Infertility: Causes, symptoms and solutions
Getting pregnant, sustaining a pregnancy and achieving a live birth proves to be difficult for some couples. Here’s what you need to know about infertility
The average woman has a 15 to 25 percent chance of conceiving a baby each cycle and about 85 percent of fertile couples will be successful within 12 months of having regular unprotected sex. However, some couples face challenges when it comes to conceiving.
Infertility is the inability to become pregnant after more than one year of regular, unprotected sexual intercourse. It is estimated that just over 10 percent of women of reproductive age have problems conceiving. In one third of cases, the problem lies with the woman’s reproductive system and in another third the problem lies with the man’s reproductive system. In the remaining third the problem lies with both partners or is not known. After a specialist’s investigation of both partners and treatment, 30-40 percent of couples achieve a pregnancy within two years.
What triggers infertility?
Why some people are infertile is not yet fully understood, but some causes have been identified. In women, it may be because ovaries are not producing eggs (anovulation). Endometriosis and pelvic inflammatory disease can damage or block fallopian tubes. In some women, mucus in the cervix may be hostile to the partner’s sperm. In men, a common cause is defective sperm. In couples, the genetic makeup of one partner may prevent the couple from achieving a pregnancy naturally, or in some cases occupational hazards (such as chemicals and working practices) are involved.
What’s causing the problem?
To determine the cause of any infertility, your doctor may see you and your partner, both separately and together.
You will have a physical examination and a detailed personal history will be taken. Obesity, acne and menstrual irregularities will be noted, and you may be asked about eating disorders, stress, occupational hazards (working with toxins, for example), exercise methods, sexual pattern, previous contraception and lifestyle habits such as alcohol, smoking and prescribed or illegal drugs. Blood tests may be carried out to seek known reasons for infertility’an excess of prolactin (a hormone regulating menstruation), excess or deficiency of thyroid hormone or an excess of androgens such as testosterone.
If you have endometriosis, uterine fibroids, polyps or ovarian cysts, the doctor may refer you to a gynecologist or endocrinologist for assessment.
For your partner, the doctor may suggest a sperm analysis. Finding out early on that he has too few sperm, no sperm at all or slow-moving or misshapen sperm may lessen the chance of you having to undergo invasive tests (though if you have other physical symptoms you may still need investigation as well).
If the doctor suspects that sexual problems could be the cause, a sex therapist may be recommended.
Searching for an answer
Various methods may be used to assess the condition of your reproductive system. Laparoscopy is a minor operation involving a small incision in the abdomen through which a special endoscope can be inserted to view the uterus, fallopian tubes and ovaries. Dye is passed through the neck of the uterus (cervix) into the tubes to check for blockage or constriction. Abnormalities may be treated laparoscopically by one of several methods–laser vaporization, electrocautery or excisional biopsy.
Hysteroscopy can be done in the operating room or office. No incision is required. A tiny tube’a hysteroscope’is passed through the cervix into the uterus to check for adhesions (scar tissue) and other possible problems.
Hysterosalpingography, an X-ray technique, uses a contrast (radio-opaque) medium injected into the uterus to outline the reproductive organs. It may identify abnormalities in the uterine cavity and tubal blockages. It should be done in the first 10 days of your cycle, when you are least likely to be pregnant, because radiation may harm a developing fetus. It may cause abdominal cramps.
If ovulation is the problem, medication can help induce ovulation. Disorders such as polycystic ovaries, endometriosis and PID can be treated. Damaged fallopian tubes can in some cases be repaired by surgery or in vitro fertilization can be used to bypass them.
Intrauterine insemination with your partner’s or donor sperm is a treatment option in cases of infertility where sperm are too few or are insufficiently motile.
Optimize your chances
It is vital to understand your monthly menstrual cycle so you know when you ovulate and which days are optimal for sexual intercourse. You can identify these by observing changes in vaginal mucus, by making a temperature chart and by calculating over several months the cycle’s length.
There are three vital stages: Fertilization occurs within 48 hours of ovulation and implantation occurs some seven days after fertilization. Ovulation takes place 14 days before the expected next period. This is not the same as saying it takes place 14 days after the last period as menstrual cycles vary in length from 24 to 35 days’hence the need to identify the usual length of your own cycle. In a 28 day cycle, the optimal time for conception is on days 11 to 17 of the cycle where day 1 is the first day of the menstrual period. Daily intercourse during this time is generally advised. ‘
You should become familiar with the changes in your vaginal mucus. Just before ovulation the mucus increases in quantity and becomes thinner and more elastic, like raw egg white, and transparent’a drop can be stretched into a long strand without breaking. After ovulation, it becomes thicker and whiter.
When do you ovulate?
To find out whether you are ovulating, you may be asked to keep a basal body temperature chart (BBT) on which you record your morning temperature on waking, along with the day of the menstrual cycle. You mark the days when bleeding with a cross, and the days when intercourse occurs with a circle. During the menstrual cycle, the BBT is higher once ovulation occurs’confirmed by a 32F (0.4C) rise in temperature for three consecutive days. ‘
Over-the-counter ovulation kits can be used to detect luteinizing hormone, which surges immediately before ovulation occurs.’ A blood test to measure progesterone levels can also confirm ovulation‘the hormone is secreted around day 22 of a 28 day cycle, about a week after the egg is released, to stimulate the thickening of the uterus lining. The doctor may do an endometrial biopsy toward the end of the menstrual cycle but before bleeding begins, to check that thickening of the uterus lining has occurred. The simple procedure is usually carried out at a doctor’s office and requires no anesthetic.
Taking these steps before trying to conceive will maximize your chances of pregnancy:
‘ Completely stop all intake of alcohol.
‘ Stop smoking and avoid smoky rooms.
‘ Practice good hygiene to avoid infections.
‘ Maintain a healthy weight for your height.
‘ Get rid of excess stressors in your life.
‘ Practice anti-anxiety techniques’deep breathing, prayer, meditation or yoga.
‘ Give your body a chance to re-establish natural periods before you try to conceive, especially if you have recently taken hormonal contraception.