Lifestyle choices impact infertility

Infertility, its causes, prevention and treatment

Monday, February 3 2014

These days, many young adults choose to prioritise their career, with more and more couples opting to have children later in life, which often leads to issues of infertility. But what causes infertility and what treatment options are available? And is there anything one could do to prevent it? With February being Reproductive Health Month, it is apt to put the spotlight on this condition, which affects 15% of couples.

“Infertility can be defined as the inability to fall pregnant after regular, unprotected sexual intercourse for 12 months or after six months in the case of women aged 35 and over,” says Dr Sascha Edelstein, fertility specialist at Netcare Christiaan Barnard Memorial Hospital in Cape Town.

There are three main reasons why a woman may struggle to conceive. The first is anovulation, when a woman does not ovulate (release an egg) every month. This may be due to hormonal causes, an increase in weight, or polycystic ovary syndrome, where egg follicles are “trapped” in an immature state and appear as cysts on the outer edge of the ovaries. The second reason is the pelvic or tubal factor where the man’s sperm is unable to reach the egg to fertilise it due to damage to the fallopian tubes, which carry the eggs and sperm. Fallopian tubes may be impaired by sexually transmitted infections (STIs), tuberculosis or endometriosis (when cells from the lining of the womb grow in other areas of the body, in this case the fallopian tubes). The third reason is attributable to the endometrium (inner lining of the uterus), where damage may be caused by fibroids or scarring. Failure to conceive could be as a result of one or a combination of these factors.

“In the case of men, there can either subfertility – ‘lazy sperm’ – or sterility, where there is no live sperm in the ejaculate. There are a variety of reasons why a man may have no live sperm in his ejaculate. Firstly, it could be due to obstructions, where the sperm is being produced but not released; secondly, there can be testicular failure, when the testes fail to produce sperm; and thirdly, there can be central nervous system failure, when the brain does not produce the hormones required to induce sperm production by the testes,” explains Dr Edelstein. Sperm are said to be subfertile when there is a reduced count, motility, or normal morphology on semen analysis.

There are three basic tests to assess what factor or factors prevent a couple from conceiving. The first one is a D21 progesterone test, which is a blood test to confirm whether a woman does in fact ovulate. If the blood test shows that ovulation is taking place, then a hysterosalpingogram (HSG) or laparoscopy is performed, to assess whether the fallopian tubes are blocked or obstructed. The final test for infertility involves a semen analysis to determine the quality of the male’s sperm.

“We find that in 30% of cases, the infertility of a couple is attributable to the woman. For 30% of couples, the infertility resides in the man. Thirty percent of cases can be attributed to both partners. For the remaining 10% of couples, the cause is unknown,” notes Dr Edelstein.

Dr Edelstein runs the HART Fertility Clinic at Netcare Christiaan Barnard Memorial Hospital together with a multi-disciplinary team which includes an embryologist, a fertility counsellor, a dietitian and an acupuncturist, all of whom specialise in infertility.

“Our approach is holistic as there are multiple aspects involved in treating infertility: diet, lifestyle factors, stress and personal relationships all have a role to play. Infertility is definitely impacted by age, only 4% of women in their 20s have problems getting pregnant while 80% to 90% of women older than 38 struggle to conceive. Women are born with a finite number of eggs, so there is a decline in the quantity and quality of these eggs over time, which decreases exponentially after a woman reaches the age of 38,” explains Dr Edelstein.

A person’s health is also an important factor in infertility. For example, excess weight may result in failure to ovulate. Dr Edelstein elaborates, “Women who have a body mass index (BMI) of over 30, which is classified as obese, are particularly affected as there is a 4% reduction in fertility for each unit of BMI above 30.” In addition, an increase in body mass in women who have polycystic ovary syndrome can also lead to anovulation.

Smoking is a definite no-no if a couple wants to fall pregnant, as it can influence both male and female fertility. This habit can also result in an unhealthy uterus for embryo development.

But the main contributing factor to infertility in sub-Saharan Africa is sexually transmitted infections, as they lead to tubal occlusion, a type of tubal factor infertility, and azoospermia, where a man has no sperm count. “The problem with STIs is that they are frequently asymptomatic, which means they show no identifiable symptoms. Women and men often only become aware of them when they battle to conceive,” maintains Dr Edelstein. This means that failing to use condoms in your early twenties, when having children may be the furthest thing from your mind, could have consequences for your reproductive potential when you want to start a family in later years.

However, with medicine advancing at such a rapid rate in the last few decades, there are many avenues open to couples who struggle to fall pregnant. “Our holistic approach to treating infertility means the course of treatment for each couple is unique. Should dietary and lifestyle changes not improve fertility, there are multiple medical options which a couple could pursue, including artificial insemination, ovulation induction and in-vitro fertilisation. So couples should not feel discouraged when they battle to conceive. With the help of a fertility specialist, most cases of infertility can be addressed,” concludes Dr Edelstein.



Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare Christiaan Barnard Memorial Hospital
Contact: Martina Nicholson, Graeme Swinney or Sarah Beswick
Telephone: (011) 469 3016
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