Benefits of Hysteroscopy in Infertility

Infertility is a complex condition which can have multiple causes. A comprehensive examination of all possible causes of infertility includes an analysis of the general health of a couple, as also a detailed and thorough assessment of the woman’s reproductive tract including the uterus, fallopian tubes, ovaries & the vaginal canal in addition to her hormonal profile . While most of this information can be obtained through a combination of clinical examination, blood tests & a good pelvic ultrasound, the assessment of the inside of the uterine cavity & cervical canal requires the use of an advanced technique called Hysteroscopy. Hysteroscopy involves the use of a special instrument – A Hysteroscope, to not only visualize the cavity of the uterus and cervix but also simultaneously treat some of the pathologies that may be detected at the time of visualization.

Very often, certain conditions that cannot be detected by routine physical examination, may be detected through hysteroscopy and can then also be corrected immediately, avoiding the need for a repeat surgery. Hysteroscopy has thus  become a frequently recommended procedure for the evaluation of infertility, recurrent miscarriages and abnormal uterine bleeding.

Hysteroscopy is generally undertaken for :

  • Checking any abnormality in the shape or size of the uterus or looking for any septum (midline separation) in the cavity of the uterus. The septum can be removed by hysteroscopy but a much more complex surgery may be needed for bicornuate uterus (a situation where the cavity is divided into two parts by birth).
  • To look for any scar tissue in the cavity of the uterus which can be removed in the same sitting . The scar tissue may have formed after a previous surgery or infection & could be preventing a pregnancy from implanting well, leading to recurrent miscarriages.
  • To diagnose any abnormality in the shape of the uterine cavity due to the presence of a fibroid tumour or a polyp in the cavity. Any fibroid or polyp can also lead to infertility & miscarriage. Certain fibroids & almost all polyps can be removed during the same sitting of hysteroscopy, using an operative hysteroscope.
  • To assess the status of the ostia , i.e the openings of the fallopian tubes into the uterine cavity. If these are found to be blocked then your doctor may attempt to cannulate & open them while doing hysteroscopy.
  • To take a biopsy of the Endometrium ( uterine lining that lodges & nourishes a pregnancy ). This collected tissue can then be tested for any tubercular infection, evidence of a precancerous or cancerous tissue and also for any discordance between the hormonal cycle & the growth of endometrium.
  • To assess any abnormality in the cervical canal.
  • Occasionally, a displaced IUCD may be found in the cavity and removed in the same sitting.

What is a Hysteroscope ?

A Hysteroscope is a narrow, telescope-like instrument having a camera and an integrated light source. It is inserted into the uterine cavity through the vagina and the cervix and enables the doctor to visually examine the cavity of the uterus & cervix, the Endometrium and the ostia. The images are displayed on a monitor, which helps the doctor to also conduct any procedure or undertake any corrective surgery, as required.

What happens in Hysteroscopy ?

Hysteroscopy is generally undertaken by a Gynaecologist in the Operation theatre after the patient has been administered anaesthesia. The cervical canal is gradually dilated by stretching till it is possible to introduce the hysteroscope into the uterine cavity. This procedure does not involve any incision or cut over the cervix. Once the cavity of the uterus has been distended by introducing fluid, to enable a better visualization of its contents, the doctor carefully examines the cavity and the lining  of the uterus, so that any abnormality that is detected can then be treated accordingly. The doctor may also decide to take a biopsy from any area that appears visually abnormal and send the tissue to the lab for testing. The hysteroscope is withdrawn after the examination and the patient can usually go home 4-6 hours after the procedure. Occasionally, an overnight stay in the hospital may be recommended for exceptional cases.

Nowadays the option of office hysteroscopy, which is undertaken in the OPD without anaesthesia, is also becoming available. In this, a very narrow Office Hysteroscope (of diameter less than 5 mm) is used, but only for diagnostic purposes. Any operative intervention, if needed, must be undertaken later in the OT under administration of anaesthesia.

What can be expected after the procedure ?

Usually, one may be discharged from the hospital on the day of the procedure itself. One may experience mild pain in lower abdomen or some cramping for a few days along with a little bit of vaginal bleeding or spotting. The doctor may prescribe some medications for these.

In most cases, one is able to resume normal physical activity in a couple of days unless the doctor specifically advises otherwise. Restarting sexual activity may however take a while depending upon the findings of the hysteroscopy.

What are the risks involved?

Hysteroscopy is a relatively safe procedure when undertaken by a competent gynecologist. A few unforeseeable complications may however occur in rare cases:

  • Perforation of the uterus happens quite rarely and is usually treated conservatively by monitoring vital parameters and keeping the patient under observation. Occasionally, a surgical intervention may be needed to correct the defect.
  • The possibility of an infection exists as with any other surgical intervention
  • There may be excessive bleeding in some cases, which is also usually managed conservatively
  • Very rarely, there are chances of the distending fluid or air entering into the blood vessels & causing a life threatening embolism, electrolyte imbalance or abnormalities related to blood clotting.

Serious or life threatening complications are however extremely rare and Hysteroscopy is generally considered a very safe & effective way of diagnosing gynaecological or fertility problems. In case of any concerns, whatsoever, it is advisable to discuss all the issues with the doctor before deciding to undergo a hysteroscopy.

All about Menstruation and Fertility Cycles

Menstruation is the periodic & cyclical shedding of the uterine lining, i.e the Endometrium, in women, accompanied by  loss of blood. Usually, it takes place at an interval of 28 days, although this  interval may normally range from 21 to 35 days in some women. The blood flow lasts between 4-5 days, but again a variation in the duration between 2-7 days is considered normal.

The menstrual cycle is linked to the production of various hormones in the body, which regulate the various reproductive & other body functions including the preparation of the uterus for pregnancy. Menstruation thus represents the breakdown & casting off of  an endometrium prepared for pregnancy, which has not materialized. As such, menstruation has even been described as the ‘weeping of a disappointed uterus’.

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The cyclical occurrence of menstruation is controlled by the cyclical rise & fall of various hormones in the body. It is interesting to note that every girl is born with a certain fixed number, about 2 million, of eggs (Primary oocytes). This number further reduces by the time of puberty to about 300,000 to 500,000 due to the spontaneous atresia & destruction of oocytes. Out of these, it is estimated that no more than 500 oocytes will actually mature in a woman’s lifecycle & the rest will simply degenerate. The maturation, release & disintegration of oocytes as well as the growth and shedding of the endometrium during the menstrual cycle is controlled by hormones produced in the brain & the ovary.

In the first half of the cycle, under the influence of Follicle Stimulating Hormone ( FSH), produced by the Pituitary gland in the brain; the oocyte/egg begins to grow in the ovary. This growing oocyte produces more & more of the hormone Estrogen, which stimulates the growth of the uterine lining (Endometrium) and also affects the cervical mucus making it thin & stretchy. Estrogen also plays an important role in maintaining bone health & cardiac function. This phase of growth of the oocyte i.e the follicle,  is called the Follicular phase. It is also called the Proliferative phase from the perspective of the uterine lining as at this time the Endometrium grows and proliferates to prepare itself for the implantation of a pregnancy, if fertilization occurs.

It  takes an oocyte about 14-16 days (sometimes a little longer or lesser) to reach maturity & be ready for release by the ovary. At this time, it is surrounded by a capsule of Granulosa and Theca cells in the ovary. The process of release of oocyte from the ovary is called Ovulation. This process again is controlled by a complex interplay of hormones produced by the Pituitary gland & the ovary.

It is the sudden rise in Luteinising Hormone (LH), produced by Pituitary gland in brain, which is the principal trigger for ovulation. The released oocyte is picked up by the fimbriae of the Fallopian tubes and transported towards the uterine cavity. Once released, an oocyte can survive for approximately 24 hours.

Meanwhile, the remaining cells of the capsule of the oocyte in the ovary form a structure called the Corpus Luteum, which produces the hormone Progesterone. This hormone is responsible for further growth of the Endometrium and, along with Estrogen, makes it suitable for nurturing a pregnancy. Under the influence of Progesterone, the Endometrium becomes edematous, more vascular, the glands enlarge & secrete nutritious substances into the stroma so as to provide nourishment to a growing uterus & pregnancy. This phase, that occurs after ovulation, is called the Luteal phase or the Secretory phase of the menstrual cycle.

If the oocyte is fertilized within its survival period by a sperm, then the fallopian tube transports the zygote towards the uterine cavity where it gets implanted & the pregnancy  progresses. If  however,  the  oocyte  is  not fertilized, it degenerates after 24 hours. In the absence of fertilization, the Corpus luteum gradually disintegrates and the levels of Progesterone & Estrogen fall. This leads to a shrinkage and disintegration of the glands and superficial layers of the Endometrium. Eventually, the necrosed superficial layers of the Endometrium & the ends of blood vessels in these layers, breakdown &  the bleeding starts. This marks the beginning of the vaginal bleeding, which is counted as the first day of menstruation. Simultaneously the next oocyte starts to grow in the ovary and the whole cycle is repeated.

The cyclical production of hormones during the menstrual cycle leads to various cyclical changes in a woman’s body & these changes have been studied and used for predicting the ovulation & the fertile/unsafe or safe period while planning to achieve or avoid a  pregnancy.

Cervical mucus changes-  The cervix is the terminal part of the uterus which leads into the vagina. It is lined by several glands which secrete mucus under the influence of hormones. The cervical mucus plays an important role in fertility because it gets altered in character & amount depending on the influence of the hormones. In the days immediately after menstruation, the cervical mucus is dry & scanty. Gradually, under the effect of Estrogen, it becomes profuse, watery & stretchy. This happens around the time of ovulation & it facilitates the passage of sperms from the vagina into the uterus while also nourishing the sperm at the same time. This increases the chances of conception when the sperm fuses with the egg.  After ovulation, in the premenstrual phase, the mucus becomes sticky, dry & thick; thus preventing any further entry of sperms into the uterus. This change in character and amount of cervical mucus has been often used to predict the fertile period.

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Basal Body Temperature monitoring–  Basal body temperature is the body temperature at complete rest. It has been established that the Basal Body Temperature increases on ovulation. A woman is likely to be most fertile 2-3 days prior to the body temperature rise and around the time of ovulation. Hence , tracking the early morning basal body temperature daily is often used to predict ovulation. The temperature rises by about 0.5 deg F on ovulation & persists for about 3 days, thereafter it falls to normal values. A persistent rise in basal body temperature for 2 weeks or more can also be an early sign of pregnancy.

New boost to family planning methods

Injectable contraceptives could become more popular among women in India in the days to come, as part of the Government’s national family planning programme. More women may have the option of taking injectable contraceptives following the Government’s proposal to include injectable contraceptive Depot MedroxyProgesterone Acetate, or DMPA, in the national family planning programme.

Most gynaecologists come across many women who, due to limited access to contraceptives, face unwanted pregnancy – and, thereby, morbidity related to pregnancy and abortion. According to the World Health Organisation, every eight minutes a woman in a developing nation will die of complications arising from an unsafe abortion. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity, often with tragic consequences. Introduction of new contraception methods in the public health system will, therefore, allow women to select methods based on their specific needs and preferences.

An injectable contraceptive is a shot that can offer pregnancy protection for up to three months. It is a simple, safe, and reversible family planning method than can be administered discreetly. The method is especially convenient for women who cannot remember to take a pill everyday or negotiate with their partner for using a condom. However, it is essential to visit a doctor for the first screening and counselling on eligibility and potential side effects.

DMPA is a progestogen shot, usually administered in the arm, hip or buttocks. It thickens the cervical mucus which stops the sperms from reaching the egg. It also makes the womb lining thinner and prevents the release of an egg. Progestogen is similar to the natural hormone progesterone, which is released by a woman’s ovaries during her menstrual cycle.

Injectables are 99.7 per cent effective in preventing pregnancy. As per current WHO recommendations on the use of injectable contraception, for women aged 18 to 45 years of age, there should be no restrictions on the use of DMPA, including no restrictions on the duration of its use (medical eligibility criteria Category 1). Among adolescents (menarche to less than 18 years) and women over 45 years, the advantages of using DMPA generally outweigh the theoretical safety concerns regarding fracture risk (MEC Category 2). There are no restrictions on the use of hormonal contraceptives, including DMPA for women at high risk of HIV (MEC Category 1). Women and couples at high risk of HIV acquisition should also be informed about and have access to HIV preventive measures, including male and female condoms irrespective of the family planning method they choose.

These hormonal contraceptives are safe and suitable for nearly all women, including women who are breastfeeding, who have or have not had children, and even those who may just have had an abortion or miscarriage. DMPA has a high acceptability as it is provided by an injection every three months, which can be given outside clinical facilities. Women who are HIV positive can also safely use injectables. However, it should be noted that injectables do not provide protection against any sexually transmitted diseases including HIV. Therefore, a condom must be used for protection against these diseases.

This injection must be taken within seven days of menstrual bleeding or within the first seven days after a miscarriage or abortion. In case of breastfeeding mothers, the injection can be taken after six weeks of childbirth, and within six weeks after childbirth in case of non-breastfeeding mothers. Till the woman does not wish to have babies, she can continue to take these injections after every three months. An important point to note, however, is that the injection has to be discontinued nine to 10 months prior to planning a baby, as the conception may take some time.

All contraceptives have side effects. Therefore, women should be counselled about DMPA’s side-effects and provided a leaflet or other material to inform them about DMPA’s mode of action. Some women may experience lighter or irregular bleeding while in some cases there may be no menstruation. Other possible side effects may include headache, dizziness, breast tenderness, and weight gain. Most side effects usually become less or stop within the first few months of using the injectable.

Source : The Pioneer (via Syndication)

Influence of diet on conception

When trying to conceive, often even the smallest thing, like the food that one eats, makes a difference. What one eats certainly affects the sex drive. But it can also impact the chances and the quality of conception. Lifestyle factors, like the diet and ways of life, can greatly influence overall health and well-being, including fertility. The good things is that these can be easily modified to suit one’s objectives.

The results of a 8 year study covering over 18,000 women published in The Fertility Diet (McGraw-Hill) by Jorge E. Chavarro, M.D., Walter C. Willett, M.D., and Patrick J. Skerrett “uncovered evidence based suggestions for improving fertility”. Instead of the many traditionally suggested fertility food items like oysters, ginseng, yam and garlic, ovulatory infertility, which is the underlying cause in almost a quarter of all cases of infertility, is now believed to be prevented much more through a complete and balanced diet.

At least five servings of fruits and vegetables: Inclusion of fresh fruits and vegetables in the diet not only ensures overall health and fitness, but also fulfills the requirement of essential vitamins and minerals in the body, required for both male and female fertility. Some deficiencies, especially those of folic acid and certain minerals, can play havoc with the fertility of both sexes, reducing the quality of sperm in males and abilities to sustain a pregnancy in women.

Plenty of unrefined carbohydrates: Whole grain cereals in multi-grain breads, pasta or chapatti helps meet the requirement of carbohydrates while also providing the body with essential fiber. Sufficient carbohydrate is important not only to ensure adequate energy levels and overall fitness but also to maintain the appropriate biochemical balance in the body.

High quality proteins: While non-vegetarians can include fish, sea-foods and poultry, as sources of protein, in their diets, people with vegetarian diets also have a wide choice of pulses, soya products, milk and milk-products for sourcing their protein requirement. One should also include eggs in the diet if it is an option. It is advisable to include at least 2 servings of protein rich foods in the daily diet. Besides strengthening the muscles and improving stamina, some protein sources like certain pulses and meats also help in meeting the requirement of folic acid in the body.

Adequate water: The adequate intake of water per day depends on various factors like gender, activity level, health and of course the environmental conditions. Though there are various recommendations on the right quantity of water to be consumed per day, the Institute of Medicine recommendation, for temperate climates, is fluid intake per day of 3 liters for men and 2.2 liters for women. This is almost the same as the often mentioned thumb rule of “8 glasses” per day. Just remember that the intake covers all fluids.

But besides ensuring that one switches to a diet that is appropriate for supporting a healthy conception, one must also be aware of certain things that need to be avoided for the same.

AlcoholConsumption of alcohol, especially if not strictly regulated, affects not just the overall health and fitness but also both male and female fertility. Since it is not often easy to regulate, couples trying to conceive should attempt to completely stop alcohol consumption.

Smoking: Couples trying to conceive should abstain from smoking and generally any kind of tobacco use. Smoking inevitably affects both the sperm quantity and quality in males and thereby the chances of a conception. In women, smoking affects how receptive the uterus is to the egg.

Cessation of smoking and alcohol consumption are lifestyle modifications which apply to to both the partners if they are desirous of having a baby. For dads-to-be, limiting alcohol is even more important when compared to moms-to-be. According to a research study, ‘Effects of caffeine, alcohol and smoking on fertility’, published in the journal of The Fertility Society of Australia, the mechanisms by which alcohol impairs fertility are unclear, but in men it has been found to cause impotence, reduction of libido and poorer sperm quality.

Caffeine: Caffeine is present in tea, coffee and in some soft drinks. It is known to drastically reduce the chances of conception. Studies have shown that consumption of even 200 mg of caffeine per day almost doubles the average risk of miscarriage of 12.5%. This doesn’t mean that one has to altogether give up their coffee or tea if they want to conceive…just limit it to a reasonable level. While some experts suggest during pregnancy a limit of 100 mg of caffeine per day from all sources (1 cup of brewed coffee or 2 cups of tea), there is no specific basis for the same.

It is important to note here that alcohol consumption and smoking are undesirable not only during the phase of conception, but also throughout pregnancy. So when it comes to planning a baby, the first step should be a decision to abstain from both of them. According to National Health and Medical Research Council and National Institute of Clinical Studies, pregnancy is a time when smoking cessation advice has been found to be most effective.

Mercury: While it may sound a bit bizarre, we may unknowingly intake a lot of mercury by consuming certain soft water fishes, which are known to have high mercury content. High mercury levels can lead to Menamata disease, which interferes with fertility and can also cause miscarriage and preterm delivery.

To summarize… A healthy, complete and balanced diet, that includes lots of carbohydrates, good quality proteins, fruits and vegetables and less refined foods and fats, when combined with abstinence from alcohol and tobacco consumption and moderation with caffeine, can support a successful and healthy conception.

Female Infertility: Cause and Treatment

The worst news that a woman trying to conceive can receive is that she is infertile. In the United States, 10 per cent of the women face the nerve-racking problem of infertility, which is the inability to get pregnant naturally. This is not solely a curse for women as men can be infertile as well.

The Center for Disease Control (CDC) states that out of all instances when infertility causes distress to a couple; female and male infertility each account for one third of those instances. A combination of problems from both the man and the woman who are trying to conceive, account for the rest of the cases after accounting for 20 per cent of the cases, where the doctors are unable to identify any obvious cause of infertility.

Causes of Female Infertility

Cervical Issues – In some cases, an abnormal mucus production or a previous surgical procedure performed on that area can cause a blockade that prevents the sperm from passing through the cervical canal. There is a workaround for this problem – intrauterine inseminations. In this process, the sperm is placed inside the uterus artificially to help with fertilization. This procedure increases the number of sperms that reach the egg.

Damage to Fallopian Tubes – A damaged fallopian tube can prevent the egg from reaching the uterus where it can met by the sperms. The fallopian tubes are responsible for carrying the eggs from the ovaries to the uterus. A damage to the tube can be caused by pelvic surgeries, pelvic infections and endometriosis.

Uterine Problems – In this case, the structure of the uterus is not hospitable for the foetus. This is caused by the presence of polyps and fibroids. Polyps are the abnormal growths of tissue that are most commonly present in the uterus, nose or colon. They can be present in any organ that has blood vessels. Fibroids are specific to the uterus. They are also abnormal growths that affect 70 to 80 per cent of the women of African-American descent who are above the age of 50. The incidence among Indian women is about 25% as per a study conducted by the National Institute of Health.

Hormonal Causes – The hormonal causes involve problems with ovulation (when a matured egg is released from the ovaries). Because of some hormonal changes, this transfer of the mature egg does not take place. Blood tests to detect the hormone levels beside ovulation predictor kits and basal body temperature charts can be used to detect this ovulation problem.

Unexplained Reasons – As the name suggests, an unexplained infertility is when the causes are not clearly identifiable. This happens in 20 per cent of infertility cases. More advanced methods of investigation are required to analyse such other causes.

Diagnosing Infertility

Blood Tests – Can be used to detect a number of potential causes including improper hormonal levels.  The level of testosterone in men is also analysed through a blood test.

Laparoscopy – This procedure involves looking at the outside of the uterus, ovaries, and fallopian tubes by inserting a fiberoptic camera attached to a thin tube through an incision near the belly button. Laparoscopy helps doctors look for abnormal growths in the area. This happens in the case of endometriosis which is due to the formation of endometriotic tissues in other parts of the body apart from being present in the uterus.

Hysterosalpingography (HSG) – An HSG involves inserting a dye or saline into the cervix. Thereafter through X-ray or ultrasound, doctors can find out whether the fallopian tubes are open or blocked.

Semen Analysis – Is performed in the case of male infertility to determine the strength and number of the sperms.

Treating Female Infertility

In vitro fertilization (IVF) – IVF is a method of artificial insemination. In this case, the egg and sperm are combined outside the body and then placed in the uterus after the embryo forms. Since 1981, when the procedure was first introduced, it has been successfully used to give birth to over 200,000 babies.

Medical therapy – Special drugs can be given to women facing problems with ovulation. These drugs are also known to improve fertility. Gonadotropins can also be used in case of an unexplained infertility. Women with insulin resistance may receive additional drugs.

ICSI – Intracytoplasmic Sperm Injection or ICSI is done in case of male infertility. The sperm is injected directly into the egg in a dish and then placed in the uterus.

Egg donation – Egg donation involves the removal of oocytes from the ovary of a woman who has taken fertility drugs for ovarian stimulation. After the eggs have been extracted, in vitro fertilization is performed, using the sperm from the recipient’s partner.

Intrauterine insemination – This procedure involves placing the sperm in the uterus when the female is ovulating. The sperm is first rinsed with a special solution and then, using a thin plastic catheter, placed in the uterus through the cervix.

Hysteroscopy – Similar to laparoscopy, a hysteroscope is placed in the uterus through the cervix. Doctors can then use it to locate and remove scar tissue, treat endometriosis, open blocked fallopian tubes and remove ovarian cysts.

GIFT and ZIFT  In Zygote Intrafallopian Transfer or ZIFT, the fertilized eggs are placed in the uterus of the mother after IVF within 24 hours while in Gamete Intrafallopian Tube Transfer or GIFT, the sperm and eggs are mixed before insertion.

Women facing infertility need not panic as it can be treated in several ways. As a last resort, if none of the above mentioned treatments work, a couple can always go in for adoption or surrogacy. In surrogacy, the surrogate mother is inseminated with the sperm from the recipient’s partner. The surrogate mother then carries the baby and delivers it on behalf of the recipient.

Ailments affecting conception & pregnancy

If one is facing difficulty in getting pregnant i.e. suffering from unexplained infertility, then probably it’s time to look at some underlying medical causes  like obesity, hypothyroidism and asthma, which can interfere with one’s reproductive health, in many more ways than imaginable. Addressing these conditions can not only improve an individual’s overall health and fitness but also increase the chances of successful conception and pregnancy:

  • Hypothyroidism– Despite the recent increase in the problem of under-active thyroid gland, little is understood when it comes to its implications on our body and its functioning. While hypothyroidism can be managed with the right medication and lifestyle modifications, it can be very challenging to attain the exact level of thyroid activity  required to achieve and sustain pregnancy.

Also, during pregnancy fetal growth and development is controlled by the hormones produced in the thyroid of the mother. Hence, it is advisable to get your thyroid checked, and if you are already on medication for thyroid, get it rechecked even after you have conceived, as levels can vary during the course of pregnancy.

  • Diabetes- The presence of diabetes on this list may take you by surprise, but the fact is that deranged blood glucose levels can seriously lower your chances of having a baby. While high blood sugar level itself does not prevent someone from getting pregnant, it hinders the retention of pregnancy. This is because diabetes can prevent the implantation of the embryo in the uterus, causing a miscarriage sometimes even before a woman can realize that she has conceived.

For the same reason, multiple miscarriages can be a red flag for undiagnosed diabetes in women. As per the American Diabetes Association, high blood glucose levels are reported to increase a woman’s chance of miscarriage by 30-60%.

  • Obesity- While there is no direct correlation between obesity and infertility, the extra body weight inflicts physical complications like insulin resistance and hormonal imbalances, which not just reduce the chances of getting pregnant but also of maintaining it. So, maintaining a healthy body weight should be your first priority if you are trying to get pregnant.
  • Asthma- According to a research paper by Juul Gade, Elisabeth et al. “Female asthma has a negative effect on fertility: what is the connection?.” ISRN allergy 2014 (2014), asthma in the lower airways in women, due to a systemic reaction, can simultaneously cause inflammation in the mucosa of their uterus. If not treated correctly, this inflammation can inhibit normal implantation of the fertilized ovum, thereby leading to infertility. Hence in cases of unexplained infertility, especially if you have asthma, a more effective management of the condition can help achieve pregnancy.
  • Lupus- Lupus is an autoimmune disorder that can negatively influence female fertility. Due to the potential risks to the mother and baby, until sometime back, doctors used to advise women with this condition to avoid getting pregnant. But with advanced medical technology, having a child while suffering from Lupus is not that difficult.

However, the first step towards getting pregnant, in this condition is to have a complete control over the disorder. Regular review of the medication and timely consultation with the experts is also important because few medications may need to be stopped just before pregnancy.

  • Migraines- The benign migraine, which apparently has no direct relation to fertility, also reduces the chances of getting pregnant. This is because the adverse effects of the medications used to treat migraine has not been clearly identified for pregnant and breastfeeding women. Hence women who are taking long-term suppressive therapy for migraine are first advised to stop the medications for a few weeks, after consultation with their doctor, before planning a pregnancy.

It is observed that women with endometriosis are more than twice as likely to suffer from migraine as compared to women without the condition. While recurrent migraine attacks and its medication could directly interfere with fertility, it could as well be a associated with undiagnosed endometriosis,

So if you suffer from frequent migraine attacks and have difficulty  in conceiving, then it is high time to get your migraine medication reviewed and to also get a diagnostic test done for endometriosis.  Endometriosis is a disease that involves growth of endometriotic tissue in places outside the uterus. Endometriosis may grow on the lining of the abdomen and pelvis, that may sometimes cause scarring, involving the ovaries and blocking the tubes, thereby leading to infertility.

  • Epilepsy- According to the study by Singh, Pratibha et al. “Effect of epilepsy on female fertility and reproductive abnormalities.” Journal of human reproductive sciences 4.2 (2011): 100., compared to the general population, reproductive abnormalities and infertility are two to three times more common in epileptic females. This is because epileptic seizures can lead to an increase in the serum prolactin level and fluctuation in women’s reproductive hormones (Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). Around 50% of all epileptic women are also reported to have menstrual abnormalities and a higher frequency of anovulatory cycles, which also adversely impact fertility.

People with epilepsy desirous of conceiving, should talk to their doctors to get epilepsy medications prescribed that do not impair fertility, are safe in pregnancy and seek hormone therapy under proper medical advice, if required.  

  • Male Infertility – Even though women may obsess over their inability to conceive, the reason for the same may often lie in various degrees of male infertility in their partners. Obesity and Diabetes are well known for causing sexual disorders like erectile dysfunction, late ejaculation and low sperm counts. Lupus in males can also cause infertility. Epilepsy medication can reduce testosterone levels or cause impotency (reduction in amount or quality of sperms).

So, if you are facing problems in getting pregnant and you or your partner already have or suspect any of the above medical conditions, then it is high time to take some corrective steps, especially because the right medical advice and action can significantly increase your chances of conceiving. After all when it comes to becoming a parent you don’t want to leave any stone unturned.