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Infertility is a disease of the reproductive system, in either a male or a female, that inhibits the ability to conceive and deliver a child, after one year of trying with unprotected intercourse for couples in which the female is under 35 and six months of trying for couples in which the female is over 35.

Approximately 8-10% of couples experience some form of infertility problem. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the cause of the fertility problem remains unexplained in a minority of infertile couples (5-10%).

Pregnancy is a complicated process that depends on many factors:

  • The production of healthy sperm by the man and healthy eggs by the woman
  • The ability of the sperm to swim through the mouth of the uterus up to the fallopian tube
  • Unblocked fallopian tubes that allow the sperm to reach the egg
  • The sperm's ability to fertilise the egg when they meet
  • A genetically healthy embryo
  • The ability of the embryo to implant in the uterus.

Encountering difficulty at any of these steps, repeatedly, can lead to infertility.

Infertility is a medical problem, just as any other, which needs to be treated - nobody is at fault.

There may be a variety of problems, in different permutations and combinations in one or both partners. Both partners need to be investigated simultaneously and thoroughly.

Most infertility problems are not hereditary – except for a history of premature menopause in a mother or sister which could be significant (as it could be a genetic predisposition), as is a history of chromosomal abnormalities in the family.

There is no relation between blood groups and infertility.

Delayed child bearing is not advised for several reasons. By age 36 a normal woman's chances of conceiving per month is decreased by half, and by age 45 the average natural fertility rate per month is approximately 1%. Most women have about 300,000 eggs in their ovaries at puberty. By the time a woman reaches menopause there are only several thousands eggs remaining. The remaining eggs in her ovaries also age, making them less capable of fertilization and their embryos less capable of implanting, there by increasing the risk of miscarriage. Furthermore, advanced maternal age is associated with an increased risk of genetic abnormalities in the child e.g. chromosomal abnormalities such as Down syndrome. Gynaecological problems such as pelvic infection, tubal damage, endometriosis, fibroids, ovulation problems etc, also tend to increase as she has more time to develop these conditions.

A man is capable of conceiving a child at any age.

Various clinical studies have calculated the chance of pregnancy among normal couples who do not use contraception, and indicate that the probability of a live birth after exposure in any one month averages about 1 in 5, or a 20% chance.

To increase the chance of getting pregnant spontaneously, timed sexual intercourse is recommended. This means that sexual intercourse, or coitus, has to take place around the time of ovulation, (release of a mature egg from the ovary) which is the most fertile period of a woman. This is, in a normal woman, mostly about 14 days after the first day of the period. The time of ovulation can sometimes vary a few days each month, even in a regular menstrual cycle. If the circumstances are right, sperm remain alive and active in woman's cervical mucus for 48-72 hours following sexual intercourse.

The position of the hips or the coital positions is not important. It is not necessary for the woman to have an orgasm for conception to take place.

Sperm quality can decrease with high sexual activity. Therefore it is best to have intercourse 3-4 days before the expected ovulation and every other day until 2-3 days after the expected ovulation with no necessity for higher frequency. Although having sexual intercourse near the time of ovulation is important, no single day is critical.

Semen consists of sperms and seminal fluid secreted by the seminal vesicles and the prostate. Most women notice some discharge of seminal fluid immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much seminal fluid leaks out afterwards, if the semen count is normal, enough sperm will reach the cervical mucus and swim into the uterus. This “leakage” is not a cause of infertility.

Fertility potential is dependent on sperm count and not on the volume or consistency of the semen. Sperm count can only be assessed by microscopic examination. Men with totally normal sex drives may have no sperm at all.

Masturbation is a normal activity in which most boys and men indulge. This activity does not affect the sperm count, as sperm are constantly being produced in the testes.

A normal, fertile man’s sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, the weather, illness, and medications. There are other factors which affect the sperm count as well, many of which we do not understand.

Ovulation dysfunction can occur with apparently regular cycles. Tests have to be done to confirm that ovulation is normal. Irregular cycles indicate a higher chance of an ovulation problem.

Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis. 

About one in five women have a retroverted uterus that is a uterus which has fallen back. If the uterus is freely mobile, this is normal. This is not a cause of infertility and certainly not an indication for surgery.

A routine gynaecological examination does not always provide information about possible problems which can cause infertility. A systematic infertility workup is a must.

Surgeries on the pelvic structures (including D&C) must be kept to the minimum and performed only when absolutely necessary as they can damage their structure and function.

Compared to normal fertility rates, effective treatments can be expected to have, on average, up to a 25% success rate per cycle of treatment, and may therefore need to be repeated several times before a pregnancy is achieved.

Fertility drugs do increase the chance of having a multiple pregnancy (as they stimulate the ovaries to produce several eggs), however, a majority of women, (about 90%), taking them have a singleton pregnancy - with the remaining 10% being mostly twin.

No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer. The chance of a young woman developing an ovarian malignancy during her lifetime is lower than 1.5%. A number of factors have been found to increase the risk of ovarian cancer, including genetic predisposition, dietary habits and infertility itself. Each pregnancy reduces the risk of a woman contracting ovarian cancer.

The incidence of birth defects in children born following treatment with ovulation promoting drugs has never been found to be higher than that in the normal population.

© drnarvekar.com 2007