”No woman can be called barren these days for there are numerous modern medical means to make her produce a baby.”
About 1 in 7 couples can have some problems conceiving a baby. However, over 8 in 10 couples having regular sex (every two to three days) will conceive within one year if the woman is aged less than 40 years. In addition, of those couples who do not conceive in the first year, about half will do so in the second year.
There are various causes of infertility, both in men and in women. However, there will be no reason found for the infertility in about 3 in 10 cases. In around 4 out of 10 cases disorders are found in both the man and the woman. Some reasons are easier to treat than others.
What is infertility?
Infertility means difficulty in conceiving (becoming pregnant) despite having regular sex when not using contraception. There is no definite cut-off point to say when a couple is infertile. However, Doctors usually say that a couple is infertile if they have not conceived in two years, despite regular sexual intercourse. Not producing eggs (ovulating) is the cause of problems in about 3 in 10 couples. Fallopian tube, neck of the womb (cervix) or womb (uterine) problems are the cause in about 2 in 10 couples with infertility.
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. 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 you have past your middle 30s. For women aged 35-39, the chance of conceiving is about half that of women aged 19-26. It is also thought that men over the age of 35 are half as likely to achieve a pregnancy when compared with men younger than 25. Stress can be a factor. If the male or the female partner is stressed, this can affect libido and how often the couple has sex.
What are the main treatments used for infertility?
Fertility treatments can be grouped into three categories:
•Medicines to improve fertility – these are sometimes used alone, but can also be used in addition to assisted conception.
•Surgical treatments – these may be used when a cause of the infertility is found that may be helped by an operation.
•Assisted conception – this includes several techniques such as intrauterine insemination (IUI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).
Medicines are mainly used to help with ovulation. Ovulation is when the ovary makes and releases an egg (ovum).
The situations where surgery may be an option include:
Fallopian tube problems, Endometriosis, Polycystic Ovary Syndrome, Fibroids, male infertility etc
Intrauterine insemination (IUI) – This is the process by which sperm are placed into the woman’s womb.
In vitro fertilization (IVF) – IVF means fertilization outside of the body. In vitro literally means in glass (that is, in a laboratory dish or test tube). IVF is mainly used in couples whose infertility is caused by blocked Fallopian tubes, or unexplained infertility.
Gamete intrafallopian transfer (GIFT) – A gamete is an egg or sperm. Eggs and sperm are collected in the same way as for IVF.
The eggs are mixed with sperm. The mixture of eggs and sperm is then placed into one of the woman’s Fallopian tubes. Therefore, unlike IVF, the sperm fertilizes the egg naturally inside the woman’s Fallopian tube or womb, and not outside the body in a laboratory dish. GIFT is no longer recommended to be used instead of IVF.
Intracytoplasmic sperm injection (ICSI) – This technique involves an individual sperm being injected directly into an egg. (It is injected into the outer part of the egg – the cytoplasm). This method bypasses any natural barriers that may have been preventing fertilization. For example, some cases of infertility are due to the sperm of a male partner not being able to penetrate the outer part of the egg to fertilize the egg.
ICSI can also be used when a male partner has a low sperm count, as only one sperm is needed. If needed, a sperm can also be obtained by a small operation to the testis. This may be done when sperm cannot be produced in the usual way. For example, if the male partner has a blocked vas deferens, or has had a vasectomy. The egg containing the sperm is then placed in the womb in the same way as with IVF.
ICSI is used for couples who have failed to achieve fertilization through IVF, or where the quality or number of sperm is too low for normal IVF to be likely to succeed.
Egg donation – This involves stimulating the ovaries of a female donor with fertility medicines, and collecting the eggs which form. The eggs are mixed with and fertilized by sperm of the recipient’s partner (similar to IVF).
After 2-3 days, embryos are placed in the womb of the recipient via the cervix. This method is an option for women who have ovarian failure and cannot produce eggs; who have had their ovaries removed; who have conditions where the ovaries do not work (for example, in Turner syndrome); and where there is a high risk of transmitting a genetic disorder to the baby.
It is also used in certain cases of IVF failure.
Embryo donation – Couples who have had successful IVF treatment may decide to donate any spare embryos to help other infertile couples.
Some people suggest that supplements including zinc, selenium, and vitamin E may be helpful for men who have abnormal sperm counts due to an unknown cause. However, the evidence to support them is weak
Note: There is not much treatment available for miscarriages. Many women let nature take its course. Miscarriage means you have lost the baby. Use of progesterone hormone has been suggested but no concrete evidence that it prevents miscarriage.
When you meet couples who are not able to conceive give them these options and suggest that they discuss them with their Gynecologists.