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Infertility

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. Many couples take several months to conceive. About 84 couples out of 100 conceive within a year of trying. About 92 couples out of 100 conceive within two years.
Doctors usually say that a couple is infertile if they have not conceived in two years, despite regular sexual intercourse.

To conceive, an egg (ovum) from the woman has to combine with a sperm from the man. An ovum is released from an ovary when a woman ovulates. This usually occurs once a month between 12 and 16 days from the start of your last period if you have a regular monthly cycle of 28-30 days. The ovum travels down a Fallopian tube to the middle of the womb (uterus) over 12-24 hours.

Sperm lie next to the cervix (neck of the womb) when a man ejaculates (comes) during sex. The sperm travel up past the cervix to get into the main part of the uterus, and into the Fallopian tubes. If there are sperm in the Fallopian tubes then one may combine with (fertilise) the ovum to make an embryo. The tiny embryo travels down into the uterus and attaches to the lining of the uterus. The embryo then grows and matures into a baby.

What can cause fertility problems?

Ovulation problems in women

  • Early (premature) menopause.
  • Polycystic ovary syndrome (PCOS).
  • Hormone problems - for example, too much prolactin hormone.
  • Being very underweight or overweight.
  • Excessive exercise (such as regular long-distance running) can affect your hormone balance which can affect ovulation.
  • Chronic (long-term) illnesses.
  • A side-effect from anti-inflammatory painkillers and some chemotherapy medicines. Some street drugs such as cannabis and cocaine can also affect your ability to ovulate.
  • Various other problems with the ovary such as certain genetic problems.

Fallopian tube, cervix or uterine problems

Endometriosis.

  • Previous infection of the uterus and Fallopian tubes (pelvic inflammatory disease (PID)) is another common cause.
  • Previous surgery to the Fallopian tubes, cervix or uterus.
  • Large fibroids, which may also cause problems.

Male problems

The most common reason for male infertility is a problem with sperm due to an unknown cause. There are a variety of things that may affect sperm production and male infertility. These include:

  • Certain hormone problems.
  • Current or past infection of the testes.
  • Tumours of the testes.
  • Testes that haven't descended (dropped) properly.
  • Side-effects of some medicines and street drugs. These include: sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, some chemotherapy drugs, cannabis, cocaine and anabolic steroids.
  • Regular excess heat (regular saunas, hot baths, etc) is possibly a cause.
  • Environmental factors may be relevant in some men. For example, a lot of exposure to chemicals, X-rays, or heavy metals.
  • A varicocele may possibly affect male fertility. A varicocele is common and is like a varicose vein in the scrotum (the skin that covers the testes).

Age can be a factor

Older women tend to be less fertile than younger women. The fall off of fertility seems to be greatest once you are past your middle 30s.

Stress can be a factor

Do we need any tests?

  • A semen analysis (sperm test) of the male partner.
  • A blood test to check that ovulation occurs in the female partner. This measures the hormone progesterone which is high just after ovulation. The blood sample is taken on the 21st day of a regular 28-day cycle (counting day one as the first day of bleeding).

Some general advice

Smoking can affect fertility in men and women. It has been estimated that in each menstrual cycle, smokers have about two thirds the chance of conceiving compared to non-smokers.

Alcohol in excess may affect fertility.

Weight control. You have a reduced chance of conceiving if you are very overweight or underweight. For the best chance of conceiving, you should aim to have your body mass index (BMI) at between 20 and 30.

Heat and sperm production. It is often advised for men who have a low sperm count to wear loose-fitting underpants and trousers and to avoid very hot baths, saunas, etc.

Sex and fertility

It is best not to try to time when you have sex to coincide with expected ovulation. This may cause anxiety, which can sometimes lead to sexual or relationship problems.

Sperm survive up to seven days after having sex. Therefore, even though an ovum (egg) only survives 12-24 hours, having sex two or three times a week is sufficient if you are trying to conceive. Studies have shown that having sex every two to three days is likely to maximise your chance of getting pregnant.

 

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List of Health Topics related to Infertility

Infertility

What Is Infertility

Ways to Boost Your Fertility

Treatment Options

Surrogacy

Some IVF Facts

Smoking and Inferility

Semen Analysis

Risk factors of Infertility

Pelvic Exam

PCOS-Short and Sweet

IVF for Dummies

How to Select an IVF Fertility Clinic

Embryo Glue or Transfer Media

Donor Sperm

Donor Eggs

Diagnosis of Female Infertility

Diagnosing infertility

Complications of IVF Treatment

Causes of infertility

Blastocyst Culure and Transfer

Age and Fertility

10 Tricks


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