Fertility related issues, such as infertility, or more accurately, subfertility, is diagnosed when a couple is unable to conceive a child after having well-timed, and unprotected intercourse over the course of a 12 month time period.
This does not mean that you may never get pregnant, but it simply means that there are factors preventing your body from getting pregnant on its own. In such a case, you may need to learn more about your cycle, such as when you’re ovulating and what is the best time for you to have intercourse, which may increase your chances of becoming pregnant.
Infertility also does not mean that if a couple has conceived once and are not able to carry the pregnancy to full term due to several reasons, then they cannot conceive again. Every year, I personally meet many couples who seek medical assistance because they want a child, but face difficulties to become pregnant, or to carry a pregnancy to full term.
i) A female’s ovaries must be regularly producing and releasing good-quality eggs.
ii) Normal sperm must be produced in high enough numbers and delivered during sexual intercourse.
iii) Many types of problems, such as hormone abnormalities, or blockages caused by infection or scar tissue, could affect fertility. Hence, these issues should be checked for both partners.
Before we attempt to answer what is fertility and its related issues, it is important to understand that ‘infertility’ or fertility-related issues affect nearly an equal number of men and women. It is not just a women’s problem. Approximately, one-third of infertility issues are attributed to the female partner, one-third to the male partner, and one-third is caused by a combination of problems in both the partners.
About 20 per cent of infertility cases remain ‘unexplained’, even after a full diagnostic work-up. So, before labelling any partner as infertile, we have to look at certain factors in both partners.
-Polycystic Ovary Syndrome (PCOS)
-Pelvic Inflammatory Disease (PID)
-Sexually transmitted diseases (STD)
-Overall health and lifestyle
–Stress and alcohol
-Associated medical illnesses
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1. Is infertility becoming increasingly common?
Our own unpublished data shows that there has been a major increase in the proportion of couples who are infertile. Reasons for these issues are lifestyle, poor nutrition, increased BMI, smoking, and excessive intake of alcohol and drugs. Stress and lack of exercise are also contributory factors. Infertility is becoming more and more common, especially since many couples are waiting to have children later in life. Certain environmental factors such as using laptops, and environmental factors such as the usage of plastic are also contributing to fertility-related issues. Focus on being as healthy as possible, but don’t wait for a long time before seeking medical help, as when it comes to conception, timing is everything.
2. How long should we try to conceive before we see a doctor?
If the woman is under the age of 35 and has been trying to conceive for more than one year, we recommend that the couple consult a fertility specialist. If the woman is over the age of 35 and has been trying to conceive for more than six months, we recommend that the couple consult a fertility specialist. However, if you notice any symptoms like abnormal, irregular or painful periods, skin ailments, including acne, alteration in sex drive and desire, loss or thinning of hair, unexplained weight gain, painful intercourse, or inability to have intercourse, then consult a specialist at the earliest.
3. Age and fertility issues in both men and women
Fertility is not just a women’s problem alone, it is a couple’s issue. Age plays a crucial role and is the single most important factor that influences fertility in both men and women. As a woman ages, her eggs also age, and they diminish in quantity and quality. At age 30, a woman’s chance of conceiving each month is about 20 per cent. At 40, it’s about 5 per cent. Similarly, the quality of a man’s sperm decreases with age. A decline in fertility, however, occurs much more slowly in men than in women.
4. What kind of evaluation is done by the specialist?
A fertility evaluation begins with assessing the medical history of both the female and male partners. Both partners will then be asked to undergo a physical exam, including a gynaecological exam, and pelvic ultrasound for the woman. A semen analysis will be performed on the man, and a hormone screening will be performed on the woman. A woman may also undergo an evaluation of tubal patency (whether the fallopian tubes are open or blocked) and the uterine cavity. The most common treatments for infertility are ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). The fertility specialist will evaluate each couple individually and discuss a personalized treatment plan, based on their specific circumstances.
5. Impact of fertility on psychological well being
Infertility and related issues could create distress for the couple. The long term inability to conceive a child can evoke significant feelings of being lost, anxious, and being depressed. Out of 10, at least one of the partners experience post-traumatic stress after miscarriage, pregnancy loss (miscarriage or ectopic pregnancy before 12 weeks), and the stress of future conception. Couples are often left with questions on the loss of the unborn child and there are questions related to one’s own fertility. Post-traumatic stress can have a toxic effect on all elements of a person’s life, affecting work, home and relationships.
6. Stress and fertility-related issues
Almost half of the infertility in women could be attributed to stress and psychological factors. Nowadays infertility is better understood, and stress is recognized primarily as a result, rather than a cause, of fertility problems. However, there is evidence that stress can have a negative impact on sperm and egg production. Also, stress usually leads to the release of hormones that are inhibitory to implantation and fertilization. Research is ongoing to help us understand better how stress may influence fertility and the success of treatment.
While you are trying to conceive, enjoy a healthful lifestyle, and keep yourself stress-free. Yoga, meditation, exercise in any form, listening to music, having pets can keep one relaxed and increase chances of conception. Take note of the suggestions above for preventing infertility (above). An ovulation predictor (available without a prescription) also may help you determine when you ovulate so you can better time intercourse. If you have questions about when you are most likely to conceive, and also if you are unable to conceive for a long time, consult a fertility specialist.