Causes of Infertility and Ectopic Pregnancy: Live Class with Dr. Shi Armero (Part 2)

In the preceding article, we discussed the first live class with Dr. Shi Armero for our Blue Bee One audience about dealing with PCOS. Today, we will provide more information about the main causes of female infertility and some details about ectopic pregnancy during the second live class held online on Facebook.

This second live class is an important event for many viewers to learn more about some ways they need to do in order to stay on the road to fertility. 

More Information about PCOS and Infertility

Last time, the topic of the first live class was PCOS or polycystic ovarian syndrome. This time, it will be about infertility but more focused on tubal factors. Dr. Shi explained the procreative factor in weddings here in the Philippines. “Unfortunately, if the procreative aspect is lost, according to the statistics, from a total fertility rate of 7, we have gone down to 3 or 4 already,” she said. So, there is a noticeable decrease in the fertility rate of many couples in our country nowadays. 

Regarding the cases we talked about last time, Mrs. AA was diagnosed with PCOS and she had been trying to conceive for around 5 years already as their youngest child is 5 years old. Dr. Shi asked the viewers: “Do you think Mr. and Mrs. AA, apart from Mrs. AA having PCOS, could also suffer from infertility?” 

She mentioned a term called “subfertility” which means the reduced capacity to conceive. “It is not impossible to conceive but there are many factors to consider to become successful in conceiving. While fecundability is the ability to get pregnant per cycle and there is only a 20% chance to get pregnant per cycle,” she explained. This is the normal rate of a woman’s ability to get pregnant. So, impaired fecundity means that there exists a difficulty in conniving or carrying a pregnancy term. 

Different Categories of Infertility

Dr. Shi said that there are different categories of infertility. Read the following details about this matter:

• Primary Infertility – if the couple has the inability to conceive after a year of trying but they don’t have prior pregnancy.
• Secondary Infertility – if the couple already has children in ages 10-15 but they want to have children again and they are not using any contraceptive yet they did not get successful in getting pregnant again. 
• Infertility – when couples are at ages 15-49 and they are having difficulties in getting pregnant for more than 5 years, despite having a consistent union status, no contraceptive use, non-lactating, and with a desire for a child. 

Fertility Rate in the Philippines and Barriers to Pregnancy

Moreover, how often and what is the quality of sexual activity for the couple to be able to be really diagnosed with infertility or subfertility? 1 out of 10 Filipino women is infertile due to a poor understanding of the issue. Despite the Philippines being an overpopulated country, many people or about 1 in every 4 couples are affected by infertility and it is a condition that needs medical attention.

One of the factors affecting the delay of treatment for infertility in the Philippines is the influence of Filipino culture on fertility myths based on religious practices. Also, the second cause of barriers to a successful pregnancy is the higher cost and no employer support especially among female employees because they are not given leave credits due to difficulty in pregnancy. 

“We should not be discriminated against based on our capacity to be able to become pregnant,” Dr. Shi told the audience online. Also, she added that both husband and wife should have the willingness and desire to get pregnant, not only the wife or only the husband who wants to have a child. 

Tubal Factors, and Other Conditions Related to Female Infertility

Dr. Shi pointed to the pie diagram displayed during the live class. The pie diagram showed that the majority or ¾ of the infertility issues fall to the female side while only 25% of the pie diagram is the malefactor. So, what are the common causes of female infertility? 

Common Causes of Infertility

Dr. Shi makes simpler terms for the viewers to remember the common causes of infertility by using the vowels: a, e, i, o, u.  Note the following details:

• A – Aging is a crucial factor when a woman is considering getting pregnant, especially for ages above 35 years old.
• E – Endometriosis is a condition affecting women in getting pregnant. (This topic will be discussed in the next live class.)
• I – Irregular menses
• O – Obstruction of the fallopian tubes
• U – Uterine factors like polyps, typical hyperreflexia, and submucous myoma. Why are we focusing on the female factors? Aside from the reason that the majority of the people who have infertility issues are women, remember that a woman’s reproductive cycle is very complex and it takes months or years to partially identify the underlying reasons for infertility or subfertility. “Also, the female’s ability to naturally conceive will fall because a female’s ability to conceive naturally will fall by 50% when she reaches the age of 35,” Dr. Shi explained.

So, take note of the a e i o u – age, endometriosis, irregular menses, obstruction of the fallopian tube, and uterine factors. If you notice that you have these signs and symptoms, you should seek help from a specialist. 

Obi

“Mrs. MN went to me for consultation because she wanted to prepare for pregnancy. I commended her for doing so because it is very important for a woman to come before the actual pregnancy to seek prenatal or preconception counseling if she will be prepared for a pregnancy in the near future,” Dr. Shi told the audience. “She had ruptured ectopic pregnancy at the right fallopian tube. She asked if she could have the chance to have a successful pregnancy.”

Again, Dr, Shi displayed the pie diagram showing that 22% of the pie involves tubal disorder. After ovulatory disorder which is 27% of the pie, tubal factor comes second among the female. Take note that ¾ of the pie, 22% is due to tubal disorder. 

Obstruction in the Fallopian Tubes and Ectopic Pregnancy – Causes and Symptoms

Dr. Shi showed an illustration of the female reproductive system. “During ovulation, a woman is able to release an egg. Then, during contact with the sperm, it will fertilize the egg and eventually turn into a fetus or baby. It will be implanted in the uterine lining in less than 6 days. However, if there exists an obstruction like scarring in the fallopian tubes, it slows down the transport of the fertilized egg towards the uterus, leading to an ectopic pregnancy,” she explained.

What are the causes of ectopic pregnancy and obstruction in the fallopian tubes? 

• Salpingitis – Severe inflammation of the fallopian tubes due to an infection like gonorrhea which is transmitted through sexual contact or chlamydia from the external genitalia. 
• Pelvic tuberculosis – It can also cause inflammation of the fallopian tubes. If you have tuberculosis, take your medications religiously because it is very durable, and consult your doctor as soon as possible because it could spread to your pelvic organs if not treated early and properly. 
• Hormonal imbalance – Mostly because of the hormone progesterone which is usually found in IUD or intrauterine devices, progesterone-containing, and progesterone-only pills from emergency contraceptives. Elevated levels of progesterone slow down the transportation of the fertilized egg. So, high levels of progesterone will cause ectopic gestation because it slows down the process. 
• IUD – These devices can significantly lead to ectopic pregnancy.
• Smoking – Severe smoking like using 30 cigarettes per day can be risky for your pregnancy. 
• Bilateral Tubal Ligation – Reconnecting the previously ligated or cut tubes is only possible when you have a very skilled and professional surgeon with a very equipped operating room who can reconnect your tubes. So, please consider carefully if you want to get pregnant and if you really need to have a bilateral tubal ligation.
• Endometriosis – it is a condition caused by infection by bacteria, and/or inflammation due to the endometriotic implants, leading to scarring in the fallopian tube. 
• Tubal Anomaly – If you don’t have the aforementioned signs but you are struggling to get pregnant, possibly you may have a problem in your fallopian tubes anatomically. 

Signs and Symptoms of Ectopic Pregnancy

Ectopic pregnancy is a pregnancy outside the uterus and commonly happens at the edge of the fallopian tube, ovary, cervix, or in abdominal area. Also, an ectopic pregnancy occurs in the ampulla as it comprises 70% of the most common location of ectopic gestation. 

• Unilateral abdominal pain – either right or left depending on the location of the ectopic gestation in your tubes.
• Hypogastric pain
• Missed menstruation but with spotting or some bleeding

Dr. Shi said that these are the important triad we need to remember for us to be able to identify the possibility of ectopic pregnancy.

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“If you had spotting and bleeding, then the next step you need to do is a pregnancy test because there are higher chances that you will be diagnosed with ectopic pregnancy. The normal intrauterine pregnancy is when you notice in the ultrasound, supposedly at 5 weeks age of gestation, there will be a gestational sac. If you have a positive result in your home pregnancy test kit and the doctor did not see anything in the ultrasound, it is important that you take a serum beta HCG quantitative test to check if your baby is located outside the uterus.”

CONCLUSION

In this second part of the Blue Bee One health live class with Dr. Shi Armero, we learned about the common causes of female infertility like tubal factors, and ectopic pregnancy. These live virtual classes will be a monthly activity conducted by Blue Bee One PH with Dr. Shi Armero as we want to provide valuable lessons that you can use especially when you experience these conditions. Please look forward to the next article as we will discuss anything about myoma.