The term infertility is defined as the inability to conceive despite regular and unprotected intercourse for 1 years in the absence of any identifiable cause. Infertility is not sterility, which is the term used to mean conception is not possible under any circumstances. However, the presence of risk factors such as the woman's age, abnormal menstrual periods, history of pelvic inflammatory disease and whether there has been previous abdominal or pelvic surgery, history of undescended testicles may warrant earlier investigations and treatment of infertility. Infertility does affect people of all ages, ethnic backgrounds, socioeconomic groups, and both sexes Although, infertility by itself may not threaten physical health, it does have a serious impact on the mental and social well being of affected couples.
Infertility is classified into two types:
• Primary infertility if there was no previous pregnancy (approximately 40% of infertile couples).
• Secondary infertility if there was a previous pregnancy whatever the outcome (approximately 60% of infertile couples).
Incidence of infertility
About 10% to 15% of couples in the reproductive age are infertile and affects both men and women. Natural conception depends on satisfactory ovulation, transport of viable sperm and egg into the female reproductive system. Natural conception is influenced by hormonal control, timing and frequency of intercourse as well as the general health status of the couple. The most important factor affecting a couple's fertility is the woman's age. For women aged 25 or under, 60% achieve conception within 6 months and 85% at one year. However, if the woman is aged 35 years or older, the conception rates are less than half. Male fertility also declines with age.
It is important to remember that the majority of infertile couples can achieve a pregnancy and livebirth with treatment, they are subfertile. Only a minority of patients are sterile, i.e. even with treatment they would be unable to conceive. This could be due to no sperm, absent or non-functioning ovaries or an absent uterus (womb) and surgically removed or congenitally absent fallopian tubes. To help you understand what causes infertility, what investigations are needed and why, and the proposed treatment from consultant.
Is the incidence of infertility rising and why?
It appears that the incidence of infertility is rising. This is probably due to factors such as:
• Increasing tendency to postpone childbearing until women establish a career and achieve financial security,
• Rising incidence of sexually transmitted diseases resulting in damage to reproductive organs,
• Increasing obesity,
• Declining sperm count as a result of environmental pollution, possibly arising from estrogenic industrial waste.
What are the causes of infertility?
A male factor is diagnosed in almost one third of cases. A female factor is diagnosed in another third and in the remainder one third of the couple there will be a male and a female factor. These will be discussed in details under causes of infertility.
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you should consider an infertility evaluation. However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse rather than a year, so as not to delay potentially needed treatment. If you have a reason to suspect an underlying problem, you should seek care earlier.
Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age or physical findings dictate earlier evaluation and treatment.
In approximately 5% to 10% of couples trying to conceive, all the tests are normal and there is no apparent cause for infertility. In a much higher percentage of couples, only minor abnormalities are found that are not severe enough to result in infertility. In these cases, the infertility is referred to as unexplained. Couples with unexplained infertility may have problems with egg quality, tubal function, or sperm function that are difficult to diagnose and/or treat. Fertility drugs and IUI have been used in couples with unexplained infertility with some success. If no pregnancy occurs within three to six treatment cycles, IVF may be recommended.
Infertility caused by a problem in the female, for example, inability to produce an egg or if an egg is unable to travel to the womb. Infertility caused by a problem in the male, for example, inability of ejaculate or insufficient number of sperm.
Infertility is not just a disease that affects women—men suffer as well. In fact, new studies show that in approximately 35 to 40 percent of infertility couples the male partner is either the sole cause or a contributing cause of infertility.