FERTILITY PROFILING: KNOWING YOUR FERTILITY STATUS (PART 1)

By Dr Kemi Ailoje

Life is full of unprecedented challenges, with infertility being one of them hence many people although not ready to start a family or make babies are curious about their fertility status. In today’s society, women often delay childbearing until later in their reproductive years. The reason for this shift is complex but often related to social, educational and economic factors. This trend towards delayed childbearing has resulted in increased number of women seeking fertility treatment in their late 30’s, 40’s and beyond.

It is not a common trend to do routine fertility check-ups in young child bearing age by people in this part of the world. We often visit our doctor because something is wrong and not necessarily because we want to evaluate our health status and identify factors that may increase our risk for diseases and its prevention. The fact remains that our health including our reproductive health is our greatest treasure, hence the need for creation of awareness and education is of uttermost importance which brings us to the topic for the today: Fertility Profiling/Know your fertility status.

Why do you need to know your fertility status?

Fertility Profiling is a comprehensive protocol which involves examinations and tests to be done to provide foundation information as they relate to reproductive issues including fertility.

Investigative test carried out during fertility status check- up helps the female to:
• Establish fertility potential
• Identify risk factors that may predispose to infertility in the future
• Diagnose abnormalities that may need prompt management
• Identify causes of infertility that may be prevented.
• Individuals with low fertility potentials can be identified and counselled appropriately
• Prepare one to face the future with vision and make informed decisions rather than with ignorance, confusion and frustration e.g. women with Poly Cystic Ovarian Syndrome (PCOs) may need some form of assistance to get pregnant but an ignorant woman may never seek help until menopause.

There are strong indicators for fertility status check in females
• Women with a history of irregular menses irrespective of age
• Women with sudden cessation of menses before age of menopause
• Adolescents with absence of menses after puberty
• Women with a positive family history of Endometriosis, ovarian cancer, fibroids
• Women with Dysfunctional Uterine Bleeding
• Women with hormonal alterations and imbalances
• Fatigue, moodiness, loss of muscle tone, increased body fat, low sex drive

Evaluations Done To Assess Fertility Status in Women

A variety of tests are available for evaluating female fertility potential, it may not be necessary to have all of these tests done if basic results done are normal
• Medical history — A woman’s past health and medical history may provide clue to the physician who may ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.

• Menstrual history — Amenorrhea (absent menstrual periods) usually signals an absence of ovulation, which can cause infertility. Oligomenorrhea (irregular menstrual cycles) can be a sign of irregular ovulation; although oligomenorrhea does not make pregnancy impossible, it can interfere with the ability to become pregnant.

• Physical examination — A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might affect fertility. The physician will also perform a pelvic examination, which can identify abnormalities of the reproductive tract and signs of low hormone levels. The physical examination may be performed by the patient’s primary care provider, gynecologist, or infertility specialist.

• Blood Tests: To determine blood level of:

Follicle Stimulating Hormone: is important for women in the production of eggs by the ovaries and Elevated FSH in women indicates reduced egg supply whereas low levels can signal that you are not ovulating or are pregnant. Levels of FSH rise in women as egg production declines;therefore raised FSH often coincides with the onset of the menopause and is a measure of ovarian reserve.it is done on day 3 of the menstrual cycle

Luteinizing Hormone: Raised LH in women can signal that you are not ovulating, that you are menopausal or that your hormones are not in balance (as with polycystic ovaries).

These hormones control the development ofeggs, maturation, trigger of ovulation and lactation which must happen if one is to ever get pregnant. Abnormalities in level or ratio may hinder fertility.

Serum Progesterone: Progesterone is a female hormone produced by the ovaries during ovulation. It causes the endometrial lining of the uterus to get thicker, making it receptive for a fertilized egg. This test is used to determine if ovulation is occurring. Since progesterone levels increase towards the end of a woman’s cycle, the test is done during the luteal phase of the menstrual cycle (just before her period starts).

Testosterone (Free and Total) Hormonal test:Testosterone is produced in smaller amounts inthe ovaries of women. It is responsible for bone and muscle strength, as well as mood, energy and sexual function. Raised testosterone can result in male characteristics in a female such as body hair, greater bulk, a deeper voice and acne – all symptoms of polycystic ovaries, a condition in which elevated testosterone is commonly seen.

To be continued next week……