Disorder responsible  for  40 per cent of infertility in women

By Ogechukwu Agwu

Like all women with the prospects of getting married, Ada Okafor had always dreamt of being a mother. She wanted four children, two girls and two boys.

However, seven years since she got married, she is yet to have a child. She said a problem started two years after she got  married. Her words : “I was pregnant at that time, I lost the baby through a miscarriage, and the doctor said it was due to stress. I recall that fateful day, I returned home very late, there was too much traffic on the road. I had to come down from  the bus and do some trekking, I had no choice, my husband was already home, he had called me and there was no food at home, so I was in a hurry to get home. When I finally got home, I was too tired, fortunately, my husband had already prepared dinner,  as if he knew I was very tired. I was feeling very weak. I had my dinner and I slept. I woke up to urinate around 3am, I discovered I was bleeding, my husband rushed me to the hospital that night but it was too late, I lost the baby.”

“After I lost the baby, my body changed, sometimes I would miss my period and I would think I was pregnant, at other times when I see my period, it would go on for months nonstop, I have been battling this for seven years until my sister-in-law came around for a visit and dragged me to the hospital. I did some test and the result showed that I had an anovulatory cycle, this condition has been responsible for my infertility. I am on drugs now, fertility drugs and I know very soon I will carry my own baby.”

Ada  experienced anovulation. Anovulation is a common cause of female infertility occurring in up to 40 percent of infertile women. It is lack of ovulation or absence of ovulation.

More often than not, when women are trying to conceive, it’s normal to to pay close attention to your cycle, I mean in order to get pregnant you must first ovulate right? It is generally believed that seeing your period is a sign that you are ovulating but surprisingly, that is not the case. Sometimes, women menstruate without ovulating and this can go on for a long time. This condition is referred to as anovulation.

According to Dr Akaninyene Ubom of Prime Medical Consultants, Lagos, “anovulation is when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place in other words; the ovaries which are the female organs of reproduction responsible for releasing eggs of ovulation during menstrual cycle fail to do so.

“It becomes a cycle where the ovaries do not release an egg during the menstrual cycle, meaning, ovulation does not occur in the menstrual cycle. This cycle is characterised by varying degrees of menstrual intervals, the absence of ovulation and a lutheal phase. Contrary to popular opinion, ovulation must not occur during menstruation, irrespective of ovulation the hormones act, hence, you can still menstruate. There is still preparation of the womb for possible incubation of a fetus.

“Certain hormones act during menstruation, principally, estrogen and progesterone produced in the ovaries and follicle stimulating hormone (FSH) and LH leutenizing hormone(LH) produced by the anterior pituitary gland in the brain.

“During each menstrual cycle, some oocytes in the ovaries are stimulated to grow and develop by the FSH. This occurs during the first half of the menstrual cycle, increasing quantities of LH are also produced. Now at midcycle, day 14 of a 28 day cycle, there is a peak in LH production and this causes a release of the developed oocyte from the ovaries. In the second half, the ovaries produce progesterone which prepares the womb for possible incubation of the egg that should be fertilised; this preparation leads to the thickening of the lining of the womb.”

In an anovulatory cycle, the menstrual intervals are prolonged, exceeding 35 days, leading to oligomenorrhea (cycle lasting between 35 – 180 days interval) or even longer. In some cases, menstruation may be fairly regular or more frequent or there may be loss of menstrual pattern like menorrhagia, dysfunctional uterine bleeding. An anovulatory cycle occurs when a woman skips ovulation.

It is not uncommon for a woman in her prime conception years to experience an anovulatory cycle occasionally. In fact, some may have experienced one and not even noticed. This is because when a woman experiences ovulation, she may still seem to menstruate normally.

In a normal cycle, the production of progesterone is stimulated by the release of an egg. It’s this hormone that helps a woman maintain regularperiods. But during an anovulatory cycle, an insufficient level of progesterone can lead to heavy bleeding as in the case of Ada, it was very easy for her to mistake this bleeding for a real period.

Dr. Akaninyene explained that “this kind of bleeding may also be caused by a buildup in the lining of the uterus known as the endometrium which can no longer sustain  itself. It can be caused by a drop in estrogen as well.”

Anovulation is peculiar amongst girls who have recently begun menstruating; in the year following a girl’s first period known as menarche, she is more likely to experience anovulatory cycles. It is also common with women who are close to menopause. A woman between the ages of 40 and 50 is at a greater risk of changes to her hormones. This may lead to anovulatory cycles.

A change in the hormone levels can also trigger anovulatory cycles, a body weight that is too high or too low, extreme exercise habits, eating habits, high level of stress.

As with all medical conditions, there are signs or a symptom that announces the presence of the condition. Prof Agumah Bernard, another expert, charged women to be very observant with their body.

“Women should pay keen attention and be alert to pick up changes that your body may be experiencing. Everything is an indicator to something; sudden weight gain may be an indicator of pregnancy, at the same time, could be an indicator that something is wrong with the menstrual cycle, as in the case of anovulation.”

Signs and symptoms 

Usually, women with anovulation will have irregular periods, so if someone’s cycles are shorter than 21 days or longer than 36 days she may have ovulatory dysfunction. If your someone fall within the normal range of 21 to 36 days but the length of her cycles varies from month to month, that may also be a sign of anovulation.

Dr. Akaninyene said, “There could be oligomenorrhea, that is menstrual cycle intervals lasting more than 35 days hence reduced frequency of menses, polymenorrhea, that is menstrual cycle intervals less than 21 days and hence increased frequency of menses; secondary amenorrhea which is the absence of menses for more than 6 months in a woman who was previously normally menstruating, menorrhagia which is excessively heavy menstrual flow.

“Polycystic Ovarian Syndrome (PCOS) is also one of the commonest cause of anovulation, studies have shown that it affects 5-10% of women in their reproductive age. It is a syndrome of ovarian dysfunction with cardinal features of hyperandrogenism (elevated levels of testerone) and polycystic ovary morphology on ultrasound. Clinical manifestations include menstrual irregularities, hirsutism (excess facial and body hair), obesity, acne, recurrent miscarriages and infertility.

“Where the culptit is hyperprolactinemia, that is abnormally high blood levels of prolactin, a hormone responsible for milk selection, there may also be galactorrhea which is the milky nipple discharge in a non-breastfeeding woman.

“Symptoms associated with dysfunction of the thyroid gland (a  gland in the neck that secretes hormones that primarily regulate metabolism), there may be neck swelling, protusion of the eye balls, weight loss without change in diet or exercise, weight gain (despite a decreased appetite ), palpitations, heat or cold intolerance and extreme fatigue amongst others.

“Absence of mittleschmerz, otherwise called ovulation pain or midcycle pain characterised by lower abdominal/pelvic pain that occurs roughly midway through a woman’s menstrual cycle. There may also be absence of premenstrual symptoms like a swollen and painful breasts and mood swings.”

Diagnosis

Diagnosing an anovulatory cycle can be simple when a woman has no period, or periods that come erratically. But that’s not the case for every woman. However, there are a few things that your doctor can check and they include your progesterone levels, the lining of your uterus, the shape and size of the ovaries and uterus, your doctor may use an ultrasound to see if the ovaries are polycystic, your blood may also be checked for the presence of certain antibodies.

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Your doctor may also ask you to employ the basal body temperature charting technique of detecting ovulation ( where you take your temperature first thing in the morning before getting up or brushing your teeth) the temperature spike that accompanies ovulation which is caused by the hormone progesterone is absent in ovulation

Preventive measures

Women suffering excessive weight gain or low body weight should optimise their weight while those experiencing stress should address lifestyle issues.

Women with hyperprilactinomia need full investigation to exclude a medical or physiological cause. If tumour is detected, it may require surgery or may shrink if dopaminergic agonist like bromocriptine is used.

In PCOS, insulin sensitising drugs like metform may lead to a resumption of normal ovulatory cycles.

Treatment

Findings from tests will help doctors recommend the best treatment. If these cycles are related to an outside influence like nutrition or lifestyle, effective treatments will include regulation of eating habits and moderating physical activities. Making changes to your weight (gaining or losing weight as directed by your doctor) may also be enough to jump start stalled ovulation.

Sometimes, internal or hormonal imbalances are the reasons a woman is experiencing anovulatory cycles. In that case, you may get medications for fertility. These medications are designed to combat the cause of a woman’s infertility. There are drugs designed to ripen the follicles, increase estrogen and help the ovaries release an eggs.

“Ovulation can be induced with anti-estrogen medication like clomiphene citrate or exogenous gonadotrophin. Clomiphene citrate is administered during the follicular phase of the menstrual cycle ( the phase before ovulation), it acts by increasing gonadotrophin release from the pituitary, leading to enhanced follicular recruitment and growth. Ovulation can also be induced with exogenous gonadotrophins given as daily injection from the beginning of the cycle. Ovulation is usually triggered with an injection of human chorionic gonadotrophin (hcG) which binds to LH receptor.”

In extreme cases, surgery is an option. This becomes viable when something such as a tumor is discovered. If you are experiencing consistent anovulation that varies in length, identified by irregular and erratic cycles, consider some lifestyle changes like better nutrition, exercise and combating stress.

Medical screening

Women who do not ovulate and who want to get pregnant need a medical screening to find out why they do not ovulate. Drugs are often given to induce ovulation.

 

 

TIPS ON HEALTHY LIVING : Easy snoring remedies (1) 

By Patience Boulor

You may be among the 45 per cent of normal adults who snore at least occasionally or you likely know someone who does. He (or she) may be the brunt of jokes at family gatherings (“Uncle Joe snores so loudly he rattles the windows!”), but snoring is serious business.

For one, a snoring spouse often keeps the other person from a good night’s sleep, which can eventually lead to separate bedrooms. “Snoring can create real problems in a marriage,” says expert.

Not only is snoring a nuisance, but 75 per cent of people who snore have obstructive sleep apnea (when breathing is disrupted during sleep for short periods), which increases the risk of developing heart disease

Use caution before you self-treat with over-the-counter sprays and pills until you’ve checked with your doctor.”Many stop-snoring aids are marketed without scientific studies to support their claims,” Instead, try these natural solutions and lifestyle changes, which may help someone stop snoring.

Change your sleep position
Lying on your back makes the base of your tongue and soft palate collapse to the back wall of your throat, causing a vibrating sound during sleep. Sleeping on your side may help prevent this.

A body pillow (a full-length pillow that supports your entire body) provides an easy fix.. It enables you to maintain sleeping on your side and can make a dramatic difference.

Taping tennis balls to the back of your pajamas can also stop you from sleeping on your back. Or you can recline the bed with the head up and extended, which opens up nasal airway passages and may help prevent snoring. This may cause neck pain, however. If snoring continues regardless of the sleep position, obstructive sleep apnea may be a cause. See a doctor in this case,

 Lose weight

Weight loss helps some people but not everyone.Thin people snore, too. If you’ve gained weight and started snoring and did not snore before you gained weight, weight loss may help. If you gain weight around your neck, it squeezes the internal diameter of the throat, making it more likely to collapse during sleep, triggering snoring..

Avoid alcohol.

Alcohol and sedatives reduce the resting tone of the muscles in the back of your throat, making it more likely you’ll snore. Drinking alcohol four to five hours before sleeping makes snoring worse. People who don’t normally snore will snore after drinking alcohol.