What Is Infertility?
To a couple who is happily married and geared up to start a family, to be suspected or be told of either one or both suffers from infertility is extremely distressing and ego-damaging. If you are age twenty and twenty-five years old, you have the best fertility potential; on average, 70% of you will become pregnant within three months, and 85% within six months and 95% at the end of one year. Fertility declines with age. If you are age thirty and thirty-five years old, then your chance of being pregnant at end of three, six and twelve months are 40%, 60% and 80% respectively. Regardless of age, for a couple who are having regular unprotected sexual intercourse, there is an 80% chance of conception after 12 months and a 90% chance of conception after 18 months. A couple therefore should seek medical attention if they are unable to conceive within one year of unprotected regular intercourse. For those women who are more than 35 years old, they should see a doctor within 6 months of active trying.
Prevalence Of Infertility
About 15% of couples of reproductive age find difficulty in conceiving. It is estimated that about a third is due to problem affecting the woman, about a third is due to problems affecting the man, and the rest involving both parties. In brief, to be pregnant successfully, the woman needs to have eggs, mature and release them regularly at the middle of menstrual cycle, and able to traverse the Fallopian tube into the womb cavity. The man needs to produce mature sperm of the right quality and quantity, able to be deposited in the vagina and travel upward, overcoming the resistance at the neck of the womb. The egg and the sperm have to meet at the right site of the tube, move into the womb cavity at the right pace and be well implanted into the womb lining. About 25% of infertility is due to a lack of eggs, about 25% is due to a problem with the sperm, about 25% is due to tubal problems and in the remaining 25%, the reason for infertility is never discovered (so called unexplained infertility).
Common Causes Of Infertility
When you have regular monthly menstruation, it strongly suggests that you are ovulating. In fact, majority of healthy women in the reproductive age group ovulate regularly. You may be able to tell if you are ovulating when you notice thin and runny cervical mucus or short sharp pelvic pain at the time of ovulation. Monthly release of the egg is under very tight hormonal control, and many conditions disturb this control at the level of the brain, the mid-brain or the ovary itself. As expected, you will most likely present with irregular or absent menstruation when this hormonal control is deranged. One very common condition that we see is polycystic ovarian syndrome. Lifestyle factors, such as work stress, extreme dieting, excessive physical training, can lead on to hormonal imbalance and failure to ovulate. Other serious medical disorders involving the pituitary and thyroid glands may also be implicated. If you have previous pelvic surgery for whatever reason, or suffered from previous pelvic infection, you are at risk of having damage to the fallopian tubes. Another common cause of tubal damage is endometriosis. We recognize that the tubes may be damaged structurally or functionally. To date, we do not have an easy reliable assessment of tubal function, the only being successful spontaneous intrauterine pregnancy. Nevertheless we can determine if the tubes are blocked by ultrasound imaging (sono-hysterography), X-ray imaging (hysterosalpingogram) or laparoscopic hydrotubation. In all these tests, some form of dye (contrast) has to be infused into the womb and observe for easy spillage of the dye (contrast) through the other end of the tube.
Every man starts to produce sperm when he reaches puberty, and is expected to release at least 20 million sperm per millilitre of semen. The standardized way to appreciate sperm quality is through its count, whether they are alive, whether they moves well and whether they are well formed structurally. Abnormal sperm quality may exist from birth, or come about later in life – having suffered from an illness, infection or injury affecting the male testes. It is important to unveil any history of trauma or surgery to the male gonads. Alcohol and drugs (coccaine, marihuana) can temporarily reduce sperm quality. Environmental toxins like pesticides and lead compounds may also impact sperm quality. Use of chemotherapy for cancer treatment, radiation exposure or long term drug treatment for chronic childhood conditions has to be looked into.