Smoking Many medical conditions can contribute to in- fertility. In fact, most cases of are Endometriosis is a condition in which cells that line the uter- Cigarette smoking can harm a woman’s due to underlying medical problems. These us grow in areas outside of the , such as the ovaries. and contribute to a decrease in eggs. Studies disorders can damage the fallopian tubes, in- The condition can interfere with a woman's ability to become show that women who smoke are more likely to terfere with , or cause hormonal com- pregnant. Endometriosis may account for as many as 30% of reach earlier than women who do plications. infertility cases. Endometriosis rarely causes an absolute ina- not smoke. bility to conceive, but, nevertheless, it can contribute to it Pelvic Inflammatory Disease both directly and indirectly. Alcohol, Caffeine and Marijuana Use

Pelvic inflammatory disease (PID) is a major Alcohol and caffeine use may contribute to infer- cause of worldwide. PID com- tility. prises a variety of infections caused by differ- ent bacteria that affect the reproductive or- Environmental Factors Causes of gans, appendix, and parts of the intestine that lie in the pelvic area. The sites of infection most often implicated in infertility are in the Exposure to environmental hazards (such as femal e fallopian tubes, a specific condition referred to herbicides, pesticides, and industrial solvents) as . may affect fertility. Estrogen-like hormone- disrupting chemicals are of particular concern Infertility for infertility in men and for effects on offspring Causes of PID. PID may result from many dif- of women. Phthalates, chemicals used to soften ferent conditions that cause infections. Among plastics, are under particular scrutiny because them are: Endometrial cysts may cause infertility in sev- they may disrupt hormones. eral ways: • Sexually transmitted diseases (cause of most Stress and Fertility PID). Chlamydia trachomatis is an infectious organism that causes 75% of infertility in the • If implants occur in the fallopian tubes, they Neurotransmitters (chemical messengers) act in fallopian tubes. Gonorrhea is responsible for may block the egg's passage. the hypothalamus gland, which controls both re- most of the remaining cases. productive and stress hormones. Severely elevated • Pelvic tuberculosis • Implants that occur in the ovaries prevent levels of stress hormone can, in fact, shut down the release of the egg. . For couples who undergo IVF treat- • Nonsterile abortions ments, research indicates that up to 55% have Dr. Raymond Mansoor • Ruptured appendix • Severe endometriosis can eventually form stress as a significant co-factor in their cause of rigid webs of scar tissue (adhesions) between infertility. B Sc , MB BS , DM (O&G) FACOG the uterus, ovaries, and fallopian tubes, there- Obstetrician & Gynaecologist by preventing the transfer of the egg to the tube. Effects of PID. Severe or frequent attacks of Tanner St. & Corn Alley PID can eventually cause scarring, abscess formation, and tubal damage that result in P.O. Box 1361W Polycystic Ovarian Syndrome (PCOS) St. John's infertility. About 20% of women who develop symptomatic PID become infertile. PID also Antigua Tel: (268) 463 2232/3 significantly increases the risk of ectopic preg- Polycystic ovarian syndrome (PCOS) is a condi- nancy (implantation of the embryo in the fallo- Fax: (268) 562 8128 tion in which the ovaries produce high amounts pian tubes). The severity of the infection, not email : [email protected] of androgens (male hormones), particularly the number of the infections, appears to pose testosterone. PCOS occurs in about 6% of wom- www.mansoormedical.org the greatest risk for infertility. Information contained in this booklet is meant for en, and or oligomenorrhea informational purposes only and should not substitute (infrequent menses) is quite common. the visit to your doctor nor his/her advice for your health care.

April 2017 Causes of premature ovarian failure include: nancy or nursing (called galactorrhea) are a tell- Weight Infertility …. tale symptom of high levels and should be investigated. The Causes • Adrenal, pituitary, or thyroid gland deficien- Although most of a woman's estrogen is cies Structural Problems manufactured in her ovaries, 30% is pro- In PCOS, increased androgen produc- Causing Obstruction duced by fat cells, which transform male tion results in high levels of luteinizing • Genetic disorders, such as Turner syndrome hormones produced by the adrenal hormone (LH) and low levels of follicle- and fragile X syndrome Inborn Abnormalities. Inborn genital tract ab- glands into estrogen. Because a normal stimulating hormone (FSH), so that normalities may cause infertility. Mullerian hormonal balance is essential for the follicles are prevented from producing a • Cancer treatments (radiation, chemotherapy, agenesis is a specific malformation in which no process of conception, extreme weight mature egg. Without egg production, the or both) vagina or uterus develops. Even in these cases, levels (either high or low) can contribute follicles swell with fluid and form into some women can become mothers by undergoing to infertility. cysts. Every time an egg is trapped in vitro fertilization and having the fertilized Autoimmune disorders (such as type 1 diabe- within the follicle, another cyst forms • egg implanted in another woman who is willing and the swells, sometimes reach- tes, systemic lupus erythematosus (SLE), au- and able to carry the pregnancy (a surrogate Being Overweight. Being overweight or ing the size of a grapefruit. Without toimmune , Addison's disease) mother). obese (fat levels that are 10 - 15% above ovulation, progesterone is no longer are associated with a higher risk for early normal) can contribute to infertility in produced, whereas estrogen levels re- menopause various ways. Obesity is also associated main normal. Uterine or Abdominal Scarring. Bands of scar with polycystic ovarian syndrome tissue that bind together after abdominal or (PCOS), an endocrinologic disorder that Uterine Fibroids pelvic surgery or infection (called adhesions) can can cause infertility. The elevated levels of androgens restrict the movement of ovaries and fallopian () can cause obesity, tubes and may cause infertility. Asherman syn- facial hair, and acne, although not all Benign fibroid tumors in the uterus are extreme- drome, for example, is scarring in the uterus Being Underweight. Body fat levels 10 - women with PCOS have such symp- ly common in women in their 30s. Large fibroids that can cause obstructions and secondary 15% below normal can completely shut toms. PCOS also poses a high risk for may cause infertility impairing the uterine lin- amenorrhea. It may be caused by surgery, re- down the reproductive process. Women at insulin resistance, which is associated ing, by blocking the , or by dis- peated injury, or unknown factors. risk include: with type 2 diabetes. About half of torting the shape of the uterine cavity or alter- PCOS patients also have diabetes. ing the position of the . Risk Factors • Women with eating disorders, such as Premature Ovarian Failure Elevated Prolactin Levels anorexia or bulimia. (Early Menopause) (Hyperprolactinemia) In the U.S., about 10% of women ages 15 - 44, or about 6.1 million women, have problems getting • Women on very low-calorie or restric- Premature ovarian failure is the early pregnant or carrying a baby to term. tive diets are at risk, especially if their depletion of follicles before age 40, Prolactin is a hormone produced in the pituitary periods are irregular. which, in most cases, leads to prema- gland that stimulates breast development and Age ture menopause. It affects about 1% of milk production in association with pregnancy. • Strict vegetarians might have difficul- High levels of prolactin (hyperprolactinemia) women and is typically preceded by ir- Fertility declines as a woman ages. Fertility ties if they lack important nutrients, reduce gonadotropin hormones and inhibit ovu- regular periods, which might continue begins to decline when a woman reaches her such as vitamin B12, zinc, iron, and folic lation. Hyperprolactinemia in women who are for years. In this condition, follicle- mid-30s, and rapidly declines after her late 30s. acid. not pregnant or nursing can be caused by an stimulating hormone (FSH) levels are As a woman ages, her ovaries produce fewer underactive thyroid gland or pituitary . elevated, as they are during perimeno- eggs. In addition, the quality of the eggs is poor- Marathon runners, dancers, and oth- (Pituitary are benign tumors that • pause. Premature ovarian failure is a er than those of younger women. Older women secrete prolactin.) Some drugs, including oral ers who exercise very intensely. significant cause of infertility, and wom- have a higher risk for eggs with chromosomal contraceptives and some antipsychotic drugs, en who have this condition have only a 5 abnormalities, which increase the risk for mis- - 10% chance to conceive without fertili- can also elevate levels of prolactin. carriage and birth defects. Older women are also ty treatments. more likely to have health problems that may Secretions from the breast not related to preg- interfere with fertility.