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Infertility is a condition where the couple is unable to conceive after 12 months of regular sexual relationship without birth control.
There are two kinds of infertility - primary and secondary:
Primary infertility means that the couple has never conceived. Secondary infertility means that the couple has experienced a pregnancy before and failed to conceive later.
To understand infertility, we need to understand the process of fertilization.
PROCESS OF FERTILISATION
To conceive, an egg (ovum) from the woman has to combine with a sperm from the man. An ovum is released from an ovary when a woman ovulates. This usually occurs once a month between 12 and 16 days from the start of her last period if she has a regular monthly cycle of 28-30 days. The ovum travels down a Fallopian tube to the middle of the womb (uterus) over 12-24 hours.
Sperms are placed near the neck of the womb (cervix) when a man ejaculates during sex. The sperms travel up past the cervix to get into the main part of the uterus, and into the Fallopian tubes. If there are sperm in the Fallopian tubes then one may combine with (fertilize) the ovum to make an embryo. The tiny embryo travels down into the uterus and attaches to the lining of the uterus. The embryo then grows and matures into a baby.
THE FERTILE PERIOD
If you've had more than a year of regular sexual relationship without birth control and you haven't achieved pregnancy, it's best to seek help. One can also try to plan to have sexual relationship during the days the woman is ovulating which is known as her fertile period. If a woman has regular menstrual cycles, sexual relationship between the 8th & the 20th day will help.
WHEN TO SEE A DOCTOR
It's a myth that infertility is always a "woman's problem". Half of all cases of infertility result from problems with the man's reproductive system. Of couples that seek medical treatment for infertility, 20% conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, so contacting a doctor and counseling helps. 50% conceive within two years from starting treatment. Most infertility results from physical problems in a man or woman's reproductive system.
It is usually worth seeing a GP if you have not conceived after one year of trying. A GP can check for some common causes, talk things over, and discuss possible options. You may want to see your GP earlier, if the woman in the couple is over the age of 36 or if either partner has a history of fertility problems.
CAUSES OF INFERTILITY
Causes in women
Not producing eggs (ovulating) is a reason for infertility in about 3 in 10 couples.
There are various causes of ovulation problems including:
- Early (premature) menopause.
- Polycystic ovary syndrome (PCOS). This also leads to excessive hair growth, acne, and menstrual problems, and is associated with being overweight.
- Hormone problems - Excess prolactin hormone is a cause. This hormone is produced by the pituitary gland that lies just beneath the brain and helps with milk production. Too little or too much thyroxine hormone also affects fertility.
- Being very underweight or overweight. Women with anorexia nervosa often do not ovulate.
- Excessive exercise can affect your hormone balance which can affect ovulation.
- Long-term illnesses. Some women with severe chronic illnesses, such as uncontrolled diabetes, cancers and kidney failure, may not ovulate.
Fallopian tube, cervix or womb problems
- Endometriosis, which causes about 1 in 20 cases of infertility. Tissue that normally lines the womb is found outside the uterus. It is trapped in the pelvic area and can affect the ovaries, uterus, and nearby structures. It often causes pain and/or painful periods.
- Pelvic inflammatory disease (PID) is another common cause. Chlamydial infection can be a cause of PID. PID can cause scarring and damage which can affect fertility.
- Previous surgery to the Fallopian tubes, cervix or uterus.
- Large fibroids may also cause problems
Causes in Men
Some men are born with testicles that do not make any sperm or they make very few sperm. Some are born without testes or without a vas deferens.
The most common reason for male infertility is a problem with sperm, due to an unknown cause. The sperm may be reduced in number, less mobile (less able to swim forwards), and/or be abnormal in their form.
There are a variety of factors that may affect sperm production and male infertility. These include:
- Current or past infection of the testes (eg, mumps).
- Tumors of the testes.
- Testes that have failed to descend properly.
- Side-effects of some medicines like sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, some chemotherapy drugs, cannabis, cocaine and anabolic steroids.
- There may be an association between an increased scrotal temperature and reduced semen quality, however it is still uncertain whether wearing loose-fitting underwear actually improves fertility.
- A varicocele is like a varicose vein in the scrotum (the skin that covers the testes). Varicoceles are found in just over 1 in 10 men with normal sperm and 1 in 4 men with abnormal sperm.
- Certain hormone problems (eg, problems with the pituitary gland in the brain leading to Cushing's disease or hyperprolactinaemia.
No cause can be found in about 3 in 10 couples with infertility.
Older women tend to be less fertile than younger women. The fall off of fertility seems to be greatest once women are past the mid 30s.
If the male or the female partner is stressed, this can affect libido and how often the couple has sex.