Understanding the causes of infertility

Hi Dr Flo

My wife and I have been trying to conceive unsuccessfully for the past two years. What could be the cause?

Walter

Dear Walter,

After a year of regular unprotected sex without conception, then there are concerns about fertility. The cause of the sub-fertility may be due to challenges with either or both partners and sometimes no underlying problem can be identified at all.

In women, fertility reduces with age, especially after 35 years, and also in situations of extreme stress, excessive physical exertion, excessive alcohol consumption, smoking, severe weight loss and obesity. Underlying causes of reduced fertility in women include problems with ovaries, fallopian tubes or the uterus and hormonal disorders.

Medical conditions such as  polycystic ovary syndrome, thyroid problems, endometriosis, uterine fibroids and ejaculation disorders can lead to infertility.

In men, fertility may be reduced due to hormonal disorders, genetic disorders, problems with testicular function or problems with ejaculation. Other possible contributory factors include excessive alcohol consumption, smoking, testicular injury, obesity, use of steroids and other drugs, toxins or radiation.

Since you have been trying to conceive unsuccessfully for two years, it would be advisable for both of you to visit a gynaecologist. The doctor will ask some questions then do some tests to determine the reproductive health for you both. Other tests may be done to check for other conditions that may be contributing to the problem. Treatment is usually given based on the diagnosis. There are medications that may be given for either or both of you to increase the chances of conception. Where these treatments do not work, and there is no natural conception, assisted conception may be done through intra-uterine insemination or in vitro fertilisation.

Dear doctor,

How do I reduce the smell from my urine?

Dear reader,

Usually, urine has the smell of ammonia and this smell is either stronger or weaker depending on how well hydrated you are. You will notice that on days you take a lot of fluids, the urine smell is far less and the colour is light yellow or clear.

The smell of urine can also be affected by what you eat or drink, especially with strongly flavoured foods and drinks like onions, garlic, salmon, spices, coffee and alcohol. Medications can also affect the smell of urine. Some conditions can change how urine smells. For instance, in uncontrolled diabetes, the urine smells sweet. The smell changes when you have a urinary tract infection and for some women, the smell changes during pregnancy. Other diseases that can affect the smell of urine are rare genetic diseases like phenylketonuria and maple syrup disease.

To reduce the smell of your urine, take a lot of water and avoid any foods or drinks that may be affecting the smell of urine and if you have any underlying illness like diabetes or urinary tract infection, then it should be treated.

Dear doctor,

I have recurrent heartburn. I have been given H.pylori medication, but the problem came back after a few months. What could be the problem?

Millie

Dear Millie,

Heartburn refers to the burning sensation or discomfort experienced due to inflammation or irritation of the lower part of the food pipe (oesophagus) and/or the stomach due to reflux of the stomach acid. This may happen because of excessive alcohol consumption or due to infection such as with H.pylori or it may be due to genetic factors. For some people, some foods and medications may trigger the heartburn. Other conditions that may be associated with recurrent heartburn include anxiety and stress, inflammatory conditions of the gastrointestinal tract, hiatus hernia, liver disease, kidney disease and stomach cancer. For some people, there is no identifiable reason.

With heartburn, the pain is usually in the upper abdominal area and may be burning or sharp and stabbing in nature. The pain may be worse when hungry and improve after feeding though this may not be true in every instance. Heart burn may have other symptoms like chest pain, nausea, vomiting, loss of appetite, bloating and indigestion. Recurrent inflammation can lead to a break in the lining of the stomach, forming a wound or ulcer. This can also happen in the lower part of the oesophagus (the food pipe) or in the first part of the small intestines (duodenum). An ulcer can cause severe pain, vomiting blood, dark stools, weight loss, and in very severe cases, the ulcer may rapture or the bleeding may lead to shock, both of which are emergency situations.

When there are recurrent symptoms despite treatment, it is advisable for you to be seen by a doctor and preferably a gastroenterology specialist. Tests that may be done include endoscopy and barium tests. Treatment may include medicines to reduce the amount of acid that your stomach makes and medicine to neutralise the acid, medication to control the reflux and nausea, and medicine to protect the stomach lining. Because of the recurrent symptoms, the medicine will be used for a long duration or on and off.

You can make some lifestyle changes to reduce or avoid the recurrence, for example, avoiding skipping meals, avoiding alcohol and smoking and avoiding use of long-term use of steroids and some painkillers like ibuprofen, aspirin and diclofenac. You can keep a food diary and identify any foods that trigger and/or worsen the symptoms, and these trigger foods and drinks are different for different individuals.

Some foods that may trigger symptoms are spicy foods, chilli, very fatty foods, sodas, black tea and coffee, or very concentrated tea and coffee and other foods and drinks that are acidic. In the long run, the purpose of treatment is to relieve the symptoms so that you can be able to eat what you would like.

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