Health issues that may affect a woman's fertility

Fertility is a sensitive but important topic when it comes to health. The focus in this article is on female fertility, but male fertility is just as important and should be catered for. Couples that have used birth control pills for extensive periods may find it difficult conceiving in the first few months after they stop birth control but should succeed within a year of medically unassisted trying. It becomes alarming when trying goes beyond a year without success for those under 35. Alarm is raised much faster for women above 35, as fertility decreases with age. Women above 35 who have been trying for six months and those below 35 who have tried for a year without success should consult a doctor and investigate the cause of the challenge. Here are the common health conditions that affect fertility.

Endometriosis: Endometriosis is one of the causes of painful menstruation and fertility. It is a painful disorder in which tissue that normally lines the endometrium (the interior of the uterus) grows outside your uterus. It can lead to the fallopian tubes being scarred and blocked, which prevent the egg and sperm from meeting in the fallopian tubes for fertilization.

Pelvic Inflammatory Disease (PID): Some STIs such as chlamydia and gonorrhea may be asymptomatic thus go untreated. When untreated, these infections can lead to PID. PID is an infecton of the organs of a woman's reproductive system, such as the uterus, ovaries, fallopian tubes and cervix. PID can cause a build-up of tissue that blocks the fallopian tubes, which prevents the sperm and egg from meeting and causes infertility. In rare cases, bacterial vaginosis can also cause PID. A single episode of PID increases a woman's risk of infertility by 15%. A second episode of PID doubles the risk to 30%. After a third episode or more, the  risk increases to over 50%.

Polycystic ovary syndrome (PCOS): This disorder which is associated with an imbalance in female sex hormones affects 7-10% of women of childbearing age and is the most common cause of infertility. This imbalance in sex hormones can prevent the development and release of mature eggs, without which neither ovulation or pregnancy can occur. PCOS can also cause a surge in testosterone which is primarily a male sex hormone. In women, testosterone is normally produced in small amounts. The unbalanced sex hormones in PCOS patients causes irreglar ovulation and menstruation which make conception difficult.

Uterine fibroids: A uterine fibroid is a non-cancerous tumor which can be found in any part of the uterus. They can be classified into subserosal, intramural and submucosal fibroids. Women with large and/or multiple fibroids tend to experience long, heavy periods; irregular menstruation; constipation; and/or pain or pressure in the pelvis and back. Submucosal fibroids affect fertility the most, possibly because they divert blood flow from the endometrium, preventing it from thickening which in turns hinders the implantation of a fertilized egg or the development of an embryo. 

Hormonal imbalances: The journey to pregnancy begins with ovulation. If a woman ovulates infrequently or does not ovulate at all, pregnancy becomes difficult. There are two main hormones that control ovulation; luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones signal an egg to develop and be released from the ovary. Pituitary tumors, extreme stress, injuries to the hypothalamus, excessive exercise all interfere with the normal release of LH and FSH. Hormonal conditions such as diabetes, an underactive or overactive thyroid, early menopause, PCOS, and cushing's syndrome (a disorder that causes an overproduction of cortisol (the stress hormone) also affect fertility in both sexes.

Sexually Transmitted Infections (STIs): STIs like chlamydia and gonorrhea are the leading causes of preventable infertility. Chlamydia causes a lot of inflammation in the fallopian tubes which blocks the tubes and prevents eggs from reaching the uterus, hence tubal infertility. Chlamydia is responsible for as many as half of all cases of tubal infertility in the developed world. STIs affect both male and female fertility.

Smoking, alcohol consumption and consumption of recreational drugs: Smoking tobacco and its derivatives changes a woman's cervical mucus, thereby affecting the way the sperm reaches the egg. Marijuana can disrupt a woman's ovulation cycle, interfering with the release of the egg. Smoking also ages the ovaries and prematurely depletes a woman's eggs. Chronic alcoholism causes ovulation-related disorders. Heroin and cocaine have similar effects in addition to a higher risk for PID and HIV associated with risky sexual behavior. Heroin can lead to an absence of periods in some women. Smoking and consumption of recreational drugs have a more crucial effect on male fertility.

Being overweight or underweight: A very low body mass index (being underweight) or a very high body mass index (BMI) - being overweight can make conceiving difficult. Ideally, women's BMI should be between 21 and 25. BMI is calculated as weight in kilograms/height in metres2. An overweight or underweight person may not ovulate monthly which results in irregular periods and problems conceiving.

Chronic medical conditions: Chronic diseases such as sickle-cell disease, HIV/AIDS, kidney disease, liver disease, hepatitis B or C and others make conceiving difficult.

Excessive caffeine consumption: Studies have found that women who drink large amounts of caffeine may take longer to get pregnant and may have a higher risk of miscarriage.