The Health Blog

The problem may lie in one of these areas:

• The woman—70 to 75 per cent of infertile couples have a female factor.

• The man—30 to 35 per cent have a male factor.

• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.

However, the most common causes of infertility are:

• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.

• Having blocked fallopian tubes—about 20 per cent.

• Sperm problems—about 20 to 30 per cent.

Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.

Anovulation. A hold-up in egg production can arise for a variety of reasons. Making eggs requires a delicate balance of the right hormones in the right place at the right time, and an ovary capable of producing them.

Hormone imbalances can result from problems in the brain, specifically in the hypothalamus and pituitary gland, where the ‘stimulating’ hormones are produced. Too much or not enough hormone may be produced, for a variety of reasons, including (stress, weight, illness, etc.). Often there is no obvious cause.

One specific, though relatively uncommon, hormonal cause of anovulation is having too much prolactin, the milk-stimulating hormone. It is produced in the pituitary gland, and sometimes the gland will overgrow, causing what is known as an adenoma, a benign (non-cancerous) tumour. These prolactinomas account for 3 to 5 per cent of cases of infertility, and can be treated with medication or surgery.

The ovaries may not respond to the signals sent to them by the brain for various reasons. Polycystic ovary syndrome is one condition in which the messages don’t result in an egg being produced. Instead the ovaries produce heaps of little cysts. The hormone imbalance related to this condition can also lead to increased weight and hairiness, and acne. It is usually diagnosed by ultrasound and can be treated with hormones.

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Most of the tests available these days work on the fact that pregnant women will have a particular hormone in their urine and their blood. This hormone, human chorionic gonadatrophin (fortunately, known as HCG), can be identified with special urine and blood tests.

In the past there was a fair degree of difference between the blood and urine tests, with the blood test being considered more accurate, and able to detect HCG earlier in the pregnancy than the urine test. Better urine tests have now been made, and varieties of these are available from pharmacies. Doctors also commonly use urine tests, and the makers claim that they are nearly as accurate as a blood test, becoming positive within a few days of a missed period.

If you are having a urine test to see if you are pregnant, it is best to wait until your period is at least a few days late. It is also recommended that the wee you use for the test be from first thing in the morning, because urine concentrates overnight. If there is HCG in it, it is likely to be easier to find if it is more concentrated.

So you can do a home pregnancy test, or go to your doctor and have a test. Even if you do a home test, you will usually need to see your doctor to make arrangements for your pregnancy. Your doctor is likely to confirm the pregnancy with another urine test. A positive urine test is enough to confirm a pregnancy. It is not generally necessary to follow a positive urine test with a blood test.

If you have missed a period, and your pregnancy test is not positive, there may be other reasons for this. Women can miss periods for lots of reasons. Stress, illness, hormonal variation, sometimes no reason at all. It may be that you are pregnant, but simply that the test is not yet positive, and a doctor might suggest you repeat the test in a few days. Sometimes a blood pregnancy test will be recommended if there is a doubtful urine test result.

Most pregnant women will have positive pregnancy tests within a week of a missed period. Some women will take longer to have positive tests, and still be pregnant. Only very few women will have a positive pregnancy test and not be pregnant.

Sometimes a woman will have a test which is positive, and within a week or so have a negative pregnancy test, and a period-type bleed will follow. This can result from very early pregnancy failure; a pregnancy which may have just started, and was never going to continue, and fizzled. The resulting period is often a little heavier than usual. If the woman had not actually done the pregnancy test, and not known she was pregnant, this may have seemed like simply a slightly heavier period, a bit late. In fact that is how it probably should be considered, rather than a failed pregnancy, or miscarriage (more on miscarriage later).

Pregnancy tests eventually become negative in an ongoing pregnancy, but that does not tend to happen until the pregnancy has progressed a few months. The level of HCG starts falling after about ten weeks, even if the pregnancy is continuing.

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Infection with hepatitis B may not be noticeable (‘asymptomatic’, or ‘subclinical’, doctors call it), or it may make you ill, even so ill you need to be in hospital. The virus affects the liver, so the liver may malfunction for a few weeks, making you sick with vomiting, weakness, headaches, and maybe dark wee and pale poo, and yellow skin. This phase usually hits between six weeks and six months after the bug has entered the blood stream. After the initial infection, one of two things will happen. Your body may have fought the bug, and it goes away, and you are no longer ‘infectious’ (able to pass the bug on to anyone else). Or sometimes, and we don’t know exactly why, the bug hangs around in the blood stream. You don’t usually feel sick, or even know it is there, but it is, and you are therefore infectious. This may be lifelong.

Having the bug in the blood stream (being a ‘carrier’), may do you no harm. (It may not be too good for other people if you give it to them; see ‘prevention’.) Unfortunately, a proportion of carriers do get problems, in the form of ‘chronic hepatitis’. This means that the bug gradually destroys the liver, or increases the risk of cancer of the liver. This is definitely not a good thing. We need livers to live.

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It is difficult to understand how such an innocent looking little tablet could be the centre of so much controversy. In the twenty or more years since being introduced ‘the pill’ has been seen as a major determining factor in social change, as the liberator of women, the instrument of the Devil, the supposed cause of every discomfort, disease and cancer experienced by women, and more.

There is a lot of misunderstanding about the pill, perhaps partly due to inadequate explanation by the medical profession. It is not our job to tell women whether or not they should take the pill; that is a decision an individual woman should make, guided by reliable information, and in consultation with her doctor. Unfortunately, many decisions are based on misinformation. A woman may make an inappropriate contraceptive choice guided by hearsay, and consequently runs the risk of unwanted pregnancy.

How it works. The combined oral contraceptive pill gives a daily dose of synthetic hormones. The hormones are an oestrogen (usually ethinyl oestradiol), and a progesterone type (usually either levonorgestrol or norethisterone). These synthetic hormones act like the natural hormones in the body. When there is a certain level of these hormones acting on the brain, the ovary does not get stimulated to produce an egg. This is the mechanism by which the pill provides effective contraception (no egg, no pregnancy).

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Like other mammals, we have mammary glands, which we call breasts. Breast tissue produces milk, deigned to have all the correct nutrients for babies. Not only that, but it is cheap, warm, and portable. Clever.

Each breast has glands, and ducts, which drain out of a central nipple. The nipple is surrounded by an area of darker, thicker skin called the areola. The skin of the areola and the nipple also contains many nerve fibres, and is quite sensitive. The nipples tend to become more erect when the surface is stimulated during sexual arousal, or by cold temperatures, or other stimulation. Some people have what are known as accessory breasts or nipples, which arc little extra bits of breast and/or nipple tissue, usually below the normal breast. They are probably remnants from when we, like other mammals, had two lines of breasts down our fronts.

Breast tissue responds to hormonal stimulation. It grows and develops during puberty, under the influence of a variety of hormones, to become mature and functional. It responds to increased levels of the hormone prolactin (secreted from the pituitary gland) by producing milk.

Breast tissue can undergo change, which can result in lumps forming. Many of these are benign (non-cancerous), but some are malignant (cancerous).

We think of breasts as typically female appendages, but men do have a small amount of breast tissue beneath their nipples. Without the stimulus of female sex hormones it docs not develop further.

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