEMALE FERTILITY TESTING PROCESS

The first step in diagnosing female fertility is a thorough and extensive discussion of the patient's medical history and lifestyle with the fertility doctor. Topics to be discussed will include birth control methods, menstrual and pregnancy history, sexual practices current and past, medications used, surgical history, lifestyle as well as work/living environment. This will most likely be followed by a thorough physical exam, win which the thyroid, breasts, and hair growth will be looked at. The possible examination of the pelvis is also an important part of evaluating female fertility, as well as a pap smear.

After the discussions and initial physical exam, the physician may want to proceed with some testing. This will be aimed at evaluating occurrences such as when ovulation should be occurring, ovarian function, and uterine function during the ovulation process.

Ideally, patient would have already begun tracking their ovulation through fertility awareness or a fertility monitor. This will provide the reproductive specialists with valuable information about the patient's ovulation. Usually one of the first questions regarding female fertility is whether one is ovulating or not.

  • Ovulation evaluation

This may be broken down into types:

Ovulation testing - looking through temperature charts, using ovulation predictor kits and blood tests as well as ultrasound to confirm if ovulation occurs at all.

Ovarian function tests:The tests that look to see how the hormones function during the ovulation cycle. This may include the 3 Day FSH (to measure follicle stimulating hormone), 3Day Estradiol (to measure estrogen), ultrasound (to confirm occurrence of ovulation) and blood tests to determine the levels of inhibin B.

Luteal Phase testing: A test which will evaluate progesterone levels, and possibly an endometrial biopsy

  • Hormone tests:

These hormone tests include the following:

  • Estradiol test
  • Prolactin test
  • Free Testosterone test
  • Luteinizing Hormone test
  • Androstenedione test
  • Follicle Stimulating Hormone test
  • Progesterone test
  • Free T3 test
  • Total Testosterone test
  • DHEAS test

The following tests are also commonly used:

  • Cervical mucus tests - This involves bacterial screening and a post-coital test (PCT) to determine if the sperm is able to penetrate and survive in the cervical mucus.
  • Ultrasound tests - This test assesses the thickness of the lining of the uterus (endometrium), to monitor follicle development and to check the condition of the uterus and ovaries. To confirm that an egg has been released, an ultrasound may be conducted two to three days later.

Should the semen analysis and the ultrasound test return normal results, additional tests may be recommended.

These tests may include any of the following:

Hysterosalpinogram (HSG) - An x-ray of the uterus and fallopian tubes in which a dye is injected through the cervix into the uterus and fallopian tubes. The dye enables the radiologist to determine if there is a blockage.

Hysteroscopy : This is a procedure that may be used if the HSG indicates the possible presence of abnormalities. An instrument which can be introduced into the body to give a view of its internal parts (The hysteroscope) is inserted through the cervix into the uterus. This allows the specialist to see any abnormalities, growths, or scarring in the uterus. The hysteroscope also allows the physician to take pictures which can be used for future reference.

Laparoscopy - This involves the use of a narrow fiber-optic telescope. It is a procedure that is done under general anesthesia. The laparoscope will be inserted into a woman's abdomen to provide a view of the uterus, fallopian tubes, and ovaries. Abnormalities such as endometriosis, scar tissue or other adhesions if they are found, can be removed by laser. The patient will have to confirm that she is not pregnant before this test.

Endometrial biopsy - This procedure involves the scraping of a small amount of tissue from the endometrium just prior to menstruation. This is to determine if the lining is thick enough for a fertilized egg to implant in and grow. The patient will have to confirm that she is not pregnant before this test.

It is important to emphasize that these are not mandatory tests our fertility specialists will know which tests to recommend in a particular situation.

FERTILITY TESTS FOR MEN

If their female partners are not getting pregnant, the men must be proactive and visit an urologist. There are lots of tests men can take to find out if they are infertile.

An evaluation

The urologist will conduct a physical exam and ask the man questions about his lifestyle and medical history, such as:

  • Surgeries he has undergone,
  • Medications he takes,
  • His exercise habits,

Whether he smokes or takes recreational drugs

He may also have a frank discussions with him about his sex life, whether you he ever had any STDs (sexually transmitted diseases).

The patient will probably be asked to give a sample of semen for analysis.

Finding out the cause of infertility in men can be challenging, but here are some of the tests you can expect;

  • Sperm and Semen Analysis
  • Physical Exam
  • Genetic Testing
  • Anti-Sperm Antibodies
  • Hormone Evaluation

Sperm and semen analysis - The fertility specialist will check the sperm count, their shape, their movement etc. A higher number of normal-shaped sperm, means higher fertility, however there are plenty of exceptions to this. A lot of men with low sperm counts or abnormal semen are still fertile.

If the first semen analysis is normal, your doctor may order a second test to confirm the results. Having two tests returning normal would mean the patient has no significant infertility problems. If something unusual appears in the results, the doctor might order more tests to be sure of the problem.

Not having any semen or sperm at all might be because of a blockage that can be corrected with surgery.

Physical Exam : This process can find abnormal formations of veins above the testicle (varicoceles). This condition can be corrected through surgery.

Hormone Evaluation - Testosterone and other hormones control the making of sperm. It is noteworthy however, that in more than ninety percent (90%) of infertile men, hormones are not the main problem.

Genetic Testing : This test can identify specific obstacles to fertility and problems with the sperm.

Anti-Sperm Antibodies

Some men make abnormal antibodies that attack the sperm on the way to the egg, which keeps your partner from getting pregnant.

For other guys, making sperm isn't the problem: It's getting the sperm where they need to go. Men with these conditions have normal sperm in their testicles, but the sperm in semen are either missing, in low numbers, or abnormal.

There are several reasons you might have low sperm in your semen even if your body makes enough of it:

Retrograde ejaculation. In this condition, your sperm ejaculates backward, into your bladder. It's usually caused by an earlier surgery.

You're missing the main sperm pipeline (the vas deferens). It's a genetic problem. Some men are born without a main pipeline for sperm.

Obstruction. There can be a blockage anywhere between the testicles and the penis.

Anti-sperm antibodies. As mentioned, they attack your sperm on the way to the egg

PROTECTING YOUR FERTILITY

You're more likely to get pregnant if you and your partner are both in good health.

Making some changes to your lifestyle may improve your chances of getting pregnant and having a healthy pregnancy.

Medical conditions such as diabetes, asthma, obesity and other problems can affect your pregnancy.

More than 80% of couples in the general population will conceive within 1 year if they don't use contraception and have sex regularly (every 2 or 3 days).

Of those who don't conceive in the first year, about half will do so in the second year.

Healthy weight

Being overweight or underweight can affect your chances of conceiving.

Too much or too little body fat can make you have irregular periods or stop them completely, which can affect your ability to conceive.

Your weight is healthy if your body mass index (BMI) is between 20 and 25.

Women whose BMI is more than 30 or under 19 may have problems conceiving.

If your partner's BMI is more than 30, his fertility is likely to be lower than normal.

Read more about exercise and how to lose weight safely.

Alcohol and smoking

The Chief Medical Officers for the UK recommend that if you're pregnant, or planning to become pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum.

Your partner should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more. Drinking alcohol excessively can affect the quality of his sperm.

Smoking, including passive smoking, may reduce fertility in women.

If you smoke and need help to quit:

get advice from your GP

visit the NHS Smokefree website

call the NHS Smokefree helpline on 0300 123 1044

There's also a link between smoking and poorer quality sperm, although the effect on male fertility isn't certain. But stopping smoking will improve your partner's general health.

There's no clear evidence of a link between caffeine, which is found in drinks such as coffee, tea and cola, and fertility problems.

A number of prescription, over-the-counter and recreational drugs interfere with male and female fertility. Talk to your GP if you're concerned.

The best time to get pregnant

You're most likely to get pregnant if you have sex within a day or so of ovulation, when your ovaries are releasing an egg.

This usually happens about 14 days after the first day of your last period.

An egg lives for about 12 to 24 hours after it's released. For you to get pregnant, a sperm must fertilise the egg within this time. Sperm can live for up to 7 days inside your body.

For the best chance of success, you should have sex every 2 to 3 days throughout the month. You don't need to time it to coincide with the days when you ovulate

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