Everything Else & How It Impacts Fertility
Abnormalities of the uterus, or otherwise known congenital uterine abnormality, has an impact on the ability to carry a baby to term.
This abnormality is formed before a woman is born and is very common. Some women are unaware that they have an abnormality.
The uterus oversees many critical steps in the reproduction process, such as sperm migration, embryo implantation, foetal nourishment, growth, and development and, lastly, labour. Therefore, any abnormality can influence fertility.
Women see a consultant only after either having missed periods, no periods, miscarriages, or infertility. Diagnosis is usually via an examination or an ultrasound
There are several types of uterine abnormalities:
- Unicornuate uterus - although a rare condition, it means the uterus is half the size of a normal uterus. The likelihood of ectopic pregnancies or pre-term labour are common with unicornuate uterus.
- Bicornuate uterus - a uterus that is shaped irregularly, a heart shaped uterus. Bicornuate uteri have two interfused cavities, whereas a normal uterus has one cavity. Pre-term birth and possible cervical incompetency are possible risks associated with bicornuate uterus.
- Septate uterus - the uterus is divided in two by a thin membrane that runs down the middle of the uterus. There is a higher chance of pregnancy loss, miscarriage, and preterm birth with septate uterus.
- Uterus Didelphysis – a condition whereby women are born with two uteri and two cervixes and may have two vaginas in very few cases. It is a rare condition and is known to impact fertility.
- Arcuate uterus - an indentation on the top of the uterus which increases the chance of miscarriages.
An ectopic pregnancy occurs when a fertilised egg implants and grows outside the main cavity of the uterus. It most often occurs in the fallopian tube, however it can occur in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix).
A medical emergency can arise from an untreated ectopic pregnancy. The sooner you receive treatment, the lower your risk of ectopic pregnancy difficulties, the higher the likelihood of future healthy pregnancies, and the lower the risk of long-term health issues.
There are several risk factors:
- Smoking - the more you smoke the greater the risk of ectopic pregnancy
- Tubal surgery - surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy
- Previous ectopic pregnancy - the likelihood is greater if you have had a previous ectopic pregnancy
- Fertility treatment - there is a very small percentage of patients undergoing any fertility treatment having an ectopic pregnancy
- Inflammation or infection - sexually transmitted infections, such as gonorrhoea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy
Pelvic inflammatory disease
Pelvic Inflammatory disease (PID) is an infection of the female reproductive system, upper genital tract, including the uterus, ovaries, and fallopian tubes.
It is a sexually transmitted disease and is treated with antibiotics. Gonorrhoea and chlamydia are the most common bacteria that cause PID. Signs and symptoms can be mild, but if left untreated it can lead to infertility and chronic pelvic pain.
There are several risk factors
- Multiple sexual partners
- Being in a sexual relationship with someone who has multiple partners
- Unprotected intercourse
- Having a history of previous PID or sexually transmitted infection (STI)
- Douching regularly – affects the normal vaginal flora
There are several complications associated with PID
- Infertility - damages the reproductive organs
- Ectopic pregnancy – scar tissue that develops in the fallopian tubes from PID, prevents the embryo from travelling through the fallopian tube into the uterus
- Chronic pain during sexual intercourse and ovulation from scarring on the fallopian tubes and reproductive organs
- Tubo-ovarian abscess - a collection of pus in the reproductive tract , if left untreated can be life-threatening
Prevention is to practice safe sex, use a condom, you and your partner get tested for STI’s, and do not douche.
Termination of pregnancy
A medical process of ending a pregnancy that does not result in a child being born.
According to law, this needs to be carried out before 24 weeks of pregnancy. It’s a personal choice women make which is not easy.
Counselling and advice are of the utmost importance before the decision is made to terminate a pregnancy. This can be done medically – taking medication or surgically – involving minor surgery. It all depends how many weeks pregnant a woman is before the medical team can carry out a termination.
There are several reasons women might want to terminate a pregnancy
- Congenital abnormalities of the foetus
- High risk pregnancy to the mother
- Underage pregnancy <16 years
- Personal circumstances
Neither the choice to maintain a pregnancy, nor the decision of terminating a pregnancy need ever be explained to anyone.
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