Infertility has come to be defined as the inability to conceive within 12 months, most couples will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months.
Many families struggle with infertility at one point in their marriage Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help.
Dr. Rose Gitonga, a gynecologist said there are various scenarios one may be advised to seek help earlier.
“We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.” She said.
When a woman has regular menstrual periods, defined as regular cycles occurring every 21 to 35 days, this almost always indicates that she ovulates regularly.
Ovulation of the egg occurs approximately 2 weeks before the start of the next period. If a woman has cycles at intervals of greater than 35 days, it may indicate that she is not ovulating an egg predictably, or even at all.
“Ovulation of the egg is essential for pregnancy. Therefore, we recommend an evaluation if menstrual cycles are irregular in a couple attempting pregnancy.” She said.
A history of pelvic infections or sexually transmitted diseases may also cause a problem in ovulation.
Sexually transmitted infections, such as Chlamydia or gonorrhea, can cause inflammation and permanent scarring of the fallopian tubes.
The presence of open tubes is essential for natural conception, as sperm must traverse the tubes in order to reach and fertilize the ovulated egg.
Immediate evaluation for a couple attempting pregnancy is recommended when the woman has a prior history of pelvic infection.
“If a male partner has a history of infertility with a prior partner, or if there are abnormalities on his semen analysis, then we advise earlier fertility evaluation, ideally within 6 months of attempting pregnancy.” She added.
Possible causes of infertility
According to Dr. Rose, there are causes of infertility these are the various causes of infertility.
1) Advancing Maternal Age.
Historically before the latter 20th century, women were conceiving in their teens and twenties, when age-related abnormalities with the egg were not evident.
Female age-related infertility is the most common cause of infertility today.
For unknown reasons, as women age, egg numbers decrease at a rapid rate. And as aging occurs, egg quality, or the likelihood of an egg being genetically normal, decreases as well.
“Hence the ability to conceive a normal pregnancy decreases from when a woman is in her early 30s into her 40s. A woman is rarely fertile beyond the age of 45. This applies to the ability to conceive with her eggs, but not with donor eggs.” Rose said
However, in our modern era, women are delaying child birth until their thirties and forties, which has lead to the discovery of the adverse effect of advanced maternal age on egg function.
2) Ovulation Disorders
Normal and regular ovulation, or release of a mature egg, is essential for women to conceive naturally.
Ovulation often can be detected by keeping a menstrual calendar or using an ovulation predictor kit.
There are many disorders that may impact the ability for a woman to ovulate normally.
The most common disorders impacting ovulation include polycystic ovary syndrome(PCOS) hypogonadotropic hypogonadism (from signaling problems in the brain), and ovarian insufficiency (from problems of the ovary).
“If your cycles are infrequent or irregular, you need to be examined to perform the appropriate testing to discover which problem you may have and present the appropriate treatment options.” She said
3) Tubal Occlusion (Blockage)
A history of sexually transmitted infections including Chlamydia, gonorrhea, or pelvic inflammatory disease can predispose a woman to having blocked fallopian tubes.
Tubal occlusion is a cause of infertility because an ovulated egg is unable to be fertilized by sperm or to reach the endometrial cavity. If both tubes are blocked, then in vitro fertilization (IVF) is required.
“If a tube is blocked and filled with fluid (called a hydrosalpinx), then minimally invasive surgery (laparoscopy or hysteroscopy) to either remove the tube or block/separate it from the uterus prior to any fertility treatments is recommended.” Reiterated Rose.
4) Uterine Fibroids
Fibroids are very common whereby approximately 40% of women may have them and the mere presence alone does not necessarily cause infertility.
There are three types of fibroids: 1) subserosal, or fibroids that extend more than 50% outside of the uterus; 2) intramural, where the majority of the fibroid is within the muscle of the uterus without any indentation of the uterine cavity; and 3) submucosal, or fibroids the project into the uterine cavity.
Submucosal fibroids are the type if fibroid that has clearly been demonstrated to reduce pregnancy rate, roughly by 50%, and removal of which will double pregnancy rate. In some cases, simply removing the submucosal fibroid solves infertility.
“Often, but not always, submucosal fibroids can cause heavy periods, or bleeding between periods. There is more controversy regarding intramural fibroids, where larger ones may have an impact and may necessitate removal.” Said Rose.
5) Sperm Allergy
Sperm allergy, sometimes called semen allergy or seminal plasma hypersensitivity, is a rare allergic reaction to proteins found in a man’s semen. It mostly affects women.
Common symptoms of sperm allergy are redness, swelling, pain, itching, and a burning sensation in the vaginal area.
Symptoms usually start about 10-30 minutes after contact with semen. They may not be confined to the vaginal area; they can occur in any area that has contact with semen, including the skin and the mouth.
Symptoms can last for a few hours or a few days.
For some women, the symptoms are localized – they stay in one main area. But for others, the symptoms can affect their whole body. They may have hives, swelling, trouble breathing, or anaphylaxis, a life-threatening allergic reaction.
Male fertility is a complex process. To get your partner pregnant, various processes must occur
You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.” She added.
6) Use of Drugs
Drugs that are prescribed to help manage and treat certain illnesses and diseases can sometimes have a negative affect on both male and female fertility.
If you are trying to conceive, it is important to speak with your health care provider about the possible effects that your prescribed medication may have on your fertility.
Drugs including steroid shots, high blood pressure medication, and antidepressants can all negatively affect the reproductive system. The most common side effect of these medications is loss of libido, however, some of these medications can also lead to lowered sperm count, erectile dysfunction or menstrual irregularities.
Heavy consumption of alcohol has a startling effect on both male and female fertility.
Men and women who drink more than six alcoholic beverages per day are more likely to suffer from hormonal imbalances, affecting both the generation of sperm and ovulation.
Women who are heavy drinkers commonly suffer from luteal phase defects, in ovulation or amenorrhea.
Men who are heavy drinkers can suffer from, low sperm count, poor sperm motility or poor sperm morphology.
It does appear that moderate alcohol consumption can kill off some sperm-producing cells in the testicles and may contribute to impaired sperm morphology.
Some studies also show that women who are light to moderate drinkers may experience some hormonal imbalances.
Most men and women are familiar with the hazards of tobacco use during pregnancy. However, few people recognize that tobacco has the potential to affect your chances of conceiving. In fact, cigarette smoking and tobacco chewing both been related to a number of fertility problems in both men and women.
Infertility Treatment
Infertility treatment can be a stressful time. You and your partner will probably feel overwhelmed by a hectic schedule of medical checkups and infertility tests.
According to Dr Rose, guidance to infertility treatment is a great tool for helping to curb stress while you’re undergoing infertility treatment.
You’ll find information on compiling your personal history and medical records, mapping out your treatment timeline, researching your health insurance coverage and much more.
When getting medical help for infertility, it is very important to compile a medical history for both you and your partner. This will help your doctor discern more quickly the cause of infertility and, in turn, make sure you get the best infertility help possible.
Compile a journal of you and your partner’s health and reproductive backgrounds.
Gynecological history that include information about menstruation, for instance, age of inset, length and frequency of cycle, heavy bleeding or cramping, contraceptive use, for example, birth control bills and IUDs, sexually transmitted diseases, such as Chlamydia and genital warts, abnormal PAP smears and whether you’ve had previous pregnancies or abortions.
When seeking treatment, include the information about medical history.
These include information on chronic medical conditions such as asthma, hypertension, ulcers, cancer therapy, chronic bladder or Urinary Tract Infections (UTI’s) and allergies to medicine. Family history of fertility-related problems, history of recurrent miscarriages or complicated pregnancies, history of genetic disorders, such as sickle cell anemia.
Infertility can lead to a wide variety of emotions, including sadness, anger, frustration and anxiety.
