It is distressing for a woman to try to conceive but in vain. Infertility is defined as trying to get pregnant for at least a year with no success. Many things can go wrong in the processes that lead to infertility. Dr Iba Mayele, a gynaecologist at Clinic Galien, Kimironko, says to get pregnant, a woman’s ovaries must produce and release an egg, a process known as ovulation, she needs to have regular intercourse during her fertile time, and she is required to have open fallopian tubes and a ‘normal’ uterus. He adds, for pregnancy to occur, every step of the reproduction processes has to happen correctly. In women, a number of factors can disrupt this process. Female infertility is caused by one or more of the factors below: Mayele says that a damaged or blocked fallopian tube keeps sperms from getting to the egg or blocks the passage of the fertilised egg into the uterus, thus the damage of the tube. He says, failure to ovulate can also be a cause of infertility. Not ovulating can result from several causes, such as, ovarian or gynaecological conditions, for example, primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS). “Endocrine disorders, such as thyroid disease or problems with the hypothalamus, which affect the hormones produced by the body, so that there might be too much or too little of a hormone or group of hormones,” Mayele says. Endometriosis may also be the cause of infertility, this occurs when the cells that usually line the uterine cavity, called the endometrium, are found outside the uterus instead, he adds. Mayele explains that difficulties with the menstrual cycle can also lead to infertility, this is the process that prepares the female body for pregnancy. The menstrual cycle includes several phases, and any problem can lead to difficulty in getting pregnant, or to infertility. He notes that uterine or cervical stenosis can influence fertility by interfering with implantation or increasing the likelihood of a miscarriage, benign polyp, and uterine abnormalities. Cervical stenosis is the narrowing of the cervix and can be caused by an inherited malformation or damage to the cervix. Mayele also points out that the main symptom of infertility is the inability to get pregnant. A menstrual cycle that is too long (35 days or more), too short (less than 21 days), irregular or absent is sign for not ovulating. Mayele further notes that when seeking for help, age matters. Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment. For those between 35 and 40, he urges discussing with doctors about concerns after six months of trying. If a woman is over 40, her doctor may suggest beginning testing or treatment immediately. Dr Kenneth Ruzindana, a consultant at University Teaching Hospital of Kigali (CHUK), says fibroids can contribute to infertility and are found in five to 10 per cent of infertile women. Uterine fibroids are noncancerous growths that form inside the uterus. He says that autoimmune disorders, such as lupus, Hashimoto’s disease and other types of thyroiditis, or rheumatoid arthritis, may affect fertility. They are believed to contain inflammation in the uterus and placenta or medications used to treat the diseases. Ruzindana explains that failure for eggs to mature may cause infertility. This can be due to a variety of reasons, such as polycystic ovary syndrome-PCOS, obesity, and absence of specific proteins needed for the egg to mature. “Implantation failure is also another cause of infertility; it refers to the failure of a fertilised egg to implant in the uterine wall to start pregnancy,” he says.
