In Summary

Infertility explained. Increasingly, women of various ages struggle with infertility. Beatrice Nakibuuka sought explanations from the experts.

Charity Asaba had travelled to Russia to pursue her medical course but upon arrival, the new environment, little exercise, poor diet and stress acted on her hormones and she did not get her menstruation periods for about three months.

“I went to see a gynaecologist but was told to wait for three months and try to work out. After the three months, I still did not see my periods. When I went back, I was diagnosed with secondary Amenorrhea and I was given a pill that induced my periods. When I got them, I was started on hormonal treatment.”

Secondary amenorrhea, according to Dr Charles Kiggundu, a gynaecologist at Mulago Hospital, is the absence of menstrual bleeding in a woman who had been menstruating but suddenly stops for three or more months in the absence of pregnancy, breast feeding, cycle suppression with birth control pills, or menopause.
The hormonal pills according to Asaba were to be taken daily to help her body normalise but she had to supplement it with exercise and diet which consisting of foods that stimulate periods.
She says, “I took the pills for six months but would get only a week’s break. My periods were dependent on the pills. After that, my periods became normal again.”

Some women who have conceived before may find it hard to conceive again especially when they cannot have regular periods.
According to Dr Kiggundu, there are several factors to blame for the delay to conceive. These range from lifestyle to hormonal imbalance, poor nutrient content and genetic variances as well as chronic medical problems, including stress and diet.

Reproductive problems
Common reproductive problems such as uterine fibroids, endometriosis, and pelvic inflammatory disease (PID) can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg cannot travel through the tubes into the uterus.
Dr Kiggundu says, “blocked fallopian tubes account for about 20 per cent cases of infertility and often women are unaware that they suffer from it because there are no obvious symptoms. Women with blocked tubes still ovulate and get their periods.”
Blocked fallopian tubes are caused by sexually transmitted infections such as Candida and Chlamydia trachomatis which can cause tube obstruction such that fertilisation cannot take place.

If left untreated, the infections can cause damage by leaving scars in the fallopian tubes so that the sperm and the egg cannot meet, thus, the egg cannot be fertilised to make a baby.
According to Dr John Mulwanya, a gynaecologist at Kayunga Hospital, depending on where they are growing, uterine fibroids can prevent or interfere with conception. In some cases, a fibroid may stop a fertilised egg from implanting properly in the uterus. This can result in an early miscarriage.

Age and Poor timing
As a woman ages, changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman’s 30s and 40s, the eggs released each month are of poorer quality than those produced in her 20s.
It is harder to get pregnant when the eggs are poorer in quality. As a woman nears menopause, the ovaries may not release an egg each month, which also can make it harder to get pregnant. Also, as a woman and her eggs age, she is more likely to miscarry, or have a baby with genetic problems, such as Down’s syndrome.

Dr Mulwanya says many elite couples who do not live together have failed to conceive because of poor timing. “If a woman has a normal menstrual cycle of 28 to 32 days, about five to seven days after her menstruation (ovulation time), a woman is fertile and can actually conceive but when the husband is away, the cycle will have moved so it becomes harder to conceive.”

Hormonal contraceptives
It is usually hard to conceive immediately after one has stopped using the hormonal birth contraceptives. “while it is a highly effective method of birth control, the injectable Depo-Provera is also the one hormonal contraceptive that can have lingering effects on fertility. This is because it persists in the body for months even after you have stopped using it,” Dr Mulwanya says.
Although there are women who may get pregnant immediately, it may take some of the women about six months to be able to conceive again.

Lifestyle and foods

\Women who are trying to conceive should avoid stress, smoking, alcohol use and doing a lot of strenuous exercises because these negatively impact on a woman’s fertility.
According to Catherine Nanozi, a nutritionist at Cathy’s Wellness Centre in Nsambya, a healthy diet is paramount for a woman trying to conceive. She adds that when planning to conceive, women should have a normal weight per height ratio (BMI) which gives the growing child a strong foundation.
“Provided there is no physical condition to affect your fertility, eating nutritious meals can improve your fertility. However, there are some foods that may lower your chance of conceiving and these include liver and liver products, caffeine and hibiscus,” she says.

Eating fatty foods in excess can increase infertility risks. High fibre, low sugar acting foods such as cassava and whole wheat bread boost fertility. However, low fibre, high sugar acting foods lower fertility.
Nanozi says, “Fruits and vegetables will help towards achieving a balanced diet and contain a sizeable amount of minerals that support fertility. Folic acid improves the blood stores and helps the placenta to grow well which is vital for foetal development. Dark green vegetables, avocado and lentils have the high levels of folic acid. One should also get enough vitamin D, from the sun or eggs.”