Health News

The problem may lie in one of these areas:

• The woman—70 to 75 per cent of infertile couples have a female factor.

• The man—30 to 35 per cent have a male factor.

• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.

However, the most common causes of infertility are:

• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.

• Having blocked fallopian tubes—about 20 per cent.

• Sperm problems—about 20 to 30 per cent.

Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.

Tube problems. Not only do the sperm need to travel up the tube to meet the egg, but the fertilised egg must also make it down through the tube to the uterus. If the tube is kinked or narrowed it is less likely that a pregnancy will result. If the tube is completely blocked, then it’s pretty unlikely indeed.

Things that muck up tubes, such as the most common causes, infection and endometriosis. Chlamydia and gonorrhoea are the main causes of sexually transmitted pelvic inflammatory disease (PID). Non-sexually transmitted PID, for example infection following an abortion or other gynaecological operation, or related to an intrauterine contraceptive device (1UD), accounts for some cases. Scarring following pelvic surgery or appendicitis can also affect the tubes.

Endometriosis can damage the tubes if it causes scarring. It can also slow the rate at which things travel through the tubes, by exerting a type of hormonal effect.

Having an ectopic pregnancy (a pregnancy which settles in the tube or ovary rather than in the uterus) can damage the fallopian tube, as an operation is usually performed to remove the ectopic pregnancy. Generally that means removing some or all of the tube on that side. Surgeons try to be as careful as possible, and in some cases are able to conserve the tube.

Another reasonably common cause of tube problem is previous surgery. Some women who have had their fallopian rubes operated on (either cut and tied, or had clips applied), will request reversal of their operation to restore their fertility. Men who have had a vasectomy may also change their minds, and seek a reversal operation. Reversal may work, but success rates would vary depending on the surgeon and the degree of damage to the tube from the sterilization procedure. You should never have a sterilisation operation thinking you can change your mind later, because the results of reversal are so unpredictable.

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There are several ways of working this out. The most common is by dates. The first day of your last period is counted as day 1, and an average pregnancy is about forty weeks. The ‘expected due date’ is calculated in this way. Most babies arrive between thirty-eight and forty-two weeks, not necessarily on their ‘due date’.

If your first missed period was two weeks ago, you would be about six weeks pregnant, because it is counting from your last real period, (only thirty-four weeks to go!). This method assumes that most people have cycles of about four weeks and regular periods, as most people do.

However, if you have a usual cycle of five weeks, and your missed period was two weeks ago, you may not be seven weeks pregnant (which you would be by counting from your last real period). You are more likely to be six weeks, because most women ovulate about two weeks before their period, regardless of how long it is between periods. If you have irregular cycles it may be impossible to tell the gestation (stage of development of the pregnancy) from the dates alone.

It is generally not absolutely necessary to know the exact gestation. If it is, then an early (less than ten weeks) ultrasound can be used to assess gestation. This measurement will be accurate to within a few days.

Less accurate, but still useful, is a physical examination. The size of the uterus can give an idea of how far the pregnancy has progressed. The limiting factors in this method are the experience of the doctor performing the examination and the fact that the uterus may not be that easy to feel.

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Again, some blood tests will tell you:

• if you have ever been in contact with the bug, and have developed antibodies

• if you still have the infectious part of the virus, the ‘antigen’, floating around your blood stream, and are infectious to other people—a carrier

• if your liver has been damaged by the virus, if you are a carrier.

Again, there is a ‘window period’, as explained in the previous section on AIDS—HIV infection, so sometimes a repeat test may be necessary to exclude infection.

Treatment. Unfortunately, there is no effective cure. Being a virus, it doesn’t respond to antibiotics. The best we can do is try to stop it spreading, and give symptomatic relief to those who are in the ’sick’ phase of the disease.

There are drug treatments being tried on people who have chronic hepatitis, with varying success. Ultimately some people will be treated for liver failure, as the chronic stage progresses, and they will sometimes be candidates for liver transplants.

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The drug companies realized that there would be ‘gold in them there pills’, and consequently there are lots on the market. This breeds a bit of confusion among the pill takers, when they realize they are on one type of pill, and all their friends are on different ones. Are some better than others? Generally no. In fact some of the ‘different’ pills are in fact identical, but made by a different company, so have a different brand name and packaging. Some have different doses and some contain different types of progesterone, but they all work in the same way.

There are many presentations of the pill. All contain combinations of oestrogen and progesterone. Some of the commonly prescribed ones include:

• 30 microgram oestrogen—stable dose—21-day or 28-day (which includes seven ’sugar’ tablets as well as the twenty-one hormone tablets). The idea of the sugar tablets is so the taker gets into a routine of taking a pill every day. The sugar pills do not make you fat. You don’t actually have to eat them if you don’t want to. Trade names: Microgynon 30, Microgynon 30 ED ‘every day’, Nordette 21 and Nordette 28.

• 35 microgram oestrogen—stable dose—21-day or 28-day package. Trade names: Brevinor, Brevinor-1.

• 50 microgram oestrogen—stable dose—21-day or 28-day packets. Trade names: Microgynon 50, Microgynon 50 ED, Nordette 50, Nordiol, Nordiol 28, Norinyl-1, Ovulen.

• Triphasic and Diphasic packets—21 -day or 28-day. These vary the amount of hormone taken throughout the month, but work in the same way to prevent ovulation. Some triphasic preparations have a lower overall dose of hormone when added up for the month. Trade names: Triphasil, Triphasil 28, Triquilar, Triquilar ED, Synphasic 28-day (35 microgram oestrogen), Biphasil (50 microgram oestrogen), Sequilar ED (50 microgram oestrogen).

• Preparations with other progesterones are also available. These specific progesterones may be more suitable for some people, as they are less likely to adversely affect skin (acne and hair growth). Trade names: Diane 35 ED, Marvelon.

When starting the pill for the first time, often the lower dose (30 microgram) pill, or a triphasic preparation will be prescribed. If ‘breakthrough bleeding’ occurs regularly, a higher dose may be prescribed. Breakthrough bleeding or spotting is not uncommon when first starting any pill, and will usually settle down within three months. If it doesn’t it may be worth trying a different pill.

The higher dose (50 microgram) pills may be better for people with certain problems, such as acne, breakthrough bleeding, or people taking certain medication already. Tablets for epilepsy, among others, can interfere with the effectiveness of the pill, so a higher dose is required to provide adequate contraception. If you are on a regular or frequent medication, check with your doctor about interactions with the pill. Together, a woman and her doctor can work out the alternatives. It is not uncommon for women to find they tolerate one type of pill better than another. Women may try several different ones before finding a pill they are happy with.

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Then there are the bits we can’t see, like hormones. Hormones are chemical messengers which float around in the blood stream, telling different bits of your body to do their jobs. Like little floating supervisors, there are hormones which control a variety of body functions. For example, growth hormone tells the various growing cells to multiply at a particular pace, mainly during childhood and adolescence. Without sufficient growth hormone we do not grow at the usual rate. Insulin is a hormone, made in the pancreas, which controls the sugar level in the blood. Diabetes is the condition which arises when insulin it not made, or stops having its effect, and blood-sugar levels rise. There are many hormones floating around the body at any particular time, regulating the many functions of the body. The ones are the ones which affect the reproductive organs.

There are two major female sex hormones. One is oestrogen (also spelled estrogen). Progesterone is the other. There arc other hormones related to reproduction, with poetic names like follicle stimulating hormone (FSH), luteinising hormone (Ml), and women also possess the ‘male’ sex hormone testosterone.

These hormones are produced by, and act on, a variety of organs.

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